Habit reversal training is a behavioral therapy that is effective in reducing tics associated with Tourette's syndrome as well as troublesome behaviors associated with impulse control disorders such as trichotilomania (hair-pulling) and pathological skin picking.
What Is Habit Reversal Training?
Habit reversal training has four main components: awareness training, development of a competing response, building motivation and generalization of skills. Let's take a closer at each of these.
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:
Step 1: The person describes in detail each time they carry out the behavior (e.g., eye-rubbing, hair-pulling, skin-picking) while looking into a mirror.
Step 2: The therapist will tell the person whenever he or she carries out the tic or impulse. This is done repeatedly until the person notices every time they do their tic.
Step 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.
Step 4: The person identifies all the situations in which the tic or impulsive behavior occurs.
Development of a Competing Response
Once the patient has developed good awareness of their tic or impulsive behavior the next step is to develop a competing response that replaces the old tic or impulsive behavior. Usually the competing response is opposite to that of the tic or impulsive behavior and is something that can be carried out for longer than just a couple of minutes. As well, it is usually helpful to choose a response that will be more or less unnoticeable by others.
To keep the tics and impulsive behaviors from coming back, the patient is encouraged to make a list of all of the problems that were 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 patients to demonstrate their ability to suppress tics or impulsive behaviors to others.
Generalization of New Skills
In this phase of treatment, patients are encouraged to practice their new skills in a range of different contexts, not just those that they have mastered to date. For example, while it might be easy to learn to suppress a tic or impulsive behavior in the relative safety of the doctor's office this also needs to be practiced at home, at work, at school and other environments.
Woods, D.W., and Miltenberger, R.G. "Habit Reversal: A Review of Applications and Variations". Journal of Behavior Therapy and Experimental Psychiatry1995 26: 123-131