Reducing risky behavior with habit reversal: A review of behavioral strategies to reduce habitual hand-to-head behavior

Habit-reversal training: a psychotherapeutic approach in treating body-focused repetitive behaviour disorders

Body-focused repetitive behaviours (BFRBs) are recurrent, compulsive, destructive behaviours directed towards the body. Although studies have demonstrated a 12-14% prevalence rate, researchers found that dermatologists and psychiatrists show a lack of knowledge regarding psychodermatology resources and information about BFRB disorders (BFRBDs) such as trichotillomania (TTM). There is limited research about treatments including ones investigating the clinical applications of various self-help training such as decoupling (DC) and DC in sensu (DC-is) as well as about habit-reversal training (HRT). HRT is a five-component behavioural intervention that aims to develop a competing response to a specific unwanted behaviour. Studies have found substantial support for HRT's efficacy in treating a variety of maladaptive repetitive behaviours including onychotillomania, TTM, skin-picking disorder and chronic cheek biting. Additionally, many psychotherapies can augmented HRT. Psychotherapies include acceptance and commitment therapy, dialectical behaviour therapy, psychodynamic psychotherapy, mindfulness mediation and the cognitive psychophysiological model. A recently investigated variant of HRT, DC-is, resulted in consistently satisfactory objective and subjective improvement for treating BFRBDs, and HRT showed good subjective but poor objective improvement compared with standard DC. HRT and HRT variants are effective therapeutic treatments for BFRBDs; however, further randomized double-blinded and placebo-controlled trials are required to examine HRT's therapeutic profile.

Impact of a Serious Game (#RedPingüiNO) to Reduce Facial Self-Touches and Prevent Exposure to Pathogens Transmitted via Hands: Quasi-Experimental Intervention

BACKGROUND

After the COVID-19 pandemic, society has become more aware of the importance of some basic hygienic habits to avoid exposure to pathogens transmitted via hands. Given that a high frequency of touching mucous membranes can lead to a high risk of infection, it is essential to establish strategies to reduce this behavior as a preventive measure against contagion. This risk can be extrapolated to a multitude of health scenarios and transmission of many infectious diseases. #RedPingüiNO was designed as an intervention to prevent the transmission of SARS-CoV-2 and other pathogens through the reduction of facial self-touches by thoughtfully engaging participants in a serious game.

OBJECTIVE

Facial self-touches should be understood as behaviors of limited control and awareness, used to regulate situations of cognitive and emotional demands, or as part of nonverbal communication. The objective of this study was to ensure that participants become aware of and reduce these behaviors through a game of self-perception.

METHODS

The quasi-experimental intervention was applied to 103 healthy university students selected by convenience sampling and put into practice for 2 weeks, with 1 control group (n=24, 23.3%) and 2 experimental groups (experimental group with no additional social reinforcement interventions: n=36, 35%; experimental group with additional social reinforcement interventions: n=43, 41.7%). The objective was to improve knowledge and perception and reduce facial self-touches to prevent exposure to pathogens transmitted via hands not only in health multihazard scenarios but also in ordinary circumstances. The ad hoc instrument used to analyze the experience consisted of 43 items and was valid and reliable for the purpose of this study. The items were divided into 5 blocks extracted from the theoretical framework: sociological issues (1-5); hygiene habits (6-13); risk awareness (14-19); strategies for not touching the face (20-26); and questions after the intervention (27-42), designed as a postintervention tool assessing the game experience. Validation of the content was achieved through assessment by 12 expert referees. External validation was performed using a test-retest procedure, and reliability was verified using the Spearman correlation.

RESULTS

The results of the ad hoc questionnaire, which were analyzed using the Wilcoxon signed-rank test and McNemar index to identify significant differences between test and retest for a 95% CI, showed that facial self-touches were reduced (item 20, P<.001; item 26, P=.04), and awareness of this spontaneous behavior and its triggers increased (item 15; P=.007). The results were reinforced by qualitative findings from the daily logs.

CONCLUSIONS

The intervention exhibited a greater effect from sharing the game, with interactions between people; however, in both cases, it was helpful in reducing facial self-touches. In summary, this game is suitable for reducing facial self-touches, and owing to its free availability and design, it can be adapted to various contexts.

