Habit Reversal in Individual

counselling

Presented by:
Foram
Gadha
Vipanchika
Introduction
Habit reversal technique uses reinforcement and other behavioral and
relaxation techniques

To help recognise
● Tics before they happen
● Monitor their own behavior
● Perform alternative behaviors in place of the undesirable behaviours.

**these undesirable behaviours are tics, trichotillomania, skin scratching and

skin picking.
Overview of “undesirable behaviors”
● Tic: an idiosyncratic and habitual feature of a person's behaviour.
a habitual spasmodic contraction of the muscles, most often in the
face.
Overview of “undesirable behaviors”
● Trichotillomania: in DSM 5 classified under obsessive compulsive and
related disorders heading. involves recurrent, irresistible urges to pull hair
from the scalp, eyebrows, eyelids, and other areas of the body, despite
repeated.
Overview of “undesirable behaviors”
● Skin picking/scratching : (in dsm 5 called excoriation disorder) classified
under obsessive compulsive and related disorder heading. characterized
by repeated picking at one's own skin which results in skin lesions and
causes significant disruption in one's life.
 Overview of “undesirable behaviors”
● Nervous habit : nervous habits include nail biting, hair pulling or twirling,
and thumb or finger sucking (hand-to-head habits); lip, mouth, or tongue
biting and teeth grinding (oral habits); and other repetitive movements such
as scratching and object manipulation.
 Overview of “undesirable behaviors”
● Stuttering: involve a number of disfluencies in the production of speech,
including repetitions of word sounds, words, or phrases; prolongation of
a word sound; or a hesitation (sometimes called a block) when
attempting to speak.
Using habit reversal technique
AWARENESS TRAINING: to bring awareness towards ticks and other
behaviors.
● While watching in mirror, the person describes in detail each time the
behavior is carried out
● The therapist will point the behavior each time the person carries out the
behavior until the person notices himself.
● Person learns to identify warnings when the impulse is about to take
place. E.g. urges, thoughts and sensations.
● Person eventually learns to identify all the situations when impulsive
behavior is about to occur.
Using habit reversal
DEVELOPMENT OF COMPETING RESPONSE

developed a good awareness of his tic or impulsive behavior the next step is to
develop a competing response—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 aren't likely to notice.
Using habit reversal
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.
Using habit reversal
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 doctor's office is
one thing.
● More challenging is reaching a point at which it becomes easy to control
impulsive behaviors where it really counts—in the real world: at home,
work, school, and in other public places.
Applications
· Habit-reversal training (HRT) has demonstrated efficacy in adults and in children
above 9 years of age with tic disorders.

· Habit reversal training has also be used in treatment for depression, smoking,
gambling problems, anxiety, procrastination, obsessive-compulsive disorders, and other
behavioral problems.

· It is recognized that behavioral techniques, especially habit reversal therapy (HRT),

can offer an effective alternative or complement to pharmacotherapy for Tourette
syndrome (TS)
Merits
● The therapy can be conducted in different formats, face-to-face:
individually or within a group setting. Self-help resources are also
available.
● It is a short-term therapy, a minimum of 4 sessions
● The therapy is simple to understand and is a very pragmatic approach to
the problem.
● Research has shown that it can be effective for people who scratch
and/or pick their skin.
 Demerits
● Few reports of treat- HABIT REVERSAL 465 ment failures with habit reversal, recent
research suggests that it may not be effective for young children or individuals with
developmental disabilities (Long, Miltenberger, Ellingson, & Ott, 1998; Long,
Miltenberger, & Rapp, 1998; Rapp et al., in press), most likely because of problems
with treatment compliance by these individuals.
● It is not suitable for those who pick for reasons other than habit. Other reasons might
include emotionally picking the skin or picking focused at reasons such as trying to
change the way your skin looks. Again, it is only for those for whom their
scratching/picking has become a habit.
● The therapy requires a great deal of motivation and consistency. To benefit from the
therapy you need to be motivated to change/ committed to the process of therapy.
Therapists can help you get to this stage and discuss your motivation.