Habit Reversal

Description of the Strategy

Azrin and Nunn developed habit reversal in 1973. The intervention includes four phases, including awareness, competing response, motivation, and generalization. The goal of the awareness phase is to increase the client's awareness of the target behavior, either a tic or habit. First, the client is instructed to describe the target behavior in detail. This is often done with the client looking in a mirror and reenacting the tic or habit. The client is then instructed to spontaneously acknowledge the target behavior when it occurs during the session. The therapist assists in identifying tics or habits that the client fails to acknowledge and teaches the client to become aware of the early signs or sensory preconditions of the target behavior. The therapist concludes the awareness phase by assisting the client in identifying situations in which the tic or habit occurs most frequently. Thus, the client describes all the situations, persons, and places in which the target behavior occurs. The client also describes how the behavior is enacted in each situation.

After the client has become fully aware of the manifestations of the target behavior, the competing response phase is initiated. The goal of the competing response phase is to teach the client to engage in a behavior that is incompatible with the target behavior. The competing response must (a) be the opposite of the target behavior, (b) be maintained for several minutes, (c) produce an isometric tensing of the muscles involved in the target behavior, (d) be socially inconspicuous and compatible with usual ongoing activities while still incompatible with the target behavior, and (e) strengthen the opposing muscles. The client and therapist mutually determine the appropriate competing response for each specific target behavior. The client is instructed to perform the competing response when the target behavior occurs or, ideally, at first awareness of the early signs of the tic or habit.

In the motivation phase, the client is encouraged to continue to implement the awareness and competing response phases. However, three motivation techniques are additionally employed: habit inconvenience review, social support procedure, and public display. In the habit inconvenience review, the client reviews all the problems, embarrassments, discomforts, and inconveniences that are caused by the target behavior. It is also important for the client and therapist to discuss the advantages of eliminating the target behavior. The social support procedure is presented after the client has displayed control of the target behavior in the therapy sessions. Family and friends are taught to praise the client for nonoccurrence of the target behavior and to remind the client to practice the competing response technique when they notice occurrences of the target behavior that are not recognized by the client. In the public display, the client is taught to demonstrate control of the target behavior in front of a friendly audience (e.g., family, friends).

The final phase of generalization training consists of symbolic rehearsal. Enhancing generalization of the results of the above procedures to all areas of the client's life is the goal of this phase. In symbolic rehearsal, the client is instructed to imagine one of the situations discussed during the situation awareness training technique. The client imagines detecting [Page 326]an early sign of the target behavior and consequently performs the competing response.

...