psyc 164

Habit Reversal Therapy

A. What are Habits?

Habits are repetitive behaviours that are not

functional to the individual except to

temporarily stimulate under-arousal (bored) or

to sedate over-arousal (anxiety, stress, fear).

There are three main types:

 Nervous Habits: repetitive

activities such as pulling or

playing with hair, biting nails,

bouncing leg/fingers/pens

repeatedly, cracking your knuckles, back or neck, picking at your skin, bite lips or inside

of cheeks, chew on pens/pencils, etc.

 Tics: Motor tics are repetitive contracting/relaxing of certain muscle groups (e.g.

clenching and unclenching jaw, making a fist then relaxing, forcefully blinking, etc.)

Vocal tics are repetitive sounds made without the intention of communication (e.g.

repetitive clearing of throat, humming, groaning, etc.)

 Stuttering: repeating first sound or sounds in a word, repeating words in a sentence.

*A quick word on stuttering: There are cases of stuttering that are severe and have an organic cause,

such as an underlying condition, damage to respiratory system, larynx or musculature of the throat and

mouth. Here we are referring to stuttering that occurs as a result of muscle tension that interferes with

fluid production of sound as a result of anxiety. For example, if you are nervous about making a

presentation in front of a group of people, you may find yourself stuttering. Or, if you have children,

you likely noticed that between 3 and 5, they naturally stuttered quite a bit as a result of having a brain

that had so much to communicate paired with a delivery system that couldn’t keep up.  These are

normal stages of development and most children grow out of this type of stuttering by ages 7 or 8. Here

we speak specifically to stuttering that occurs as a result of anxiety/stress/fear.

B. What is Habit Reversal Therapy?

Habit Reversal Therapy is a set of four skills that seek to make the individual aware of and to compete

with his/her habits, regardless of which type. Please watch the following video, which does an excellent

job of introducing and describing these skills in the context of nail-biting, and following the video I’ll

summarize and expand on some of the points:

https://www.youtube.com/watch?v=jzgT8_g7dVI

So, in summary, the four skills are:

1. Awareness training: Becoming aware of the antecedents (what is happening in the

environment just before the behaviour occurs – this includes the outside environment,

but also the internal environment including feelings and thoughts) and the

consequences of the behaviour (including how you feel afterwards) is important to the

ultimate success of this technique. If the habit is complex, make sure you define exactly

what the behaviour looks like. Using a journal to note time, date, and the ABCs of each

instance will further give you information about frequency and triggers. If you have

difficulty becoming aware of when you’re engaging, enlist the help of someone who is

close to you and can give you an indication that it’s happening.

2. Competing Response Training: briefly engage in a behaviour that is incompatible with

your habit (e.g. chew gum if you bite on your cheek or lip, put your hand in your pocket

if you crack your knuckles or nail-bite, put your pen on the desk if you normally tap it,

breathe through your mouth for a minute or two if you are stuttering or engaged in a

vocal tic – having musculature make a quiet “ah” sound further relaxes the musculature,

stretch eye muscles by raising eyebrows if you forcefully blink, etc.) The idea is not to

replace one habit with another, but to briefly interrupt the habit by engaging in an

incompatible response. This brings awareness to the habit and by disrupting the cycle,

it acts as a mild form of punishment. The incompatible response, then, should only

occur for about 30 seconds to a minute each time.

3. Social Support: involving people who are around you a lot and who can be a supportive

presence not only helps you become more aware when you’re engaging in the habit,

but also to reinforce you when you engage in competing response training. Both of

these increase the chances you’ll be successful.

4. Involve motivational tactics: You can offer yourself incentives for decreasing habit

behaviours, such as a manicure for not biting nails, etc. or look up the aversive

consequences of engaging in a particular behaviour, as the young woman did on the

video.