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 for people with unwanted repetitive behaviours or habits.
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:
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
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.
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.
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.
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:
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 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.
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 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 (hair-pulling disorder) involves repetitive hair pulling that can cause significant distress and impairment in functioning. Both children and adults suffer from the disorder.
Stuttering, also known as stammering, is a speech disorder in which the flow of speech is disrupted by involuntary repetitions and prolongations of sounds, syllables, words or phrases as well as involuntary silent pauses or blocks in which the person who stutters is unable to produce sounds.
Some of the other habits that can be very successfully treated with Habit Reversal Therapy are
Vocal Tics such as clearing the throat