Reducing face touching through haptic feedback: A treatment evaluation against fomite-mediated self-infection

Fomite-mediated self-infection via face touching is an understudied transmission pathway for infectious diseases. We evaluated the effect of computer-mediated vibrotactile cues (presented through experimental bracelets located on one or both hands of the participant) on the frequency of face touching among eight healthy adults in the community. We conducted a treatment evaluation totaling over 25,000 min of video observation. The treatment was evaluated through a multiple-treatment design and hierarchical linear modeling. The one-bracelet intervention did not produce significantly lower levels of face touching across both hands, whereas the two-bracelet intervention did result in significantly lower face touching. The effect increased over repeated presentations of the two-bracelet intervention, with the second implementation producing, on average, 31 fewer face-touching percentual points relative to baseline levels. Dependent on the dynamics of fomite-mediated self-infection via face touching, treatment effects could be of public health significance. The implications for research and practice are discussed.

Spontaneity matters! Network alterations before and after spontaneous and active facial self-touches: An EEG functional connectivity study

BACKGROUND

Despite humans frequently performing spontaneous facial self-touches (sFST), the function of this behavior remains speculative. sFST have been discussed in the context of self-regulation, emotional homeostasis, working memory processes, and attention focus. First evidence indicates that sFST and active facial self-touches (aFST) are neurobiologically different phenomena. The aim of the present analysis was to examine EEG-based connectivity in the course of sFST and aFST to test the hypotheses that sFST affect brain network interactions relevant for other than sensorimotor processes.

METHODS

To trigger spontaneous FST a previously successful setting was used: 60 healthy participants manually explored two haptic stimuli and held the shapes of the stimuli in memory for a 14 min retention interval. Afterwards the shapes were drawn on a sheet of paper. During the retention interval, artifact-free EEG-data of 97 sFST by 32 participants were recorded. At the end of the experiment, the participants performed aFST with both hands successively. For the EEG-data, connectivity was computed and compared between the phases before and after sFST and aFST and between the respective before-and the after-phases.

RESULTS

For the before-after comparison, brainwide distributed significant connectivity differences (p < .00079) were observed for sFST, but not for aFST. Additionally, comparing the before- and after-phases of sFST and aFST, respectively, revealed increased similarity between the after-phases than between the before-phases.

CONCLUSION

The results support the assumption that sFST and aFST are neurobiologically different phenomena. Furthermore, the aligned network properties of the after-phases compared to the before-phases indicate that sFST serve self-regulatory functions that aFST do not serve.

"Don't Touch Your Face!" The Contribution of Habit Reversal in the COVID-19 Pandemic

The Habit Reversal Training (HRT) is a behavioral procedure for treating the so-called nervous habits, such as nail biting, hair pulling and thumb sucking. In addition to being an established clinical procedure, HRT is also a strategy for behavioral change that can serve the entire community. For this reason, this review aims to explore the studies proposing the use of HRT for the reduction of hand-to-face habits in the context of COVID-19 pandemic. Touching one's nose, mouth and eyes, indeed, is one of the means of virus transmission that many awareness campaigns seek to highlight. After an overview of how HRT works and of the current epidemiological situation, studies supporting Habit Reversal Training for the reduction of risky hand-to-face habits are presented. The possible strategies are then exposed and critically discussed to identify their limitations and propose a new version according to the Relational Frame Theory.

Hand-to-Face Contact of Preschoolers during Indoor Activities in Childcare Facilities in the Republic of Korea

PURPOSE

This study aimed to characterize hand-to-face contact (HFC) in children and analyze the factors that affect HFC behaviors of preschoolers in childcare facilities in Korea.

METHODS

Thirty preschoolers aged between 13 and 84 months were enrolled with parents' voluntary participation. Videotaping (10 children/childcare center/2 h) and video reading was performed from 23 November 2018 to 7 January 2019.

