Competing Response Training

Awareness Training

The goal of awareness training is for the client to become aware of each instance of the habit behavior as soon as it occurs and to become aware of the immediate antecedents to the habit behavior. In this way, the client can use the competing response contingent on the incipient occurrence of the behavior or its antecedents. To develop awareness of the habit behavior, the client first describes the behaviors involved in the habit and then practices detecting each instance of the behavior that occurs in the treatment session.

For motor or vocal tics, habit behaviors that are likely to occur numerous times in the session, the client identifies (verbally or by raising a finger) each instance of the tic that occurs in the session. The therapist praises the client for correctly identifying the tics and points out the occurrence of any tics that the client failed to detect. The therapist and client continue the process until the client can detect each tic as it occurs.

For nervous habits (e.g., hair pulling, nail biting, etc.) that typically would not occur in the presence of the therapist, the client simulates the behavior to enhance awareness. The client simulates situations in which the habit behavior is likely to occur (sitting in a chair watching television) and simulates the behavior exactly as it would occur in the natural setting. As the client simulates the habit behavior, the therapist tells the client to stop at various points in the behavioral movement. For example, if a client engages in hair pulling, the therapist might have the client stop as the hand is being raised up to the head, as the finger first touch the hair, as the fingers isolate a hair to pull, and so forth. By stopping the movements at various stages, the client becomes more aware of the occurrence of the behavior.

The final part of awareness training involves teaching the client to become aware of the sensations, behaviors, or environmental circumstances that precede the occurrence of the habit behavior. The client first describes the possible antecedents and then notes their occurrence as the habit behavior occurs in session. Alternatively, the client may simulate their occurrence in session. Increasing awareness of the antecedents helps the client detect the imminent occurrence of the habit behavior.

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