5 It is effective and its effects are stable over time.5 Punishment Punishment is not effective in the treatment of NB. The effect of punishment is not more than placebo.24 Habit Reversal Some authors believe that NB is a learned habit, rather than an emotional condition.36 Habit reversal is a form of behavioral therapy, which uses a similar or dissimilar competing response. Both Inhibitors,research,lifescience,medical of the similar and dissimilar competing responses improve oral-digital behavior. The two

approaches do not differ from each other in terms of improvement degree or acceptability.40 There is a controversy about the long-term efficacy of habit reversal training for the treatment of NB.41 Habit reversal consists of awareness training, relaxation training, competent Smad inhibitor response training, and contingency management. The recording of NB frequency, videotaping of NB behavior and describing its frequencies increase awareness. Its frequency Inhibitors,research,lifescience,medical should be recorded on a card. It will help children to monitor their behavioral changes. Situation awareness is the type of awareness that children with NB habit identify the situations Inhibitors,research,lifescience,medical or places in which NB is better or worse. Patients with NB habit can be trained for different types of relaxations such as self-statements of relaxation, visual imagination, muscle relaxation, and deep breathing. For competing

response training, a behavioral pattern that is incompatible with NB is Inhibitors,research,lifescience,medical introduced. Competing responses should be contingent

with NB. There are different types of contingency managements. Parents can comment on improvement of the behavior, and provide some praise for the improved child. For example, the child can go to some places or enjoy activities that he/she has been avoided before. Competing responses should be practiced every day. Parents should encourage Inhibitors,research,lifescience,medical children with NB habit using competing response. Behavioral changes are long processes, and parents and their children should be informed that they will not happen over a few days or weeks. This is very important because parents or children usually give up soon. Relaxation training may not be included in simplified habit reversal because HR does not suppose that NB is an anxiety reduction behavior.5 However, more studies are in need to examine the long term effects of habit reversal. Competing Response In this behavioral method, STK38 subject perform a competing response whenever he/she has the urge to bite or finds his/hers biting nails. For example, a behavior to stop or avoid moving upper limbs towards face or lips, or a behavior to stop or inhibit entering fingers into mouth is employed. This method has been shown to be more effective than not using it,36 Competing response type is not important for the suppression of target behavior, and it does not probably function as an incompatible behavior.