Nail-biting is a body-focused repetitive behavior (BFRB) disorder. Its high prevalence is increasingly becoming a concern for psychiatrists and psychologists. The Behavioral disorder involves high frequency of biting nails attributed to underlying psychological disorders such as stress, mild depression and anxiety. Various studies investigating the phenomenon agree it is a continuum of OCD (Obsessive Compulsive Disorder) adopted by patients to control mood disorders. The finding indicates that nail-biting is highly addictive, thereby making it almost impossible to quit without evidence-based treatment interventions. Scholarly results suggest treatment strategies based on environmental restriction theories intended to reverse the disorder through training and manipulative interventions. Primarily, OMT (Object Manipulation Training) and HRT (Habitual Reverse Training) are viewed as valid treatment options. However, empirical evidence indicates they are ineffective; thus, making it hard to control. Alternative treatment interventions such as the use of punishment and use of medical control approaches do not yield conclusive results. This paper seeks to show how the application of token economies effectively helps habitual nail bitters in the modification of the Behavioral disorder.
Keywords: Nail-Biting, Behavioral Disorder, Ticket Economies
Behavior Modification Project: Nail Biting
Nail-biting is a highly addictive Obsessive-Compulsive Behavior (OCB) disorder affecting all social classes. Incidence reports indicate that it is common among individuals of different age and gender. Behavioral psychologists’ attributes its high prevalence to a myriad of causal agents including stress, emotional instability and anxiety. Other factors, such as being lonely maybe lead to its emergence. Extensive research to determine its actual causes and effective treatment strategies have led to many conclusions, some of which have been deemed ineffective. For instance, a study by Miltenberger (2011) indicated that the use of punishment did not effectively eliminate the behavior from patients as the majority of them relapsed after initial treatment. The notion that Behavioral disorder is caused by reduced physical motor activity held by the ERT theory is mostly inconsistent because habitual nail-biting is a result of many factors (Miltenberger, 2011). Moreover, the treatment strategies for this disorder requires a multi-dimensional approach that not only reverses the psychological addiction but also helps the individuals to control the trigger causal agents. In light of these observations, this paper proposes the application economy tokens Behavioral change approach to treat nail-biting.
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Target Behavior Literature Review: Nail Biting
Nail-biting has received considerable scholarly attention from various scholars seeking to understand the Behavioral condition. In 2008, a study conducted by Dufrene, Steuart Watson, & Kazmerski concluded that different environmental factors play a massive role in the emergence of the condition. Notably, the conditions in the life of the individuals such as isolation, anxiousness and stressful situations triggered nail-biting (Dufrene, Steuart Watson, & Kazmerski, 2008). However, the study posed significant questions on the overall perceptions of the condition, including depression as a factor that contributes to its emergence.
The study’s subject, a University student, Mandy, asserted to having the problem since childhood. In her assessment report, she acknowledged that a nail-biting treatment program at her college was unsuccessful in reversing the behavior. Mainly, the program used an intensive counselling treatment model as the primary approach. Various clinical test to evaluate stress levels and depression came back negative.
The research introduced simplified habitual reversal treatment procedures for four weeks. Initially, “Mandy”, the test subject before the treatment procedure started, she showed no signs of recovery. However, once the SHR was administered, she showed signs of improvement with the length of her nails increasing rapidly. While the diagnosis did not show symptoms of high levels of depression or stress, when the subject’s anxiety levels, they recorded a high frequency of nail-biting. Also, when left alone in small timed sessions of watching TV, Mandy frequently bit her nails. Therefore, it is evident that as aforementioned, anxiety and mild stressful conditions triggered nail-biting.
The treatment interventions used in the study for the modification of the behavior using SHR procedural approaches yielded positive results. The test subject’s modified SHR program that included social support systems, impulsive behavior training and instant response mechanisms showed significant improvement. These conventional approaches led to an increase in the baseline length of her nails during the experimental duration.
Other studies to test the effectiveness of the SHR methodological approaches yielded similar results. Notably, a study to investigate nail-biting among children and young adults indicated that the use of SHR is an effective strategy that helps to reverse nail-biting during anxious and stressful situations (Snorrason & Woods, 2014). However, the results on the applicability of OMT therapy was inconclusive with participants recording mixed results. In the total duration of three months when all the subjects were observed, the core variable; baseline length of the nail, the researchers found that the participants responded positively to the SHR treatment plans. In the post-treatment phase, the findings showed that the majority of the patient had an increased length of their baseline nails.
The results correlate with the findings of Snorrason and Woods (2014) that indicate that the use of SHR intervention treatment plan is an effective strategy to control the condition. Reversal of the nail-biting requires case-specific strategies that consider all the factors leading to the emergence of the BFRB disorder (Snorrason & Woods, 2014). The application of multiple applied Behavioral analysis methodological interventions helps to boost recovery. In essence, successful completion of the treatment plan reduces its prevalence by 50 % in the long term. Environment centered interventions develop resistance and control of behavior attributes, therefore, eliminating the addiction. O'Connor, Lavoie, Desaulniers, & Audet (2017), observed that cognitive reconstructive of the Behavioral composition of persons with nail-biting behavior requires the application of antidepressant medication to help reduce emotional triggers of the action. Medication to control the anxiety is a practical approach in severe cases of nail-biting where depression is identified as a causal factor (O'Connor, Lavoie, Desaulniers, & Audet, 2017). The Cognitive Psychophysiological (COP) model effectively helps to treat all BFRB conditions, including nail-biting.
