Ending habit behaviors and tics

There is a very effective way to end habits and tics without medication. It is called Habit Reversal Therapy or HRT for short. The basic idea is that habits and tics occur unconsciously. And they occur as an outlet for nervous energy. HRT helps make the person aware of the behavior and then teaches a competing response. Learning HRT may take up anywhere from 10-20 sessions. Awareness and understanding of the tic or habit is key to success. Here is a description of the major components of HRT and how they work.

• Awareness:
• Describe the tic or habit in detail. Use a mirror or videotape.
• Learn what behavior cues (comes before) the tic or habit.
• Use self-monitoring. Child keeps a log of every time the behavior happens and where it happens. At first start off with just 30 minutes a day. Then build up to longer stretches until a whole day can be charted. See when and where it happens most often.
• Have parents stop comments and negative reactions.
• Competing Response (CR)
• Substitute the tic or habit with a different action - this is called a competing response (CR). The CR should be done as soon as the urge or cue appears.
• The CR usually (but not necessarily) uses the same muscle group. For example, if the tic is a shoulder shrug, then the CR could be lengthening and relaxing shoulder muscle. Or if the habit is nail biting, then the CR could be to chew gum or squeeze a rubber ball.
• CR should last 1-3 minutes.
• Teach relaxation techniques. These include deep breathing and imagery.
• Generalization
• Practice the CR with the therapist until it can be done correctly.
• Practice in front of a mirror.
• Imagine situations where they will do CR in place of the habit or tic.
• Practice the CR in different places.
• Reinforcement
• Parent praises child for doing CR.
• Show other people that you can do it and enjoy their positive reactions.