We all have habits — some we'd prefer to quit. These habits can develop early and may include things like nail biting, thumb sucking, or nose picking. Some of these habits can resolve themselves over time, but others may be harder to break and require outside assistance.
One way to break an unwanted habit is through habit reversal training (HRT). This type of training is exactly what the name implies. It's a training or behavioral therapy that helps people reverse or unlearn a bad habit by following certain habit reversal training steps.
Habit reversal training is typically used for children with certain disabilities, such as those with Tourette’s or obsessive-compulsive disorder.
Who Needs Habit Reversal Training?
Many people can benefit from habit reversal training, especially children who have certain disorders resulting in unwanted habits, including obsessive-compulsive disorder and Tourette's syndrome.
Obsessive-compulsive disorder (OCD). OCD is a common disorder characterized as a neuropsychiatric disorder. One of the main symptoms of OCD is the urge to carry out compulsive behaviors that are often repetitive motor or mental acts.
These behaviors help reduce the risk of committing acts that have harmful consequences. Some examples of compulsive acts include skin and hair picking.
Tourette’s syndrome. Unlike compulsive disorders, Tourette’s is a tic disorder that involves repetitive movements and involuntary vocalizations. Tourette’s is one of three tic disorders, alongside persistent motor or vocal tic disorder (PMVT) and provisional tic disorder.
These disorders are named based on the type of tic and how long they’ve been present. Each of these disorders comes with involuntary movements and habits that habit reversal training aims to help manage.
No matter your child's disorder, it’s important that they agree to receive treatment. Though not necessary, their approval will help any therapy be more effective. If your child is exhibiting behavioral issues such as skin picking, hair pulling, thumb sucking, or tics from Tourette’s, ask them if they want help managing their symptoms.
Allowing your child to have a say in their treatment course will make them feel like they have a part in it. It may also encourage them to seek additional help for their habits if needed.
Why Try Habit Reversal Training?
Many individuals who experience OCD habits and Tourette’s tics experience feelings of embarrassment, shame, and guilt. They may also feel distressed, anxious, or powerless over what they feel they can’t control.
Besides the emotional toll that habits and tics leave on individuals, they can also change someone’s appearance. For example, hair pulling can lead to hair thinning and even baldness, while skin picking can lead to scabs and scars.
How Does Habit Reversal Training Work?
Habit reversal training can help children deal with and manage disorder-specific habits. Receiving help for these habits can help your child:
- Recognize and identify signs of when a tic is about to start
- Become mindful regarding situations and settings where tics are more common
- Prevent tics from occurring
- Replace tics with other behaviors (e.g. avoiding repetitive eye blinking by closing the eyes for several seconds
- Engage in relaxation techniques that help them manage stressful situations
Habit reversal training is usually performed with guidance from a trained health professional, such as a psychiatrist or psychologist, who has experience with Tourette’s, obsessive-compulsive disorder, or other conditions that cause unwanted habits to form. It’s not recommended to engage in habit reversal training without the guidance of a qualified professional.
Habit reversal training is performed in outpatient sessions and usually focuses on one habit at a time. The typical timeframe for habit reversal training is around 8 to 16 weeks. Children experiencing tics and habits may be required to keep a journal to track when and in what situation their tics or habits occur.
Your child’s doctor will devise a specific plan based on your child’s needs. For the most part, habit reversal training will help your child identify their habits and replace them with a less harmful or noticeable trait.
Once you and your child have been guided through habit reversal techniques, you can practice these techniques at home. You may consider keeping a journal on your child's progress during their habit reversal training. A journal can help you track how effective the training is and what might need to be improved on.
Give your child praise as they practice proper habit reversal techniques, encouraging them to continue on. Some patients have reported a decline in their tics and habits within days of training, while others notice them after a few months. It’s important to keep going and not give up, even if you don’t see results immediately. Be positive, supportive, and patient as your child learns to manage their habits.
Habit Reversal Training Examples
Let's take a look at an example of how habit reversal training works. Say that your child keeps picking their skin. A doctor may work with your child to replace that habit with something else, such as drumming their fingers on their knees or using a fidget toy to keep their hands occupied. If your child has a tendency to pull their hair, a doctor may work with them to replace that habit with hair twirling. These replacements are known as a “competing response”.
A doctor will also help your child identify possible triggers. This way they can enact these replacements before they engage in the habit to begin with. Part of habit reversal training includes identifying these triggers to help fight urges brought on by Tourette’s and OCD and replace them with competing responses.
