Habit Reversal Training

What is habit reversal training?

Habit reversal training (HRT) is a behavioral therapy that helps you eliminate unwanted behaviors (habits) by replacing them with other actions. Habits are repetitive behaviors that are often automatically reinforced and happen without you realizing it.

We all have certain habits. Some (like forgetting to close cabinet doors), while annoying, are harmless. Others (like skin picking) can interfere with your daily activities and even your health — physically and/or mentally. If you want help quitting a habit, HRT may be a useful tool for gaining back control of your behaviors.

Two psychologists developed the framework of HRT in the 1970s. Since then, several studies have shown its effectiveness in treating a variety of habits.

What is habit reversal training used for?

Habit reversal training can help treat several unwanted habits — mainly body-focused repetitive behaviors — in both children and adults. Examples include:

• Hair twirling.
• Nail biting.
• Nose picking.
• Social smoking.
• Thumb sucking.

HRT may also be a part of treatment to manage the symptoms and behaviors of the following conditions:

• Dermatillomania (skin picking).
• Tics and tic disorders, like Tourette syndrome.
• Trichotillomania (hair pulling).
• Stereotypic movement disorder.

If you want help to stop a habit or manage one of these conditions, consider reaching out to a mental health provider (like a psychologist) who has experience with habit reversal training.

How does habit reversal training work?

During habit reversal training, you’ll work with a mental health provider. In general, the steps of HRT include:

1. Awareness training.
2. Competing response training.
3. Intensive training (motivation and compliance).

Relaxation training and generalization training may also be parts of HRT.

Awareness training

Awareness training is the first step in HRT. It involves making you more aware of when you’re doing the unwanted behavior. Your therapist may break down awareness training into further steps:

• Response description: You and your therapist identify the repetitive behavior (habit) and explain it in detail to understand the specific movements associated with the action. For example, you may rub your lips before biting your nails.
• Response detection: You acknowledge each time you do the unwanted behavior. Your therapist will praise you for recognizing the behavior and will alert you if you do the behavior without realizing it.
• Early warning training: Once you become more accurate and comfortable with detecting the unwanted behavior, your therapist will help you point out the earliest signs of the behavior. This could be an urge to do the action or an initial movement, like bringing your hand to your mouth (to eventually bite your nails). You’ll also identify situations or emotional states that may make you more likely to do the unwanted habit.

Competing response training

Competing response training is the second step of HRT. It involves learning to do a behavior that physically prevents the completion of the habit.

The replacement behavior should:

• Make it difficult or impossible to do the unwanted behavior.
• Be possible to do for at least one minute.
• Be an otherwise “normal” behavior that blends in with ongoing activities.
• Be possible to do anywhere without the need of a particular object.

If you’re trying to replace nail biting, for example, you could:

• Clench your hands into a fist and hold them at your side.
• Fold your hands together.
• Sit on your hands (if already sitting).
• Fold your arms in front of you.

Once you decide on a competing behavior, your therapist will help you use it during your sessions.

Intensive training

The final phase of HRT is intensive training. Your therapist may also call this step “motivation and compliance.” This just means that you rely on social support, like family members and friends, to help you reinforce the competing behavior.

For example, a loved one may praise you when they notice you use the competing behavior. Or they may gently remind you to do the competing behavior if they see you doing the unwanted behavior.

Relaxation training

Habits that you’re trying to break tend to happen most often when you’re under stress. So, managing stress may help reduce the frequency of wanting to do the unwanted behavior. In relaxation training, your therapist will help you use various strategies to help minimize your stress level, like:

• Mindfulness.
• Meditation.
• Deep breathing.
• Guided imagery.
• Progressive muscle relaxation.
• Physical activity.
• Reading or writing.
• Listening to music.

Generalization training

This component of HRT simply involves practicing the competing behavior in various situations and environments. If you continue to do the competing behavior and get comfortable with it, it’ll eventually become automatic and replace the habit.

Does habit reversal training work?

Overall, several studies suggest that habit reversal training is an effective method for reducing a wide range of habitual behaviors.

But it’s important to note that it might not completely treat a more complex condition, like smoking in nicotine dependence or obsessive-compulsive disorder.

You may benefit from additional treatment options, like medication and other types of psychotherapy (talk therapy), for chronic (long-term) conditions. Together, you and your healthcare provider can develop a treatment plan that works best for you.

How long does it take for habit reversal training to work?

Habit reversal training doesn’t have a set timeframe. The number of sessions with a therapist you may need depends on the complexity of the habit and other factors. You’ll also have to continue the work outside of the sessions to replace the habit with another action. This “homework” is crucial to how well HRT can work for you.

For some, successfully quitting a habit with HRT may take a couple of months. For others, it may take a year or more. Many people with chronic (long-term) conditions that cause repetitive behaviors, like tic disorders or dermatillomania, may need “maintenance” therapy sessions throughout their life after initial HRT.

When should I see my healthcare provider?

If HRT isn’t working, reach out to your healthcare provider or a mental health provider. You may benefit from other therapies to manage unwanted behaviors. If your habit returns after completing HRT, reach out to your mental health provider. Follow-up HRT sessions may help get you back on track.