Thursday, February 2, 2012

A wider perspective on habit reversal to reduce eczema scratching

I've done as much armchair research as PubMed will allow, and I've found that the psychological technique called "habit reversal" seems to be a valuable component of total therapy for eczema—but it's not covered much in the scientific literature, and in my personal experience, it’s almost completely ignored by the medical system.

Why? There’s little profit in it, sure, but it’s also unsexy—it requires patients to commit to a training regimen and then not deviate from proper practice, and it requires repeated input from nursing staff and a medium-term follow-up. It’s low-budget, time-consuming, and probably effective. But only when combined with traditional therapy such as topical steroids.

Habit reversal is a technique to reduce obsessive, compulsive scratching not generated by intense itch. The patient, instead of scratching, clenches his/her fist, and/or applies strategic pain to the itchy area by poking it with a fingernail.

I searched on PubMed and read the papers I could access on the topic. Here are the two that were most informative, besides the ones by Noren and colleagues that I wrote about previously:

Habit reversal training for the itch-scratch cycle associated with pruritic skin conditions (2007) An instruction manual for nursing staff. The authors are from Australia. They recommend four training sessions spaced a week apart, with a follow-up session one or two months later.

The effects of psychological intervention on atopic dermatitis. A systematic review and meta-analysis (2007)  The authors, from the UK and Japan, consider eight journal articles studying psychological treatment for eczema. Their conclusion: “Taken together, the most effective psychological intervention for AD would seem to be a combination of stress-managing psychotherapy, relaxation techniques and habit reversal behavioral therapy.”

Interesting. Habit reversal is not the only game in town when it comes to psychology. Someone even tried aromatherapy, but it didn't pan out.

It’s time for me to give habit reversal a shot. I’m going to train myself starting next Monday. In the initial phase, “registration,” you record how many times a day you scratch. The point is to make the patient conscious of scratching action that was previously unconscious. I’ll be making little marks with a pencil on the back of a business card. When I’m done for the day, I’ll post a photo of the card.

1 comment:

  1. Habit Reversal Therapy is a complementary treatment best used in moderate to severe eczema under the care of a Dermatologist. It is a simple behavioural therapy that works to break down the subcortical (primitive brain) automatic movements that produce non-deliberate scratching. This non-deliberate scratching flares the skin's inflammatory response, introduces infection to the skin and damages the skin and all of these processes make itching worse (the itch scratch cycle). The habit reversal therapy exercise reduces striatal chunking, an automatic movement 'program'in the basa1 ganglia. The 2007 article could be used by a psychologist to learn and provide the treatment. Or a person with eczema can do it themselves as long as you practice the 'competing response' over and over again