RESULTS

A total of 2719 cases of HFC were observed in 30 participants within 2 h. The average contact with the facial mucosa (frequency/person/2 h) was 55.6 ± 42.2, of which the mouth (25.4 ± 23.9), the nose (20.4 ± 24.5), and the eye (9.8 ± 11.7) were the most frequent contacts, in that order. The average contact duration (sec/person/2 h) with the facial mucosa was 232.6 ± 169.7, of which the mouth (145.2 ± 150), the nose (57.6 ± 62.2), and the eyes (29.7 ± 42.3) were the longest in that order. The density distribution of the frequency and duration of mucosal contact was wider in boys than in girls. The mucosal and non-mucosal contact frequencies were significantly higher in boys (p = 0.027 and p = 0.030, respectively).

CONCLUSION

Children's HFC frequency and duration were highest for the mouth, nose, and eyes. Boys tended to have a higher contact frequency than girls for both mucous and non-mucous HFC.

The suppression of spontaneous face touch and resulting consequences on memory performance of high and low self-touching individuals

Spontaneous touching of one's own face (sFST) is an everyday behavior that occurs primarily in cognitively and emotionally demanding situations, regardless of a persons’ age or gender. Recently, sFST have sparked scientific interest since they are associated with self-inoculation and transmission of respiratory diseases. Several studies addressed the need to reduce sFST behaviors without discussing the underlying functions of this spontaneous behavior. In addition, the question of why this behavior occurs very frequently in some individuals (high self-touching individuals, HT) but less frequently in others (low self-touching individuals, LT) has not yet been addressed. For the first time, we distinguished between HT and LT and investigated the behavioral consequences of sFST suppression in these two groups. For this purpose, we examined performance outcomes of 49 participants depending on sFST behaviors during a haptic working memory task. In addition, we assessed personality traits of HT and LT using the Freiburg Personality Inventory (FPI-R). The results of our study reveal that suppressing sFST in HT is negatively related to memory performance outcomes. Moreover, HT show tendencies to differ from LT in certain personality traits. Our results highlight the relevance of distinguishing between HT and LT in future studies of sFST.

Behavior analytic contributions to public health and telehealth

The Journal of Applied Behavior Analysis is launching a special series on the topics of public health and telehealth. The special series begins with the articles in this issue and will continue for the next 2 to 3 issues with an open submission window until September 1, 2020. Behavior analysis has much to offer with respect to public health and much to gain from continued and expanded use of telehealth. This paper outlines the importance of these topics in the current crisis and in our ongoing evolution as a field. The historical literature in behavior analysis is reviewed for each topic along with suggestions for future research. The articles from the special series will be combined with historical contributions from JABA into a virtual issue. We encourage continued submissions on these topics even after the special series is completed as future papers will also be incorporated into the special issue.

A Proposed Functional Analysis of Transmission Prevention Behaviors for a Respiratory Virus (SARS-CoV-2)

The coronavirus (SARS-CoV-2) pandemic has had a global impact on lives everywhere and has led to the disruption of, and interference with, virtually every aspect of life. In response, leading experts, political leaders, doctors, and scientists have released guidelines that attempt to prevent and mitigate the exponential rate of infection. The response to these safety recommendations has produced tremendous behavior variability as a society. Although a plethora of factors are likely relevant, a more complete analysis of human behavior during this time might help explain this disparity. The principles of applied behavior analysis allow for a functional analysis of an individual's use of transmission prevention behaviors (TPBs) during the SARS-CoV-2 pandemic. Thus, the purpose of this discussion is to provide a conceptual analysis for some possible explanations for why individuals might or might not engage in virus TPBs, as well as some recommendations to help combat the current pandemic, as well as those in the future.

Stop touching your face! A systematic review of triggers, characteristics, regulatory functions and neuro-physiology of facial self touch

Spontaneous face touching (sFST) is an ubiquitous behavior that occurs in people of all ages and all sexes, up to 800 times a day. Despite their high frequency, they have rarely been considered as an independent phenomenon. Recently, sFST have sparked scientific interest since they contribute to self-infection with pathogens. This raises questions about trigger mechanisms and functions of sFST and whether they can be prevented. This systematic comprehensive review compiles relevant evidence on these issues. Facial self-touches seem to increase in frequency and duration in socially, emotionally as well as cognitively challenging situations. They have been associated with attention focus, working memory processes and emotion regulating functions as well as the development and maintenance of a sense of self and body. The dominance of face touch over other body parts is discussed in light of the proximity of hand-face cortical representations and the peculiarities of facial innervations. The results show that underlying psychological and neuro-physiological mechanisms of sFST are still poorly understood and that various basic questions remain unanswered.

