Is habit reversal therapy right for you?

We all have unconscious habits. For example, we might bite our nails, pick at our skin, play with our hair, or fidget when we’re nervous. For some people, these habits can become more disruptive to their day-to-day lives. For example, they may have sudden, uncontrolled movements that may be paired with verbal outbursts. In this case, they might have tics or be diagnosed with Tourette syndrome.

Habit reversal training (HRT) is a behavioral therapy method originally created to help people manage tics. Today, it’s used to help people change a wide range of unwanted habits, from hair pulling to social smoking. Here’s how it works, and how it might be able to help you.

How habit reversal therapy works

Put simply, habit reversal training works by helping you become more aware of destructive or undesirable habits and replace them with healthier behaviors. 

We don’t usually think about many of our “bad” habits before we do them. Habit reversal training can help you slow down, notice the warning signs that you’re about to engage in a nervous habit, and stop yourself or do something else instead.

HRT isn’t a comprehensive talk therapy technique the way cognitive behavioral therapy (CBT) or dialectical behavior therapy (DBT) are. While CBT addresses thought patterns and DBT focuses on managing emotions, HRT trains you to replace unwanted habits.

The typical time frame for HRT is around 8 to 12 weeks. During this time frame, you’ll typically move through three different stages: awareness training, competing response training, and intensive training.

Awareness training

The first stage, awareness training, is simply about making you more aware of when you engage in undesirable habits. Instead of doing them unconsciously, your therapist might guide you to notice warning signs. For example, you might notice that your face feels itchy before you start picking at your skin. You might also identify triggering situations — for example, noticing that you smoke socially when you drink.

In this stage, the most important thing is to notice the behavior and its triggers, not necessarily to stop it or change it. Your therapist may praise you every time you notice that you’re doing the behavior, even if you can’t stop yourself from doing it anyway.

Competing response training

This is where you actually get to work on cutting down or replacing your habits. You and your therapist can work together to identify new behaviors that you want to do instead. 

These should be healthier or less destructive than the habits that you’re trying to change. They should also physically prevent you from engaging in behavior you’re trying to change. 

For example, you might play with a fidget toy every time you get the urge to pull your hair out. After all, you can’t use your hands to pull out your hair if they’re busy playing with the toy. Or, if you experience vocal tics as part of Tourette syndrome or tic disorder, you could quietly hum a song instead.

In this stage, you’ve already learned to notice when habits are coming on. Now, your therapist will guide you to replace the habits with the replacement behaviors you’ve chosen together. You’ll practice during sessions, but it’s also important to practice by yourself when you leave your therapist’s office.

Intensive training

The final stage of HRT is intensive training — also called motivation and compliance or contingency management. It’s focused on helping you find ways to continue replacing your habits even when you’re no longer working with your therapist. This stage may involve telling loved ones in your life how to notice your triggers and early warning signs and help you replace your behaviors.

Relaxation and generalization training

Other key components of HRT include relaxation and generalization training. 

Relaxation training helps you learn techniques to help you deal with the anxiety that might come up when you’re no longer able to engage in habits that may have felt comforting to you (like sucking your thumb, for example). Relaxation may also help you reduce stress levels overall so you’re less likely to engage in these habits to begin with.

Generalization training is about applying and practicing replacement behaviors in different scenarios in your life. For example, after you’ve mastered replacing your habits when you’re at home, you can practice replacing them when you’re out with friends.

The care you need, when you need it

Learn how Rula can support your mental health journey

Subscribe

I agree to receive emails from Rula and accept the terms outlined in Client Email Consent and Privacy Policy.

What habit reversal therapy treats

HRT can be used for a wide range of undesirable or self-destructive habits. It was originally created to help people who had tics, which are automatic repetitive habits that can range from subtle nose twitching to saying certain words or phrases out loud. HRT has been found to be very effective for tics. One review determined that it can reduce tic severity by up to 37%.

Today, HRT has the most research support for trichotillomania, which is a mental health condition that causes you to repeatedly pull out your hair from your face or body, including your eyelashes and eyebrows. Research has shown that HRT is the most effective treatment method for trichotillomania.

HRT can also be included as part of treatment in mental health conditions like:

• Dermatillomania (skin-picking disorder)
• Tic disorder
• Tourette syndrome
• Obsessive-compulsive disorder (OCD)

However, it’s important to understand that HRT isn’t a comprehensive talk therapy method. So, while it can help with some aspects of these mental health conditions, it’s likely not enough to completely treat them on its own. 

For example, if you live with OCD, you’ll likely need a combination of different treatments, including psychotherapy and medication, to find relief. But HRT could help you become more mindful of OCD-related repetitive behaviors.

On top of being used as a mental health treatment, HRT can also help people break certain habits — especially body-focused habits — even if they’re not related to a mental health condition. For example, HRT can help with behaviors and habits like:

• Biting your nails
• Clearing your throat too much
• Social smoking
• Biting or scratching your skin
• Picking your nose
• Touching your face
• Sucking your thumb

HRT can be effectively used with both children and adults.

Practicing habit reversal training at home

Once you learn the steps involved with HRT for your situation and habits, you can continue practicing it at home. In fact, practicing outside of therapy sessions is an important component of making HRT work for you.

It’s best to learn the techniques of habit reversal training from a qualified health provider. They have the knowledge and expertise about mental health conditions that might be contributing to your habits and can help set you up with a more comprehensive treatment plan.

But there are also some online tools, courses, and books that can help you learn HRT on your own — which could be enough if you’re trying to change minor habits like touching your face when you’re sick. Research has also found that self-guided HRT can be effective in reducing problematic skin picking and other body-focused repetitive behaviors. 

Getting started with habit reversal therapy

If you have habits you want to break — especially body-focused repetitive behaviors like skin picking or hair-pulling — you may be a good candidate for habit reversal training. You don’t need to have a diagnosable mental health condition to benefit.

To get started, contact a mental health professional. It may be a good idea to look for a therapist who specializes in breaking habits. If you live with trichotillomania or dermatillomania, there are therapists who have expertise in treating these conditions as well.

If you engage in habits that are part of a larger mental health condition — like OCD compulsions — it’s best to see a mental health provider for support before committing to HRT. They can recommend a comprehensive treatment plan that may include HRT but will likely also include talk therapy and medication.

Find care with Rula

Anyone who has a habit they want to change can benefit from both therapy and HRT, whether or not you have a diagnosable mental health condition. Behavioral therapy methods like HRT can help you with tics and other disruptive or undesirable habits. If these habits are part of a larger mental health condition like OCD or Tourette syndrome, a mental health professional can recommend a more comprehensive treatment plan that can address every facet of your experience. 

At Rula, we’re committed to delivering a comprehensive behavioral health experience that helps people feel seen and understood so they can get back to feeling their best. 

Rula makes it easier to find a licensed therapist or psychiatric provider who accepts your insurance so you don’t have to choose between affordable care and excellent care. With a diverse network of more than 10,000 providers, 24/7 crisis support, and appointments available as soon as tomorrow, we’re here to help you make progress — wherever you are on your mental health journey.

Find a therapist with Rula