Habit Reversal

Procedures
Habit Reversal
Procedures
• Nervous Habits
• Motor Tics
• Stuttering
 Nervous Habits
• Involve repetitive, manipulative behaviors that are
believed to be most likely occur when the person
experiences heightened nervous tension
• Examples: nail-biting, twirling/ stroking hair, tapping
a pencil, chewing on a pen or pencil, jingling money
in a pocket, folding or ripping paper
 Nervous Habits-cont.
• Hair pulling
• Skin picking, scratching, or biting
• Nail and/or cuticle biting or picking
• Lip or cheek chewing/ biting
• Thumb/ finger sucking
• Nose picking
 Nervous Habits
• Nervous habit do not typically serve any social
function for the person – are not reinforced socially
• May serve as a self-stimulatory function
• Many nervous habit do not cause any problems for
the person unless the frequency/ intensity of the
behavior becomes extreme
• Body-focused repetitive behavior problems are
nervous habits that result in physical damage or
negative social evaluation
 Nervous Habits-cont.
• Focused (Compulsive)
• Serve as an emotional regulation function
• Maintained by a reduction in anxiety or tension

• Automatic (decreased awareness)

– Maybe reinforced in environmentally restricted
situations (situations without other things to do)
 Nervous Habit-cont.
• Can be a response to sensation, such as itching,
tingling pain, etc then draws the fingers to site of
picking, pulling, biting
• Can also occur without any sensation prior to
behavior
• “searching behavior”
• Find an irregularity on which to focus (thicker,
coarser hair; rough, bumpy, jagged skin)
• Do further with the activities
 Behavior Problems
Habit Behaviors Examples

Nervous habits Nail biting, hair pulling

Motor tics Head-jerking, facial grimacing

Stuttering Word repetition, prolongations

 Habit Reversal Procedures
• Multicomponent treatment habit revearsal
– The person is taught to describe the behaviors that are
involved in the habit
– The client learns to identify when the habit occurs or
when it is about to occur (awareness training)
– The client learns a competing response (a behavior
incompatible with the habit behavior) and practices the
competing response in session after each occurrence of
the habit
Habit Reversal Procedures
– The client imagines the situations in which he or she will
use the competing response outside the session to
inhibit the habit
– The client is instructed to use the competing response
outside the session whenever the habit occurs or is
about to occur (competing response training)
Habit Reversal Procedures
– Significant others (parents/spouse) are instructed to
prompt the client to use the competing response when
the habit occurs outside the session
– They are also to praise and give certain reinforcement
– These strategies are part of social support
Habit Reversal Procedures
– The therapist reviews with the client all the situations in
which the habit occurs and how the habit may have
caused inconvenience or embarrassment
– This motivation strategy will increase the likelihood
that the client will use the competing response outside
the treatment session to control the habit
 Applications of Habit
Reversal
• The main difference between habit reversal
procedures for different types of habit disorders is
the nature of competing response.
• A different competing response must be chosen
specifically for the particular habit that the client
exhibits
 Trichotillomania – Functional
Analysis
• Triggering cues (antecedents)
– Setting (where pulling takes place) – bedroom
– Equipments associated with pulling (e.g. mirrors,
tweezers)
– Visual/ tactile sensations (color/ textures of hair)
– Cognitive cues – “my hair has to be tidy”; “these gray
hairs have to go”
 Trichotillomania – Functional
Analysis
• Consequences
– pleasurable sensations
– Sense of accomplishment
– Social reinforcers
– Alleviation of stress or boredom
– Escape from undesirable thoughts
Awareness Training
• Aware of the realm of behavior:
– Preparatory stage
– The hair is removed
– Disposition of the hair

