Habit reversal technique: what is it and how is it used?

This technique is used in the treatment of disorders related to impulse control.

The tics can be behaviors that, although simple, can imply a significant degree of discomfort in the person who manifests them.

It is for this reason that in psychotherapy one usually works on them from the technique of habit reversala tool that allows the introduction of a behavior that prevents the appearance of the tic or unwanted habit. Let us see what this technique consists of.

What is the habit reversal technique?

The technique of the reversion of the habit is a type of behavioral therapy that has been shown to be very effective in the extinction of repetitive behaviors, disruptive habits and tics..

This technique was originally developed by N. H. Azrin and R. G. Nunn, and is often used in those people who perform actions that are problematic for both their physical and mental health, as well as involving a high degree of interference in their social life. Among these problematic behaviors we can find all kinds of tics, hair pulling (trichotillomania), nail biting (onychophagia) or skin picking. The therapy is appropriate for any age group and socioeconomic background.

It is a five-phase procedure consisting of a total of eleven techniques, as proposed by Azrin and Nunn in 1973.

1. Awareness raising

In this phase the person becomes aware of the stimuli and situations that may encourage the appearance of a harmful tic, an undesired habit or an unwanted habit.an unwanted habit or a pattern of behavior that may cause some kind of harm to him/her and to others.

It is here that a detailed description of the behavior to be extinguished is made, and a training that makes the person take a voluntary solution to the problem is encouraged.

In addition, the person is trained to become aware of when he/she is performing the tic, and to know how to detect the antecedents that encourage its appearance.

2. Training in relaxation

The habits or tics can be common when the person is in a period of high stress..

It is for this reason that it can be very useful to learn skills that contribute to relax, such as deep breathing, imagination of pleasant places, mindfulness or techniques such as yoga and meditation.

3. Training in making a response that is incompatible with the habit.

In this phase the person is made to develop a non-detrimental behavior that prevents the appearance of the habit to be extinguished. that is to be extinguished.

For this, the new behavior must have the following characteristics:

• That it prevents the appearance of the tic/habit.
• That it lasts for several minutes.
• It should increase the awareness of the problem behavior.
• Be socially acceptable.
• Compatible with normal activity.
• That promotes the antagonistic muscles of the undesired tic/habit behavior.

4. Motivation

This phase is addressed both to the patient and to his close circle, usually his family..

In this phase, a review of the drawbacks of the tic or habit-problem is made, in addition to encouraging social support, getting one or more people from the patient's environment involved and helping in the success of the therapy.

5. Generalization training

It involves the realization of exercises in which the patient you should imagine yourself performing the technique in dangerous situations identified in the first stage.

Disorders in which it is used

The technique of the reversion of the habit is usually used in all disorder in which there are tics. It should be understood that a tic is a series of movements, more or less involuntary and repetitive, or inappropriate vocalizations that are not typical behaviors for the contexts in which they are taking place.

Tic disorders represent a group of interrelated disorders, including Tourette's syndrome, Obsessive-Compulsive Disorder and other anxiety disorders, such as generalized anxiety, social phobia and post-traumatic stress disorder.

However, this therapy is especially useful in trichotillomania and onychophagia, behaviors that, although depending on the degree in which they occur can be considered more or less serious, are, in essence, tics. This technique has been shown to be effective in avoiding these behaviors, which involve varying degrees of damage to the person's life.

Use in trichotillomania

Trichotillomania is a disorder in which the person suffers a chronic compulsion to pull out his hair, which involves the loss, in a notorious way, of hair, in addition to stress and social problems. In this behavioral disorder not only hair is pulled out, but also a ritual is usually performed with the pulled out hair, such as eating the root, eating the hair roots, etc.The hair is not only pulled out, but also a ritual is often performed with the pulled out hair, such as eating the root, touching it with the lips, or pulling out another hair that "meets the desired characteristics".

Although it may seem an infrequent and somewhat rare problem, the truth is that it is one of the most common pathological behaviors, with a prevalence of between 0.6% and 2.5% of the general population. It is especially high in high-stress groups such as people with psychopathology, college students or very neurotic people.

This is why the habit reversal technique is often used with people who manifest these types of tics. In this particular case, the patient is made to see why he chooses to pull out the hair, to relate how the situations of stress are given and what causes that it chooses this conduct and not for a healthier one, such as chewing gum or trying to relax. The idea is to incorporate a behavior that prevents the person from pulling out his or her hair.

Use in addictions

This technique is also used in situations where there is substance dependence, as in the case of addictions.This is the case of addictions, since the patient, aware that he/she has a problem and must overcome it, consciously tries to stop consuming. However, there are certain behaviors that are difficult for him to overcome, either because he believes that they are not related to his problems or because he has them so automated that there is no way for him to extinguish them.

Among these behaviors we could find, for example, lighting up a cigarette in the same way as he did with a joint, going into the same bars where he used to get drunk, although now only for breakfast, maintaining relationships with those people who introduced him to addiction...

These problems are usually the object of intervention in addiction treatments, but often they are not taken into account in their due consideration, so that they are ignored or underestimated. a series of factors that can cause the person to fail in his or her struggle against substance use are being ignored or underestimated..

This is why the habit reversal technique can be useful in the therapeutic approach to these patterns of behavior that lead to relapse into addiction. Although, as we said before, it is focused more on chronic tics, it can also be useful when it comes to extinguishing those behaviors that predispose to return to consumption.

Habits are incorporated that prevent the person from consuming, such as drinking a glass of water when he/she feels like drinking or smoking, playing an instrument, chewing gum...