Habit reversal therapy or training is a behaviorally-based treatment approach designed to reduce repetitive behaviors (habits) such as hair pulling, stuttering, nail-biting, and tics.
What are repetitive behaviors?
Repeated behaviors are actions that follow obsessive thoughts. From a behavioral perspective, these habits become associated with various situations and cues through the process of classical conditioning. These repetitive behaviors often serve as stress reducers to obsessive thoughts.
“The aim of these behaviors is to reduce anxiety driven by obsessive thoughts.“
When is Habit reversal training used?
Habit reversal training is used in treating behaviors raised from obsessive thoughts. Many such actions are compulsive behaviors and come under OCD-related disorders. Some of the disorders which can be effectively treated by HBT are
- Trichotillomania (Hair-pulling disorder): It is a disorder characterized by a constant and repetitive urge to pull hair to such an extent that others can notice hair fall. This disorder often causes distress, social and cognitive impairment.
- Excoriation disorder (compulsive skin picking): Also known as dermatillomania, is a OCD-related disorder charecterized by picking of own skin repetedly. If untreated, it can manifest into severe mental illness where patients spend hours picking own skin causing lesions and othe skin diseases.
- Tourette syndrome: In this syndrome, people experience unwanted movements or sounds called TICS. These are involuntary or semi-voluntary movements that occur before any action takes place. Like shrugging or blinking eyes before saying particular words.Tics can be simple or complex:
- Simple: Eye blinking, nose-lip twitchinhg, grunting, coughing(throat clearing) etc.,
- Complex: repeated observable movements, bending, hopping, making obscene gestures etc.,
Habit Reversal Training (HRT) Process:
Habit reversal therapy is designed to break conditioned habits, which are nothing but conditioned responses to different cues. HBT involves:
- awareness training,
- habit control motivation,
- competing response training,
- relaxation training
- reinforcement.
1. Awareness Trainining
Awareness training involves the use of self-monitoring to increase patient awareness of internal and external precipitants of repetitive behavior. Through this process, patients learn which situations put them at “high risk” of the habit occur.
They are also taught to think of the habit not as a single behavior but as a sequence of behaviors that includes precipitating motoric responses (e.g., face touching that precedes hair pulling or nail-biting, shallow breathing that occurs before stuttering) and internal cues (thoughts, feelings), as well as behavioral consequences and reinforcers.
2. Habit control motivation
Habit control motivation is another component of the early stages of HRT. This work is akin to motivational interviewing and involves a review of the inconveniences of the habit (e.g., how does it get in the way and what are the reasons for changing it).
3. Competing response training
Competing response training is the core of HRT. This process involves identifying a motoric behavior that is incompatible with the habit. Fist-clenching is a commonly used response that is incompatible with what is called body-focused repetitive behaviors, such as hair pulling, nail-biting, and skin picking.
Fist clenching can be done inconspicuously by making a fist, clenching a book, or firmly grasping a steering wheel. Patients learn to engage in these competing behaviors when they are in high-risk situations and when they notice precipitating behaviors or internal cues. Completing the alternative behavior for intervals of 1 to 3 minutes breaks the conditioned stimulus habit cycle.
4. Relaxation training
Relaxation training is also used to help break the conditioned habit cycles, particularly when stress or another negative mood is a precipitant for the target behavior. Repetitive behaviors are often done to reduce the stress and anxiety caused by internal or external cues. Good relaxation techniques such as Muscle relaxation, Mindfulness can help relieve stress and anxiety.
Always remember that A Tense mind can not exist in a relaxed body !!!
5. Reinforcement
Reinforcement is used as parents, therapists, or significant others provide rewards for reduced frequency of the targeted habit. For some patients, a token economy system or a self-control reinforcement program can help to facilitate and maintain treatment gains.
Further Studies
A wider range of functional relations exists between the habit and its antecedents and consequences. Patients are asked to look not only for situational and motoric precursors of the repetitive behavior, but also cognitive, affective, and sensory cues that may precipitate the habit. For example, a person with repetitive hair pulling (trichotillomania) may have thoughts like, “That hair is too grey. My eyebrows are uneven,” which increases the risk of pulling.
A patient whose nail-biting occurs primarily in response to interpersonal stress may be taught a wider range of relaxation responses, communication skills to improve social relationships or ways to modify thinking to decrease stress.
Useful Resources:
- Jungian analysis
- Hoarding Disorder
- Obsessive-compulsive disorder
- Cindrella complex
- Is selfie a mental disorder?
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