• assessing the time, situations, and

other issues associated with the
occurrence of the habit
 Examples of Competing
Responses
• Fist clenching/ arm locking
• Grasping steering wheel while driving
• Holding sides of book while reading
• Squeezing squishy ball
• Playing with clay, “play doh” or “silly putty”
• Sitting on hands
 Other supporting behaviors
• Wearing fingertip bandage
• Using scents on the wrist and fingers
• Hats, gloves, scarves
 Stuttering
• A type of speech dysfluency in which the person
repeats words or syllables , prolongs the sound
of a word or syllable, or blocks on a word
(makes no sound for a period of time while trying to
say a word)
• Stuttering may occur in young children as they are
first learning to use language, but continues in
adults in various degrees of severity.
 Stuttering
• Stuttering involves interrupted airflow through the
vocal cords that interferes with the production of
fluent speech
• The competing response in the habit reversal
procedure would involve relaxation and
uninterrupted airflow over the vocal cords during
speech
 Stuttering
• The competing response is called regulated breathing.
Client first taught to detect each instance of stuttering.
Once clients are aware of most occurrences of stuttering,
the therapist teaches the regulated breathing.
• The first component is a quick procedure called
diaphragmatic breathing. The client learns to breathe in a
rhythmic pattern using the muscles of the diaphragm to pull
air deep into the lungs.
• As the client is breathing smoothly and rhythmically, the
therapist instruct the client to say a word as he or she starts
to exhale
 Motor & Vocal Tics
• Motor tics are repetitive, jerking movements of a particular
muscle group in the body. They usually involve muscles in
the neck or face but may also involve in shoulders, arms,
legs, or torso
• Motor tics are believed to be associated with heightened
muscle tension; sometimes related to an injury or an
event that increases the tension in a particular muscle
group, but the tic movements continue to occur once the
original injury or event has passed.
 Motor & Vocal Tics
• A vocal tic is a repetitive vocal sound that does not
serve a social function. Examples: throat clearing when
there is no reason to clear the throat and coughing when
the person is not sick
• Tourette’s disorder is a tic disorder involving multiple
motor and vocal tics . It is currently believed to be caused
by a complex interaction of genetic and neurobiological
factors, as well as environmental events.
 Tics-Functional Analysis
• Social reaction
– Reaction from another person
• Escape from situation
– Change in demands on child
• Common stuations:
– Meal times
– TV time
– Homework
 Tics-Functional Analysis
• Common Antecedents:
– Demands from others
– Teasing; ridicules
– Anxiety/ Stress
• Common Consequences:
– Comforting attitude from significant others or other people around
them
– Attention- “stop doing that”
– Trouble/ anxiety of other people
– Teasing
– Leave table/ classroom/other situation
– Stop doing the activities (meal, homework, chores)
Tic Response Definition Competing Response
Head-shaking Any back-and-forth lateral movement Tensing the neck muscles while holding
of the head the chin down and in toward the neck
Rapid eye-blinking Any eye blink occuring less than 3 Opening eyes wide and blinking
seconds after the previous blink deliberately every 5 seconds while shifting
gaze about every 10 seconds
Facial tic Any outward movement of the lips Tightly pursing or pressing the lips
together
Facial tic Pulling back either or both corners of Clenching the jaw while pressing the lips
the mouth together with upward movement of the
cheek(s)
Head-jerking Any jerking downward motion of the As for head shaking
head
Shoulder-jerking Any jerking motion or either shoulder Pressing arms tightly against the sides of
or arm with the arm moving upward the body while pulling the shoulder
or toward the body downward
Competing Response

Hasil Diskusi Kelompok

Nervous Behavior Competing Responses
 Nervous Behavior
Menggoyang-goyangkan kaki
Mengelupas kulit bibir/ menggigit bibir
Menggigit kuku/ mengelupas kulit kuku/
melakukan hal-hal lain yang compulsive
dengan tangan
Mencabut rambut / twirling
Tics – menggoyangkan kepala
Latah (verbal)
Latah (perilaku)
Tics-mengedipkan/ rolling eyes
Competing Responses
Mengunci kaki pada kaki bangku atau
menduduki kaki yang terus bergerak
Mengatupkan mulut selama beberapa
detik
Meremas/ melipat tangan/ clenched fist /
menggunakan nail polish / cover nails
with antiseptic / Menggunakan gelang
yang berbunyi sebagai reminder/
menggunakan sarung tangan / melapisi
jari dengan hansaplast
Menguncir rambut
Menggunakan gibs selama beberapa
waktu untuk menghilangkan kebiasaan
Menutup mulut dengan tangan
Cross-armed
Memejamkan mata selama beberapa
detik