Overview of Habit Reversal Training

Overview of Habit Reversal Training OCD Treatment Print Using Habit Reversal Training to Reduce Physical and Verbal Tics By Owen Kelly, PhD Medically reviewed by Medically reviewed by Steven Gans, MD on July 10, 2016 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on January 24, 2020 kristian sekulic / Getty Images More in OCD Treatment Causes Symptoms and Diagnosis Types Living With OCD Related Conditions Habit reversal training is a therapy that can be effective in treating troublesome behaviors caused by a number of conditions. One of these is Tourettes syndrome, which is characterized by physical or verbal tics, such as blinking, throat clearing, repeating obscenities. People dealing with symptoms of impulse control disorders, such as trichotillomania (hair-pulling) and pathological skin picking,  also may benefit from habit reversal training,  which is composed of these four main elements.?? 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: While watching himself in a mirror, the  person describes in detail each time he carries out behavior thats associated with his conditionâ€"pulling his hair, for instance, or rubbing his eyes.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.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.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 responseâ€"an action meant to replace the old tic or impulsive behavior.?? Usually, the competing response is opposite that of the tic or impulsive behavior and is something that can be carried out for longer than just a couple of minutes. 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 arent 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. 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 doctors office is one thing. More challenging is reaching a point at which it becomes easy to control impulsive behaviors where it really countsâ€"in the real world:  at home, work, school, and in other public places.