Article: Habit Reversal

Author: Edward Christophersen Ph.D.

Habit reversal training is a set of procedures that have been used very successfully with trichotillomania (hair pulling), nail biting, thumbsucking, chronic motor tics, and the tics associated with Tourette disorder. After your physician or psychologist has shown you the procedures in the office, use the following outline for your daily practice sessions at home.

Increase your child’s awareness of the habit

  1. Have your child look in a mirror while performing the habit on purpose every day. Help your child to become aware of how his body moves and what muscles are being used when he performs the habit.
  2. Have your child identify each time he starts his habit by raising his hand when the habit occurs or by saying, “that was one,” when the habit occurs. If you see your child doing the habit and your child does not notice, signal him with a gesture or expression that you both have agreed to use.
  3. Your child should record each occurrence of the habit on a 3×5 index card. Keeping track of how often the habit occurs is the only way that you and your child can tell when progress is being made.

Practice the competing responses daily

  1. A competing response is a action your child does in place of this habit. The muscles used to do the new action make it impossible to perform the old habit. For example, instead of doing an eye blink tic, the child would be encouraged to very gently close his eyelids and hold them down for 10 seconds.

Your child’s competing response is ____________________________.

  1. Have your child practice his competing response in the mirror. This helps become comfortable with the response and assures him that the competing response is not noticeable socially.
  2. Encourage your child to use the competing response when he feels the urge to start the habit.
  3. Encourage your child to use the competing response in situations where he is likely to start his habit.
  4. Encourage your child to use the competing response for 1 minute after each time he performs the habit.

Help your child

  1. Feedback: Work with your child to help him be aware of his habit by helping him identify the habit when it occurs.
  2. Support and Encouragement: Encourage your child to use the competing response and praise him when he does so. Praise your child when you notice the habit is starting to go away.
  3. Effort: Remember, although many children and adolescents will notice a decrease in their habit within a couple days, the greatest change from using these habit reversal procedures occurs during the second and third month. Don’t give up after only a couple of days or weeks.
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