Habit reversal training

The habit reversal training (HRT) of Azrin and Nunn (1973) is a cognitive-behavioral method for the treatment of a variety of nervous behavior habits.

It is assumed that these behavioral habits become problems when they are part of chains of behavior, some of which are unconscious and are socially tolerated. Through the constant repetitions, the behavior is maintained.

The HRT includes the learning of adequate self-perception and the interruption of chains of behavior through competing behaviors, building up the motivation for change as well as measures to generalize the progress in everyday life.

Practical approach

Description of the problem behavior

First of all, the patient should develop an adequate self-perception, since the execution of the behavioral habits is usually not paid attention to. The observation of one's own behavior serves both to determine the triggering and sustaining conditions and to sensitize the client to early signs of behavioral habits in order to be able to interrupt chains of behavior as early as possible. This can be done through direct behavioral observations, systematic logging (e.g. in the form of diaries) or video recordings. Patients should usually record the frequency, duration, and framework of the behavior.

Building motivation to change

In the second step, a motivation for change should be built up, since ambivalent attitudes or attempts to conceal problem behavior often occur. Most of all, it does this by discussing the negative effects of the behavior and providing frequent feedback and reinforcement of progress.

Competing Response Training

The central component of HRT is competing response training (dt. Training of incompatible reactions): This is where behavior patterns are practiced that are incompatible with the problem behavior. Which behaviors these are depends on the problem behavior and the social context. For example, when biting a nail, an incompatible or competitive behavior would be clenching your hands into a fist. Manfred Döpfner (2001) describes examples of incompatible reactions in different tics . These behaviors are only practiced in the therapy setting and should then be transferred to everyday life. Progress and problems are usually discussed daily, which can also be done over the phone. Frequent reinforcement of the desired behavior as well as the efforts and progress on the way is important.

Generalization training

Subsequently, the progress will be transferred to many different situations. This can be done by the therapist making the patient aware of the situations in which the problem behavior occurs more intensely and the patient practicing the application of the competing behaviors in the imagination and then transferring them to reality.

Variants of HRT, such as the self-help manual decoupling , also led to a significant reduction in symptoms in trichotillomania and nail biting in randomized controlled studies .

Areas of application and effectiveness

The areas of application of HRT include:

• Chewing finger nails
• Trichotillomania
• Thumb sucking
• Tics (nervous twitching of shoulders, head, etc.)
• Cracking fingers
• stutter
• Tourette syndrome
• Dermatillomania (Compulsive skin tingling, skin picking )

With regard to nail biting, Wilhelm & Margraf (1993) report on the effectiveness of habit reversal training. In the majority of patients, symptoms usually improve after just one or two sessions. Children and adults can be treated equally, and a shift in symptoms or the replacement of problem behavior with competing behavior was not observed. According to Woods & Miltenberger (1996), HRT was also effective in treating motor and language tics, stuttering and Tourette's syndrome.

literature

• NH Azrin, RG Nunn: Habit reversal: A method of eliminating nervous habits and tics. In: Behavior Research and Therapy. 11, 1973, pp. 619-628.
• J. Margraf, E. Wilhelm: Habit Reversal Training. In: J. Margraf (ed.): Textbook of behavior therapy. Volume 1, Springer, Berlin, ISBN 978-3-540-79540-7 , 2009, S, pp. 679-698.
• S. Moritz, S. Fricke and others: Do it yourself! Evaluation of self-habit reversal training versus decoupling in pathological skin picking: A pilot study. In: Journal of Obsessive-Compulsive and Related Disorders. 1, 2012, pp. 41-47.

Individual evidence

1. ↑ Manfred Döpfner : Tic disorders. In: Gerhard W. Lauth , Friedrich Linderkamp, ​​Silvia Schneider, Udo B. Brack : Behavioral therapy with children and adolescents . 2001, ISBN 3-621-27447-2 , p. 344.
2. ↑ Steffen Moritz, Michael Rufer: Movement decoupling: A self-help intervention for the treatment of trichotillomania . In: Journal of Behavior Therapy and Experimental Psychiatry . tape 42 , no. 1 , March 2011, p. 74–80 , doi : 10.1016 / j.jbtep.2010.07.001 ( elsevier.com [accessed January 5, 2020]).
3. ↑ Steffen Moritz, Andras Treszl, Michael Rufer: A Randomized Controlled Trial of a Novel Self-Help Technique for Impulse Control Disorders . In: Behavior Modification . tape 35 , no. 5 , June 2011, p. 468-485 , doi : 10.1177 / 0145445511409395 .
4. ^ F. Wilhelm, J. Margraf: Nails chewing: description, explanatory approaches and treatment. In: behavior therapy. 3, 1993, pp. 176-196.
5. ^ DW Woods, RG Miltenberger: A review of habit reversal with childhood habit disorders. In: Education and Treatment of Children. 19, 1996, pp. 197-214.