Habit Reversal for Tics

Habit reversal is another potent therapy developed by Azrin and his colleagues. It incorporates
four components:

(1) awareness training,

(2) competing response training,

(3) relaxation training, and

(4) reinforcement.

Awareness training and competing response training seem to be the most important components.

Awareness training, which includes self-monitoring, involves extensive self-assessment to

ensure that the client is aware of the frequency and severity of the tics, their environmental
antecedents, and the individual responses that make up the tics. Clients and family members keep
a record of when, how often, where, and with whom tics occur. Because knowing the specific
component responses involved is necessary to control tics, clients are asked to observe their tics
by looking in a mirror or videotaping themselves. They learn to detect the first signs of tics so
that they will be able to stop the tics early in their sequence.

In competing response training, clients practice performing a response that

(1) competes with the tic,

(2) can be sustained for several minutes,

(3) is compatible with everyday activities, and

(4) is inconspicuous to others

Table 16-2 provides examples of competing responses for various kinds of tics.
Clients are taught progressive relaxation and are instructed to practice it daily. Additionally,
they are taught to use differential relaxation in their daily lives whenever they feel anxious or
emit a tic. Family members are asked to praise the client when they observe that the client is tic
free or shows a significant reduction in tics. Clients compile a list of the negative consequences
of emitting tics (such as embarrassment and being restricted in their activities) and the positive
consequences of eliminating tics (such as feeling confident and being able to engage in desired
activities). They write the list on a card that they carry with them, and they periodically refer to it
to remind themselves of the benefits of engaging in habit reversal procedures. Children are given
specific reinforcers for completing therapy assignments and reducing tics below a predetermined
goal level.

Habit reversal consistently has been shown to be highly effective in treating tics, reducing them
by about 90%, compared with roughly 50% with medication.