Treatment Intervention: Application of Token Economies to trigger Behavioral Change
In the view of several Behavioral control therapists and counsellors, the use of simplified approaches such as rubber-bands to control nail-biting helps to reverse addiction. However, preliminary research on existing studies shows they are only effective in mild cases. However, for severe cases, studies support the use of methodologies such as pharmacotherapy, use SHR, punishment manipulated interventions, aversive stimulation and functional analysis evaluation. According to Ghanizadeh et al. (2013), the application of self-punishment interventions to reverse nail-biting does yield any results. On the contrary, it only subjects the patient to unnecessary pain without any positive results. The study refers to the approach as a placebo to the condition and instead proposes token economies to cause a permanent Behavioral change effectively.
The logic behind the use of token of economies is inspired by the use of a reward system proven tom inspire modification of a wide range of retrogressive social behavior. The approach guarantees some form of reward tokens after successfully achieving the desired Behavioral change. The dispensation of the token follows a specific habitual pattern similar to that of the frequency of the occurrence of the Behavioral disorder. The modification of nail disorder using this approach helps to shift the attention from nail-biting to the reward token; therefore, motivating an individual to abandon it (Koritzky & Yechiam, 2011). Effective use of the “Tokens” reinforces the motivational paradigm of the individual’s commitment to pursuing efforts to quit the behavior. It replaces the nail-biting spectrum instead of the individual focusing on acting on their impulse to bite nails; they restrain themselves inspired by the promise of a reward.
Mostly, token economies are instrumental in reversing highly addictive behavior such as nail-biting. The model is a unique model that prompt instant and reliable results; therefore, it may be applied by an individual who intends to reverse their nail-biting tendencies. It is important to note that the use of the token system is progressive, with the results being gradual for cases where the individual has unsuccessfully tried other options (Koritzky & Yechiam, 2011). An effective method when applying the approach is the use of a point system, where the individual awards specific points, e.g. “y” points for every successful accomplishment.
According to Behavioral specialists, three weeks is the minimum period of making something habitual, and thus is the baseline reward period. A such, the first milestone period when using the token economy model should be a minimum of 3 weeks. In such a scenario, following the model, the individual may reward themselves about 6 points every day that they achieve the set goal of not biting their nails. However, if the individual bites nails at least once, they deduct these points by two, and if they bite twice, they only reward themselves one point and zero if they bite more than three times.
Of importance to note when applying this method is that the individual should remove any rushed desires to stop the habit because it takes time to remedy habitual tendencies. The total score determines the evaluation of the progress after the first milestone is completed. The second phase of implementation of the token system is referred to as tweaking, where the individual calculates the possible outcomes using the rewards points. According to Miltenberger (2011), the best approach is the use of a graduated system where the individual sets a progressive target score starting with a low score in the first milestone and raising it in successive periods.
The token economy requires that at least three milestone periods are incorporated during the treatment period targeting the lowest to the highest score levels. Subsequently, every successful accomplishment leads to a reward or token to celebrate achievement. Research shows that the use of a token reward system is a practical approach to help to control the problem of nail-biting because it resets the systematic sequence of addiction to the behavior (Halteh, Scher, & Lipner, 2016). In essence, full compliance with the system effectively helps to overcome the BFRB disorder with a chance of success compared to other methodological approaches. In retrospective, nail-biting prevalence among individuals of all ages is rapidly becoming an alarming issue. Not only does it affect small children but is also a disruptive behavior that affects the performance of adults in their respective work engagement.
From personal experience, the disorder interferes with productivity, concentration and total ability to achieve maximum performance. Besides, it affects one’s self-esteem and social relations. Several scholarly investigations recommend the use of sophisticated Behavioral therapy approaches such as functional assessment procedures, SHR and advanced OMT. While these approaches, in some instances, yield the desired results, they are overly complicated and does not assure positive outcomes. Consequentially, the use of token of economies as a substitute approach provides not only a permanent solution but also one that reliably helps to control the condition. It only requires the use of simple interventional strategies that rewards milestone achievements, therefore, helping to modify the behavior. Arguably, the application of token of economies is an effective treatment intervention to assist in the modification process of nail-biting behavior.
Conclusion
Nail-biting is a highly disruptive behavior affecting a wide range of individuals. Classified as a BFRB, its causal agents range from stress to anxiety, and therefore, control helps to address the underlying issues. The use of sophisticated approaches, such as OMT and SHR treatment plans have insignificant results compared to the use of token economies. The self-induced process is instrumental in reversing the condition with a high level of success. However, the existence of the nail-biting disorder must be confirmed, and its severity determined to ensure that the three milestones are sufficient to address the issue. In sum, token of economies is a simple, self-sufficient process applicable to control the chronic addiction to nail-biting.
References
Dufrene, B. A., Steuart Watson, T., & Kazmerski, J. S. (2008). Functional Analysis and Treatment of Nail Biting. Behavior Modification , 32 (6), 913-927. doi:10.1177/0145445508319484
Halteh, P., Scher, R. K., & Lipner, S. R. (2016). Onychophagia: A nail-biting conundrum for physicians. Journal of Dermatological Treatment , 28 (2), 166-172. doi:10.1080/09546634.2016.1200711
Koritzky, G., & Yechiam, E. (2011). On the Value of Nonremovable Reminders for Behavior Modification. Behavior Modification , 35 (6), 511-530. doi:10.1177/0145445511414869
Miltenberger, R. G. (2011). Behavior modification: Principles and procedures. Cengage Learning.
O'Connor, K., Lavoie, M., Desaulniers, B., & Audet, J. (2017). Cognitive psychophysiological treatment of bodily-focused repetitive behaviors in adults: An open trial. Journal of Clinical Psychology , 74 (3), 273-285. doi:10.1002/jclp.22501
Snorrason, I., & Woods, D. W. (2014). Nail picking disorder (onychotillomania): A case report. Journal of Anxiety Disorders , 28 (2), 211-214. doi:10.1016/j.janxdis.2013.10.004
