Efficacy of a Psychoanalytic Paradoxical Therapy model on Nail Biting Symptoms and Anxiety: A Clinical Case Study

Abstract

Anxiety and nail-biting are among the most common behavioral and psychological issues observed during childhood and adolescence, often associated with a range of psychological consequences. The present study aimed to examine the effectiveness of Psychoanalytic Paradoxical Therapy in reducing symptoms of anxiety and nail-biting behavior. This research was conducted as a clinical case study. The client was an 18-year-old single female diagnosed with anxiety and chronic nail-biting for more than 12 years, who received treatment at the Specialized Psychotherapy Clinic of the Faculty of Psychology, University of Tehran. The study followed a baseline–intervention–follow-up design. The therapeutic intervention consisted of six individual sessions based on the principles of paradoxical therapy and free association technique, implemented within the framework of the Psychoanalytic Paradoxical Therapy Model. Data were collected through a clinical diagnostic interview, the Malon & Massler Nail-Biting Severity Scale (1952), and the Depression, Anxiety, and Stress Scale (DASS-21; Lovibond & Lovibond, 1995). Findings indicated a significant reduction in anxiety symptoms and nail-biting severity, accompanied by stable improvement over time. Positive changes in emotion regulation, a marked decline in nail-biting behavior, and visible enhancement in nail appearance were evident in both client self-reports and therapist evaluations. The results suggest that the Psychoanalytic Paradoxical Therapy Model demonstrated high efficacy, with therapeutic improvement rated at approximately 90%. Two- and six-month follow-up assessments revealed that treatment gains were maintained over time, with no signs of relapse. This case study highlights the potential of paradoxical therapy as an effective intervention for anxiety-related and obsessive-compulsive spectrum behaviors such as nail-biting. Further controlled studies are recommended to validate these findings.