A Randomized Controlled Trial of a Novel Self-Help Technique for Impulse Control Disorders

Abstract

Nail-biting is currently classified as an impulse control disorder not otherwise specified. Although seldom targeted as a primary symptom, nail-biting is often associated with somatic complications and decreased quality of life. The present study assessed the effectiveness of an innovative self-help technique, titled decoupling (DC). DC aims at attenuating pathological nail-biting by performing motor sequences that decouple and rearrange the behavioral elements involved in the habit. A total of 72 participants with excessive nail-biting were recruited via specialized self-help forums and were randomized to either DC or progressive muscle relaxation (PMR) groups after baseline assessment. Four weeks later, participants underwent a similar assessment as before and were asked to rate the effectiveness of the intervention. The primary outcome parameter was the Massachusetts General Hospital Scale (MGH) adapted. Relative to the PMR group, the DC group showed significant progress in withstanding the urge to bite their nails. Furthermore, they appraised the appearance of their nails as considerably less compromised at the end of the treatment relative to participants undergoing PMR. At statistical trend level, the DC group showed a significantly greater decline on the adapted MGH relative to PMR. Despite methodological limitations, the present study asserts that the effectiveness of DC, previously shown for trichotillomania, extends to nail-biting.

Do it yourself! Evaluation of self-help habit reversal training versus decoupling in pathological skin picking: A pilot study

“…The technique has been successfully tested in TTM and pathological nail-biting (PNB) as a self-help strategy. The on-line administration of this technique over a period of 4 weeks led to a significant decline of TTM (Moritz & Rufer, 2010) and PNB (Moritz, Treszl, & Rufer, 2011) relative to an active control intervention. Despite tentative evidence for the efficacy of DC, its theoretical rationale needs further empirical testing.…”

Internet-Based Self-Help for Trichotillomania: A Randomized Controlled Study Comparing Decoupling and Progressive Muscle Relaxation

“…Pre-post analyses demonstrated that hair-pulling symptoms decreased to a significantly greater extent in the DC than PMR group [24] . Another study also highlighted the potential of DC to reduce nail-biting, again against an active control [25] . However, the generalizability of the results on hair-pulling symptoms is limited by certain methodological issues (e.g.…”

Impact of a Healthy Nails Program on Nail-Biting in Turkish Schoolchildren

“…Koritzky and Yechiam (2011) have pursued the effectiveness of a novel behavior modification method for dysfunctional and impulsive habits by using nonremovable reminders such as wristbands, which they reported as a beneficial technique. Moritz, Treszl, and Rufer (2011) have devised an innovative Internet-based self-help technique, which they call decoupling (DC) that can be used in helping nail-biters. The DC technique was reported to cause subjects to achieve significant success in resisting the compulsion of nail-biting (Moritz, Treszl, & Rufer, 2011).…”

“…Moritz, Treszl, and Rufer (2011) have devised an innovative Internet-based self-help technique, which they call decoupling (DC) that can be used in helping nail-biters. The DC technique was reported to cause subjects to achieve significant success in resisting the compulsion of nail-biting (Moritz, Treszl, & Rufer, 2011).…”