Habit reversal training

Domain II · Behavioural & cognitive · Azrin, Nunn · 1973

What it is

Habit reversal training (HRT) is a brief behavioural treatment for repetitive behaviours that run largely outside awareness: tics, hair pulling, skin picking, nail biting, cheek and lip biting, thumb sucking and (in the 1974 adaptation) stuttering. Azrin and Nunn first delivered it in a single…

Format

• HRT is a set of procedures rather than a fixed-length therapy. The original package had 9 to 13 procedures grouped into four components. Below are the three main delivered formats.
• Format: one session lasting one day (reported as about two hours), followed by telephone contacts; 12 volunteers aged 5 to 64. Exact follow-up schedule.

Who practises it, and how they are trained or regulated

• Components in order: (1) Awareness training: response description, response detection, early warning, situation awareness. (2) Competing response training: an incompatible, isometric response held for about three minutes on the urge or habit. (3) Motivation ("habit control motivation"): habit inconvenience (annoyance) review, social support, public display. (4) Generalization: symbolic rehearsal. Relaxation training…
• Components: awareness training, competing response, social support.
• Session outline as presented in a training deck based on the Woods & Twohig manual: 1 introduction, trigger review, homework, expectations; 2 stimulus control and HRT; 3 values; 4–5 barriers to treatment, then acceptance and mindfulness; 6–7 cognitive defusion; 8 practice plus urge surfing; 9 practice and review; 10 review and relapse prevention.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Defusion used to argue the thought away.
• Stopping CRs for earlier targets once a new one starts.
• Imagery that triggers the actual behaviour; shorten it.
• Breathing used as a hurried trick; aim for a calm pause.
• Mindfulness used to make urges go away; the aim is noticing.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.