Mental Challenges

How Aneela Idnani Is Bringing Awareness to Body-Focused Repetitive Behaviors—In More Ways Than One

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If it weren’t for the highly visible sign of Aneela Idnani’s mental-health condition, she would’ve likely kept it a lifelong secret, even from loved ones. But when she ran into her husband in the bathroom early one morning in 2013, there was no more hiding: He could see, as clear as day, that her eyebrows were completely gone, following a flare-up the previous night of her trichotillomania, a condition characterized by the urge to pull out one’s hair. Because of the stigma that's long shrouded trichotillomania, Idnani had carefully patched holes in her brows with deft makeup strokes for years, rather than address it. But it was in finally opening up to her husband that she’d soon arrive at an idea for an awareness-focused solution to help both herself and others who were in the same boat.

Shortly after revealing her condition to her husband, Idnani was engaging in her characteristic hair-pulling one day while sitting on the couch—until he gently grabbed her wrist. “That sensation created an instant a-ha moment,” says Idnani. “I thought, ‘Oh, if I could just have something on my wrist that would notify me right when I went to pull, could that help me?’” It was then that she first realized the power of real-time awareness to stop semi-unconscious behaviors, including those typical of trichotillomania and also other body-focused repetitive behaviors (BFRBs), like skin-picking and nail-biting. So formed the initial idea for a tech-enabled bracelet that could generate that helpful awareness with a slight vibration.

In 2016, Idnani—who is one of Well+Good's 2021 Changemakers—officially left her full-time position in digital advertising to found HabitAware with her husband, Sameer Kumar, whose applied physics and engineering background would help solidify the design of the company's first product, Keen. It's a wearable that you can train to detect hand gestures linked to unwanted BFRBs, like, say, lifting your hand toward your face. When Keen senses those movements, it vibrates, and, in turn, brings the user keen awareness of the behavior in question. A linked app also tracks occurrences of the behavior, which can help the user become more intimately aware of any patterns.

"With body-focused repetitive behaviors, people will say, ‘Oh, why don’t you just stop doing it, stop picking or pulling?’ But that’s like asking someone to stop pumping blood." —Aneela Idnani, co-founder of HabitAware

In many cases, that awareness alone can prove life-changing. “With body-focused repetitive behaviors, people will say, ‘Oh, why don’t you just stop doing it, stop picking or pulling?’ But that’s like asking someone to stop pumping blood,” Idnani says. “These behaviors happen mostly in the unconscious part of the brain. While you might be vaguely aware that you’re doing them, you’re mostly not in control. But when you get the vibration [from Keen], the behavior becomes fully conscious, and you have agency over whether you’re going to keep doing it, or stop.”

The role of body-focused repetitive behaviors in mental health

Actions like pulling at your brows or hair, biting your nails, or picking at your cuticles or skin may seem innocuous to those who don't contend with a BFRB. But it’s this very perception that has allowed these conditions—which affect an estimated 20 percent of the population—to exist in the shadows, until recently. The category was only added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the American Psychiatric Association’s record of all mental-health conditions, in 2013. And that’s right around the time when Idnani attempted to get help from a therapist—who merely brushed it off. “I told her I couldn’t stop pulling out my hair, and she was like, 'Okay, just stop doing that. Let’s talk about your dad’s death instead,'” she says.

“How I describe BFRBs is that they serve a purpose, which is to self-soothe, but they just don’t serve it well.” —Idnani

What the therapist was missing is that the two are inextricably connected: Body-focused repetitive behaviors are often self-soothing mechanisms, which, in Idnani’s case, had emerged as part of the way she was coping with her father’s death, and recurred when she was particularly stressed. “How I describe BFRBs is that they serve a purpose, which is to self-soothe, but they just don’t serve it well,” says Idnani. “They’re like a message from our subconsciousness to our consciousness, saying, ‘Take care of me.’”

To be sure, not everyone with a BFRB is wrestling with a deeper issue or past trauma; in many cases, that sense of discomfort triggering the behavior may be related to current stress, anxious thoughts, or overwhelm—or any of the ways someone might ignore their needs when these emotions arise. “When you become aware of a behavior happening in real time, you can then ask yourself questions to figure out the source of that discomfort: Is it one in the morning, and you’re exhausted from the day and just need to sleep? Is it one in the afternoon, and you haven’t stood up from your desk in six hours? It’s about being able to answer the call, whatever it may be,” says Idnani.

That’s precisely why the current iteration of Keen, Keen2, will soon go beyond in-the-moment awareness to include strategies for actually replacing the unhelpful behavior with a healthier one.

How HabitAware is evolving to help anyone with a body-focused repetitive behavior break the cycle

While awareness was the cornerstone of the original Keen bracelet, it “didn’t answer the full question of the behavior-change process,” says Idnani, “which is to figure out how, once you’re aware of the behavior, you can still fulfill its soothing purpose, but in a more healthful way.” Essentially, that means identifying a replacement behavior and engaging in training to reverse the initial habit altogether—both of which will be elements rolled out to Keen2.

This newer version, launched earlier this year as part of a phase-1 National Institutes of Health (NIH) research grant, has a few more wearable bells and whistles (it now includes the time and step-tracking, for instance), as well as an improved algorithm for detecting and measuring unwanted gestures as they happen. And the associated app also includes a more detailed dashboard, where users can access peer coaching and will soon be able to practice the new habit-reversal techniques.

“We’ve gamified and digitized this habit-reversal training into three elements,” says Idnani. “The first is awareness training, with a program called Beat Keen, where you’ll essentially be able to delay the vibration by showing that you’re aware of an unwanted gesture right as it starts. The second is competing-response training, where the app asks you to record a wrist-wriggling gesture, which it can later prompt you to do instead of the BFRB gesture. And the third is support training, which is delivered through motivational videos within the app.”

The goal is for HabitAware to become a one-stop shop for anyone looking to identify, get in control of, and eventually, treat a BFRB. “As we consider new innovations, it’s really about understanding what makes our user tick, in a sense. Why are you engaging in that behavior? What’s triggering you? And how can we really help you take care of yourself in a different, more supportive way?” says Idnani.

As body-focused repetitive behaviors become increasingly recognized and normalized—in part, because of HabitAware itself and the broader movement to destigmatize mental-health issues, in general—Idnani's focus is expanding to other conditions, with the help of a phase-2 National Science Foundation grant. “We’re working with treatment professionals to develop a methodology that can help folks with other conditions for which lack of awareness is paramount,” she says. “Our hope now is to see what other mental-health communities we can serve that have been largely ignored or dismissed in the past.”

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