Habit Reversal Training

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KEY POINTS

• Habit reversal training is a way to help children deal with unhealthy habits such as hair pulling, nail biting, or thumbsucking.
• The first step is to help your child become aware of how your child’s body moves and what muscles are being used when your child does the habit.
• The next step is to find a new action that your child can do instead of the habit, such as squeezing a squishy ball. Praise your child when he or she uses the competing response instead of the old habit.

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What is habit reversal training?

Habit reversal training is a way to help children deal with unhealthy habits. It is based on the theory that children are often not aware of habits they have to relieve urges or feelings. For example, your child may have a habit of pulling his or her hair when feeling stressed. Training helps your child become aware of what he or she is doing and learn how to do something else instead.

When is it used?

This method can be used to help with habits such as hair pulling, nail biting, or thumbsucking. Habit reversal training is an important part of Comprehensive Behavioral Intervention for Tics (CBIT) therapy.

How is it done?

Help your child become aware of the habit.

• Have your child look in a mirror while doing the habit on purpose. Do this every day. Help your child become aware of how his or her body moves and what muscles are being used when your child does the habit.
• Teach your child to raise his or her hand or say, "That was one," each time your child notices having done the habit. If you see your child doing the habit and not noticing signal your child with a gesture or word that you have both agreed to use.
• Don’t let your child get frustrated. Help your child stay positive so that your child feels as if he or she can change the habit.
• Keep track of how often the habit happens. This way you and your child can tell when your child is making progress toward stopping the habit.

Practice a competing response.

• A competing response is something your child can do instead of the habit. The muscles used to do the new action should make it impossible to do the old habit. For example, instead of an eye blink tic, your child could gently close the eyelids and hold them closed for 10 seconds.
• Have your child practice the competing response in the mirror. This helps with getting used to it.
• Encourage your child to use the competing response whenever your child feels the urge to start the habit and for 1 minute after each time your child does the habit. If you know your child will be in a setting where he or she might do the habit, have your child practice the competing response ahead of time.
• Praise your child or give a small reward when your child uses the competing response and when you notice the old habit is starting to go away. Many children and teens will notice a decrease in the habit within a couple of days. However, the greatest change from habit reversal training takes place after 2 or 3 months. Don't give up after only a couple of days or weeks.
• Many habits are more common when your child is tense or under stress. The use of relaxation techniques or biofeedback may help your child deal with stress. Relaxation skills include:
• Deep breathing: Focus on taking slow deep breaths.
• Mental imaging: Picture a calm place and let the muscles relax
• Mindfulness: Focus only on the present moment, without judging, and don’t think about the past or future
• Progressive muscle relaxation: Tense and relax the body, one muscle group at a time

Help your child find other ways to relax. For example, your child might be able to relax by taking up a hobby, listening to music, watching movies, or taking walks.

Habits such as tics or hair pulling that don’t go away with habit reversal training can greatly affect daily activities. Your child may need to be treated with medicine or therapy. Talk with your child's healthcare provider about this.