Hand-to-face contact behaviors during indoor activities in daily life among Korean adults: an observational pilot study using videotaping

OBJECTIVES

Hand-to-face contact (HFC) is the major route for the self-inoculation of pathogens. This study aimed to describe the characteristics of HFC behaviors among Korean adults during indoor activities.

METHODS

Thirty participants were enrolled in the study, and 2 hours of videotaped data were collected from each participant. Contact data were recorded by examining the frequency and duration of HFC on the videos. Three training sessions were conducted for 2 readers to ensure the accuracy and reliability of videotape reading. Re-reading and verification of selected video data were performed to confirm intrapersonal and interpersonal validity. Contact exposure (CE) was determined by multiplying the contact frequency (CF) by the contact duration (CD) to quantify the intensity of contact during the observation time (2 hours).

RESULTS

A total of 3,007 HFCs (1,305 mucous membrane contacts and 1,702 non-mucous membrane contacts) were observed for 60 person-hours. The median CF (person/2 hr) of the mucous membranes (eye; 4.0, nose; 15.5, mouth; 16.5) was 39.5/person and the median total CD was 177.0 sec/person. The median CE (frequency-duration/sec/person) was 5,795.0 (mouth: 1,356.0, nose: 600.0, eye: 57.5).

CONCLUSIONS

This study showed that the mouth and nose were the most frequent exposure sites for HFC. Avoiding habitual HFC, awareness of self-inoculation by HFC, and vigorous hand hygiene should be strengthened to prevent the spread of infections.

Leveraging applied behavior analysis research and practice in the service of public health

Human behavior plays a central role in all domains of public health. Applied behavior analysis (ABA) research and practice can contribute to public health solutions that directly address human behavior. In this paper, we describe the field of public health, identify points of interaction between public health and ABA, summarize what ABA research has already contributed, and provide several recommendations for how ABA research and practice could continue to promote public health outcomes. A clearer focus on behavior and widespread adoption of research designs and interventions informed by the ABA literature could lead to better public health outcomes. Reciprocally, better integration of public health goals and strategies into ABA research, harnessing of technology, and more collaboration would help diversify and disseminate our applied science and could yield more effective and scalable interventions to prevent and treat public health problems.

Tolerance of face coverings for children with autism spectrum disorder

Healthcare professionals and government officials have advised the use of personal protective equipment, such as face masks and face shields, to assist with limiting the spread of the SARS‐CoV‐2 (COVID‐19). Due to the prevalence of challenging behavior associated with other medical routines, the present study evaluated a treatment package composed of graduated exposure, prompts, reinforcement, and escape extinction on tolerance of wearing a face covering for up to 5 min for 12 children with ASD in a systematic replication of Cox et al. (2017) and Sivaraman et al. (2020). We also extended previous research by measuring generalization of face covering type (i.e., face shield) and the efficacy of a treatment extension for tolerating a face covering for up to 15 min during the participants' trial‐based instruction and play periods.

Attempting a Change in Human Behavior in ICU in COVID Era: Handle with Care!

How to cite this article: Clerk AM. Attempting a Change in Human Behavior in ICU in COVID Era: Handle with Care! Indian J Crit Care Med 2020;24(8):626-627.

[3H-estradiol binding to cytosol receptors of the rat olfactory epithelium]

Two types of cytosol receptors of 3H-estradiol with high affinity and limited quantity of binding sites (KDI = 1-2 nM, BmaxI = 8 fmoles/mg protein; KDII = 10 nM, BmaxII = 8 fmoles/mg protein) were determined in the rat olfactory tissue. The amount of high affinity receptors of type I does not change with maturation of the rats, and has no sex difference. The role of estradiol receptors in the olfactory tissue of the rats is discussed.