What Is Habit Reversal Training?

We all know that habits can be hard to break. Habit reversal training is one type of therapy that can be effective in treating troublesome behaviors and bad habits. It can be effective for changing bothersome habits, but it can also be useful for treating several different mental health conditions, such as tics and OCD.

What Does Habit Reversal Training Treat?

Habit reversal training can be useful in the treatment of a few different mental health conditions and body-focused repetitive behaviors. These include:

• Tourette's syndrome: A condition characterized by physical or verbal tics, such as blinking, throat clearing, repeating obscenities.
• Trichotillomania: An impulse control condition that involves hair-pulling.
• Excoriation disorder: A condition also known as pathological skin picking that involves compulsively picking at the skin, leading to injuries, lesions, infections, and scarring.
• Obsessive-compulsive disorder (OCD): A condition characterized by obsessive thoughts and compulsive behaviors.

Habit reversal training can also help reduce behaviors that are disruptive or distressing such as nail biting, thumb sucking, smoking, procrastinating, and stuttering. It may also help address certain behaviors that contribute to conditions such as anxiety and depression.

How Habit Reversal Training Works

Habit reversal training gives people the coping skills they need to manage habits related to their specific disorder. During treatment, people learn to better recognize the signs when a behavior or habit is about to begin.

They also develop other behaviors that they can engage in other than the one they are trying to replace. As they cope with their condition, they also practice relaxation techniques that can reduce stress and improve their ability to manage their triggers.

Components of Habit Reversal Training

Habit reversal training typically involves five key elements: awareness training, development of a competing response, motivation building, relaxation training, and generalization of new skills.

What Is Awareness Training?

Awareness training is used to bring greater attention to tics and other behaviors so that the affected person can gain better self-control. Awareness training is usually carried out in a number of smaller steps:

1. While watching himself in a mirror, the person describes in detail each time he carries out behavior that's associated with his condition—pulling his hair, for instance, or rubbing his eyes.
2. The therapist will point out to the person whenever he carries out the tic or impulse repeatedly until the person is able to notice the behavior for himself.
3. The person learns to identify the earliest warning that a tic or impulsive behavior is about to take place. These warning signs can be urges, sensations, or thoughts.
4. The person identifies all the situations during which the tic or impulsive behavior occurs.

Development of a Competing Response

Once the patient has developed a good awareness of his tic or impulsive behavior the next step is to develop a competing response—an action meant to replace the old tic or impulsive behavior.

For example, a competing response to hair-pulling might be to ball the hands into a fist and hold them rigidly alongside the body. Someone who repeatedly sticks out his tongue might purse his lips instead. Another goal of a competing response is that it is an action other people aren't likely to notice.

Building Motivation

To prevent tics and impulsive behaviors from coming back, people undergoing habit reversal training are encouraged to make a list of problems caused by their behavior. Parents and friends are also asked to praise the person for their accomplishments thus far.

In addition, it can often be helpful for people to demonstrate their ability to suppress tics or impulsive behaviors to others.

Relaxation Training

People are often more likely to engage in a behavior when they are experiencing stress. For example, people with Tourette's experience tics more frequently when they are in stressful situations. Stress can also trigger obsessions and compulsions in OCD.

When people begin to recognize the signs that a behavior will occur, they can utilize relaxation techniques to reduce the urge to engage in those maladaptive behaviors. 

Generalization of New Skills

In this phase of treatment, people are encouraged to practice their new skills in a variety of different contexts, not just those that they have mastered to date. Learning to turn off a tic in the relative safety of the doctor's office is one thing.

Things to Consider

While research suggests that habit reversal training can be effective, it may not be right for everyone. Some people may benefit from other types of therapy, such as cognitive-behavioral therapy (CBT) or dialectical behavior therapy (DBT).

Habit reversal training can help people manage their symptoms. However, it is important to remember that it is not a cure for lifelong conditions like Tourette's syndrome and obsessive-compulsive disorder. Other treatments that may also be used alongside habit reversal training include medications, other types of therapy, and deep brain stimulation (DBS).

Takeaways

Evidence indicates that habit reversal training can be an effective way to treat a variety of problem behaviors and mental health conditions, including Tourette's, OCD, skin picking, hair pulling, and nail biting. If you think this might help you, look for a trained mental health professional who has experience with habit reversal training.