Habit reversal technique: what it is and how to use it

Tics can be behaviors that, although simple, can imply a significant degree of discomfort in the person who manifests them.

It is for this reason that psychotherapy usually works on them from the habit reversal technique, a tool that allows introducing a behavior that prevents the appearance of the tic or unwanted habit. Let's see what this technique consists of.

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What is the habit reversal technique?

The habit reversal technique is a type of behavioral therapy that It has been shown to be very effective in extinguishing repetitive behaviors, harmful habits and tics..

This technique was originally developed by N. H Azrin and R. G. Nunn, and is often used in those who perform actions that are problematic both for your physical and mental health, in addition to involving a high degree of interference in your life Social. Among these problem behaviors we can find all kinds of tics, hair pulling (trichotillomania), nail biting (onychophagia) or pinching the skin. The therapy is appropriate for any age group and socioeconomic background.

It is a procedure that consists of five phases that add up to a total of eleven techniques, in accordance with the proposal made by Azrin and Nunn in 1973.

1. Awareness

In this phase, that the person becomes aware of the stimuli and situations that can promote the appearance of a harmful tic, an unwanted habit or a pattern of behavior that causes some kind of harm to him and others.

It is here that a detailed description of the behavior to be extinguished is made, and training is promoted that makes the person take a voluntary solution of the problem.

In addition, the person is trained to become aware of when the tic is being performed, and to know how to detect the antecedents that promote its appearance.

2. Relaxation training

Habits or tics can be common when the person is in a period of high stress.

It is for this reason that it can be very useful for you to learn skills that help you relax, such as be deep breathing, the imagination of pleasant places, mindfulness or techniques such as yoga and meditation.

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3. Training in making a response incompatible with the habit

In this phase the person is made to develop a non-harmful behavior that prevents the appearance of the habit that you want to extinguish.

To do this, the new behavior must meet the following characteristics:

• That prevents the tic / habit from appearing.
• Let it last for several minutes.
• That increases awareness of problem behavior.
• Be socially acceptable.
• Be compatible with normal activity
• That promotes the antagonistic muscles of the unwanted tic / habit behavior.

4. Motivation

This phase is addressed to both the patient and his close circle, usually his family.

In it, a review of the inconveniences that the tic or habit-problem supposes, in addition to social support, making one or more people in your environment get involved and help in the success of the therapy.

5. Generalization training

It involves performing exercises in which the patient must imagine performing the technique in dangerous situations identified in the first phase.

Disorders in which it is used

The habit reversal technique It is usually used in any disorder in which there are tics. It should be understood that a tic is a series of movements, more or less involuntary and repetitive, or inappropriate vocalizations that are not typical behaviors for the contexts in which they are occurring.

Tic disorders represent a group of interrelated disorders, including Tourette syndrome, Obsessive-Compulsive Disorder and other anxiety disorders, such as generalized anxiety, social phobia, and post-traumatic stress disorder.

However, this therapy is especially useful in trichotillomania and onychophagia, behaviors that, although depending on the degree to which they occur can be considered more or less serious, are, in essence, tics. This technique has been shown to be effective in avoiding these behaviors, which involve highly variable degrees of damage in the life of the person.

Use in trichotillomania

The trichotillomania It is a disorder in which the person suffers from a chronic compulsion to pull out their hair, which implies the loss, in a notorious way, of hair, in addition to stress and social problems. In this behavioral disorder not only is the hair pulled out, but also a ritual is usually performed with the hair pulled out, such as eating the root, feeling it with the lips, or pulling out other hair that "meets the desired characteristics."

Although it may seem a rare and somewhat rare problem, the truth is that it is one of the most common pathological behaviors, with a prevalence between 0.6% and 2.5% of the population general. It is especially high in high-stress groups such as people with psychopathology, college students, or very neurotic people.

This is why the habit reversal technique is often used with people who manifest these types of tics. In this particular case, The patient is made to see why he chooses to pull out his hair, relate how stressful situations occur and what makes him choose this behavior and not for a healthier one, such as chewing gum or trying to relax. It is about incorporating a behavior that prevents the person from pulling their hair.

Use in addictions

This technique is also used in situations where there is substance dependenceAs is the case with addictions, since the patient, aware that he has a problem and must overcome it, consciously tries to stop using. However, there are certain behaviors that he finds difficult to overcome, either because he believes they are unrelated with your problem or because you have them so automated that there is no way on your part to extinguish them.

Among these behaviors we could find, for example, lighting a cigarette in the same way that he did with a "joint", entering the The same bars where he got drunk, although now he only has breakfast, maintains relationships with those people who introduced him to the addiction...

These problems are usually the object of intervention in addiction treatments, but are often not taken into account in their due consideration, thus A number of factors are being overlooked or underestimated that can make the person fail in their fight against substance use.

That is why the habit reversal technique may prove useful in the therapeutic approach to these behavior patterns that induce a relapse into addiction. Although, as we said before, it is focused more on chronic tics, it can also be useful when it comes to extinguishing those behaviors that predispose to use again.

Habits are incorporated that prevent the person from consuming, such as drinking a glass of water when they feel like drinking or smoking, making them play an instrument, chewing gum ...

Bibliographic references:

• Azrin, N. H. and Nunn, R. G. (1973). Habit-reversal: a method of eliminating nervous habits and tics. Behavior research and therapy, 11 (4), pp. 619-628.
• Carr, J. AND. and Chong, I. M. (2005). Habit reversal treatment of tic disorders: a methodological critique of the literature. Behavior Modification, 29 (6), pp. 858-875.
• Piacentini, J. and Chang, S. (2005). Habit reversal training for tic disorders in children and adolescents. Behavior Modification, 29 (6), pp. 803-822.
• Ruiz, M. A., Díaz, M. I. and Villalobos, A. (2012). Manual of cognitive behavioral intervention techniques. Bilbao: Desclée de Brouwer.