Habit Reversal Therapy
What is habit reversal therapy?
Habit reversal therapy (HRT), sometimes referred to as habit reversal training, is a type of behavioral therapy. It has been in use since the 1970s and, subsequently, has been the subject of several studies examining its efficacy.
The most common application of HRT is for reducing the repetitive behaviors associated with tic and habit disorders in both adults and children.
What can habit reversal therapy help with?
HRT is used to help reduce disruptive or distressing repetitive behaviors, such as:
- Hair pulling (trichotillomania)
- Skin picking (excoriation)
- Tourette’s syndrome and other tic disorders
- Nail biting
- Thumb sucking
Does habit reversal therapy work?
Yes, the research shows that HRT is an effective treatment for the kinds of repetitive behaviors described above which are associated with tic and habit disorders (1). HRT is one of the more well researched and effective types of psychological therapy for Tourette’s syndrome. A review of the research concluded that HRT can significantly reduce the severity of tics for people who have Tourette’s syndrome or related disorders (2). It can help improve quality of life and also provides a treatment alternative to medication for people with tic and habit disorders.
How does habit reversal therapy work?
At its core, HRT helps people to reduce unwanted repetitive behaviors by:
- Becoming aware of cues that indicate that the maladaptive behavior is about to happen
- Learning to replace maladaptive behavior with incompatible behaviors
HRT can be used alone or as one component of a treatment plan - in conjunction with medication, or other psychological therapies such as exposure and response prevention (ERP). Here’s what you can expect from ERP therapy.
Length and frequency of habit reversal therapy sessions
HRT does not have a set timeframe, but is often delivered over 8 to 14 sessions, depending on individual needs. The frequency of sessions also depends on individual circumstances.
Structure of habit reversal therapy sessions
HRT has several components, as follows:
1. Awareness training with self-monitoring
Participants learn to identify when the behavior is about to happen by becoming aware of the preceding experiences or cues. This might mean, for example, noticing the muscle sensations that occur just before a tic, or noticing the mounting muscle tension that occurs with the urge to pull hair in trichotillomania. This phase of therapy involves the use of self-monitoring forms to identify cues, triggers, and patterns.
2. Relaxation training
Participants learn relaxation and breathing exercises. Building on the first component of HRT, participants apply relaxation training whenever they notice the urge to engage in the maladaptive behavior.
3. Competing response training
Once participants have developed an awareness of the cues that the behavior is about to happen, they learn to replace the behavior with another. Participants learn a competing behavioral response; a behavior that is incompatible with the original unwanted behavior. The therapist helps the individual to select appropriate behaviors to substitute.
For example, a person might become aware that, prior to hair pulling, they reach their hand up to their scalp and stroke their hair. Once they become aware of this physical cue that precedes hair-pulling, they could practice moving their hand to their ear and rubbing their earlobe instead. Over time and with practice, the person learns to replace the habit of hair pulling with this alternative behavior.
What happens in a typical habit reversal therapy session
The content of HRT changes from session to session as you progress through the stages of therapy outlined above. Typically, however, sessions begin with a review of any homework tasks set in the previous session. For example, you might review a self-monitoring form, where you have been making a note of the sensations or other experiences that occur just before engaging in the unwanted behavior. Your therapist might help you to notice patterns and learn to identify the triggers for and antecedents to the behavior.
You might then practice, or learn a new relaxation exercise in session - these are often set as daily homework activities.
Once the awareness training is underway, you might explore with your therapist which appropriate competing behaviors could be practiced to replace the unwanted behavior. You might try several before finding a good fit, or you might have more than one behavior to use as a replacement.
Over the following sessions, you’ll practice the competing behavior replacement process at home. In sessions, the therapist will review the success of these behaviors and help adjust them to be more effective, as needed.
What to look for in a therapist for habit reversal therapy
There are several factors to keep in mind when selecting an HRT therapist, including:
Specialization: Look for a therapist who has:
- Experience treating the condition or behavior you are seeking therapy for, and
- Has completed training in HRT
Therapists often include this information in their biography on their website or online profile.
Qualifications: With so many different provider types available, it can be difficult to decide which type of mental health professional to see. The most important thing is to look for a currently licensed therapist. This ensures that your therapist has completed the appropriate level of education to practice. All therapists on Zencare have already been vetted.
Personal fit: The trusting relationship between you and your therapist, known as the “therapeutic alliance” can have a huge impact on the efficacy of therapy. It’s important to work with someone you trust and feel understood by.
The best way to judge how you might feel about a therapist is to ask for a preliminary phone call. This also allows you to ask about their HRT training, experience, and what therapy will be like. Try to speak to a few different therapists before deciding.
Find therapists specializing in habit reversal therapy
Find therapists who specialize in habit reversal therapy on Zencare. Search by insurance, fees, and location; watch therapist introductory videos; and book free initial calls to find the right therapist for you!
Sources and references
- (1) Bate, K.S., et al., 2011, “The efficacy of habit reversal therapy for tics, habit disorders, and stuttering: A meta-analytic review”. Accessed online February 2020 at https://www.ncbi.nlm.nih.gov/books/NBK81987/
- (2) Dutta, N., & Cavanna, A.E., 2013, “The effectiveness of habit reversal therapy in the treatment of Tourette syndrome and other chronic tic disorders: a systematic review”. Accessed online February 2020 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3812724/
- “How Habit Reversal Therapy Works for Tics”, Child Mind Institute. Accessed online February 2020 at https://childmind.org/article/how-habit-reversal-therapy-works-for-tics/
- Gupta, S., & Gargi, P.D., 2012, “Habit Reversal Training for Trichotillomania”. Accessed online February 2020 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3358939/