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Habit Reversals 


As a Cognitive Behavioural Hypnotherapist, I work with children, young people and adults who have identified that they have habits they would like to change. I use Habit Reversal Therapy (HRT) to achieve results for my clients. 

Habit reversal therapy (HRT) is an evidence-based highly effective behavioural therapy that is commonly used d in the treatment of Body Focused Repetitive Behaviours (BFRBs).

The American Psychiatric Association publishes the Diagnostic and Statistical Manual of Mental Disorders (DSM), offering clinicians official criteria for diagnosing mental health conditions. BFRBs (Body-Focused Repetitive Behaviours) are categorised under 'Obsessive-Compulsive and Related Disorders' in DSM-5.


Although there are shared compulsive and ritualistic features between Obsessive-Compulsive Disorder (OCD) and Body-Focused Repetitive Behaviours (BFRBs), distinctions exist. OCD is primarily driven by unwelcome intrusive thoughts, leading to compulsive actions aimed at preventing negative outcomes. In contrast, BFRBs are typically performed to alleviate tension, stress, or out of habit, rather than in response to intrusive thoughts.


However, it is indisputable that BFRBs can be just as distressing for individuals suffering from them, significantly impacting their social lives. These behaviours transcend mere habits or tics; they represent intricate disorders compelling individuals to repetitively touch their hair and body, causing distress. Similar to OCD, BFRBs profoundly affect a person's ability to function, and in some instances, they may result in physical damage.


HRT works on behaviours such as: tics, hair pulling, nail biting, and skin picking to name a few, and is appropriate for people at any age. Often we don’t really understand what is driving our behaviors (like relief from urges or feelings) until we look for them with the help of a professional.

Habit Reversal Training is made up of five parts:

  1. Awareness training: brings attention to the behaviour so the person can gain better self-control and awareness. In this stage you will work to notice when you are performing the behaviour, identify the earliest warning that a behavior is about to take place, and identify the situations where the behaviour occurs

  2. Competing response training: you will work with your therapist to come up with a different behaviour to replace the old unwanted behaviour and practice performing this new behaviour.

  3. Motivation and compliance: you may make a list of all the problems that were caused by the behavior to remind you of the importance of sticking with it. Parents and friends may be asked to offer praise and encouragement for the person’s progress, support of family and friends can increase your chances of kicking an unwanted behavior.

  4. Relaxation training: habits or tics can be common when a person is under stress, it can be helpful to learn relaxation skills such as deep breathing, mental imaging, mindfulness, and progressive muscle relaxation to keep urges at bay.

  5. Generalisation training: you will practice your new skills in a number of different situations so the new behavior becomes automatic.

For people with hair pulling, skin picking, and nail biting, these behaviors have become automatic - and repeated - responses to triggers. These behaviors do serve a purpose, as coping/soothing mechanisms, but they don't serve us well! When we engage in these behaviors our brain does feel a momentary sense of relief, like a reward, which makes the brain want to do it again. And so we enter The Habit Loop: 

Habit Reversal Training (HRT) is a way of breaking "The Habit Loop" and undoing these habits, or behaviors. 

HRT shows high efficacy rates in reducing Body-Focused Repetitive Behaviour (BFRB)

The above examples illustrate what it is like for those who struggle with Body-Focused Repetitive Behaviors. Some common BFRBs are:

  • Hair pulling

  • Nail biting

  • Skin picking

Body-focused repetitive behaviors are compulsive, repetitive behaviors directed toward one's body that ultimately alters one's physical appearance (i.e. thinning hair, bald spots, scabs, missing eyelashes, chewed nails), and may lead to loss of self-esteem, shame, and even social alienation. Despite this, stopping or reducing these behaviors can be very challenging.

Clients who have had difficulties resisting the urge to bite their nails increased their nail lengths by 22 percent after using HRT.

  • Tics 

Tics are involuntary raid recurrent non-rhythmic movements or sounds. Tics that produce movements are called “motor tics” and those that produce sound are called “vocal tics”.  Tics are sudden and purposeless. Tics are categorised into 2 sections - simple and complex.

Simple Tics include eye blinking, lip pouting, head turning, head turning, clearing throat, coughing, sniffing, hissing, grunting.

Complex Tics include Hopping, Clapping, Squatting, touching objets, kissing, repeating words and phrases, unusual rhythms, tine and volume, mimicking accents.

Although Stress does not cause tics, it can exacerbate tics. 

  • Thumb Sucking

I use simplified habit reversal, a method which has been used to eliminate thumb sucking in developmentally typical children, and includes training the child to recognize when thumb sucking occurs, and to engage in a competing behaviour when thumb sucking is detected.

  • Nail Biting
Nail-biting is a common and frustrating habit for many children, teens and parents. Roughly half of all children bite their nails.  
A Study carried out in 2016. 
Used the habit reversal procedure to reduce the nail-biting behaviour of 13 11-38 yr old Ss. The procedure was immediately effective in eliminating nail-biting, generally requiring only 1 counseling session of about 2 hrs duration. Results lasted for all clients who followed the prescribed instructions throughout a 16-wk follow-up. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
  • Trichotillomania
Trichotillomania is indeed a body-focused repetitive behaviour (BFRB) disorder characterised by the urge to pull out one's own hair, leading to noticeable hair loss. This behavior can occur in various areas of the body, including the scalp, eyebrows, eyelashes, and other body regions. It's considered an impulse control disorder and is often classified under obsessive-compulsive and related disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Trichotillomania can vary in severity, and the reasons behind the behaviour can be complex, involving a combination of genetic, environmental, and psychological factors. Individuals with trichotillomania may experience tension or anxiety before pulling out their hair and a sense of relief or gratification afterward. However, they may also feel distress or shame about their inability to control the behaviour.
Treatment approaches for trichotillomania include cognitive-behavioral therapy (CBT), habit reversal training, and medication. CBT aims to identify and modify the thoughts and behaviours associated with hair pulling, while habit reversal training teaches individuals alternative behaviours to replace the hair-pulling action. 
It's important for individuals experiencing trichotillomania to seek professional help if the behaviour is causing significant distress or impairment in their daily lives.
Skin Picking 
Skin picking disorder, medically referred to as excoriation disorder, is characterised by repetitive and compulsive picking of one's own skin. This behavior goes beyond occasional picking, leading to significant tissue damage. Individuals affected by this disorder experience distress and may encounter difficulties in various aspects of life, including work, social interactions, and daily activities.
When skin picking results in tissue damage and interferes with daily life, it's important to seek professional help and support. This disorder is treatable, and seeking assistance can lead to effective strategies for managing and overcoming it.
Some of the other habits that can be very successfully treated with Habit Reversal Therapy are
  • Lip Biting
  • Knuckle Cracking
  • Snacking
  • Nose-Picking
  • Vocal Tics such as clearing the throat

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