OCD Treatment Using Habit Reversal Training to Reduce Physical and Verbal Tics By Owen Kelly, PhD Owen Kelly, PhD Owen Kelly, PhD, is a clinical psychologist, professor, and author in Ontario, ON, who specializes in anxiety and mood disorders. Learn about our editorial process Updated on September 18, 2020 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Akeem Marsh, MD Medically reviewed by Akeem Marsh, MD LinkedIn Twitter Akeem Marsh, MD, is a board-certified child, adolescent, and adult psychiatrist who has dedicated his career to working with medically underserved communities. Learn about our Medical Review Board Print kristian sekulic / Getty Images Habit reversal training is a therapy that can be effective in treating troublesome behaviors caused by a number of conditions. One of these is Tourette's syndrome, which is characterized by physical or verbal tics, such as blinking, throat clearing, repeating obscenities. People dealing with symptoms of impulse control disorders, such as trichotillomania (hair-pulling) and pathological skin picking, also may benefit from habit reversal training, which is composed of these four main elements. What Is Awareness Training? Awareness training is used to bring greater attention to tics and other behaviors so that the affected person can gain better self-control. Awareness training is usually carried out in a number of smaller steps: While watching himself in a mirror, the person describes in detail each time he carries out behavior that's associated with his condition—pulling his hair, for instance, or rubbing his eyes.The therapist will point out to the person whenever he carries out the tic or impulse repeatedly until the person is able to notice the behavior for himself.The person learns to identify the earliest warning that a tic or impulsive behavior is about to take place. These warning signs can be urges, sensations, or thoughts.The person identifies all the situations during which the tic or impulsive behavior occurs. Development of a Competing Response Once the patient has developed a good awareness of his tic or impulsive behavior the next step is to develop a competing response—an action meant to replace the old tic or impulsive behavior. Usually, the competing response is opposite that of the tic or impulsive behavior and is something that can be carried out for longer than just a couple of minutes. For example, a competing response to hair-pulling might be to ball the hands into a fist and hold them rigidly alongside the body. Someone who repeatedly sticks out his tongue might purse his lips instead. Another goal of a competing response is that it is an action other people aren't likely to notice. Building Motivation To prevent tics and impulsive behaviors from coming back, people undergoing habit reversal training are encouraged to make a list of problems caused by their behavior. Parents and friends are also asked to praise the person for their accomplishments thus far. In addition, it can often be helpful for people to demonstrate their ability to suppress tics or impulsive behaviors to others. Generalization of New Skills In this phase of treatment, people are encouraged to practice their new skills in a variety of different contexts, not just those that they have mastered to date. Learning to turn off a tic in the relative safety of the doctor's office is one thing. More challenging is reaching a point at which it becomes easy to control impulsive behaviors where it really counts—in the real world: at home, work, school, and in other public places. 3 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Mcguire JF, Ung D, Selles RR, et al. Treating trichotillomania: a meta-analysis of treatment effects and moderators for behavior therapy and serotonin reuptake inhibitors. J Psychiatr Res. 2014;58:76-83. doi:10.1016/j.jpsychires.2014.07.015 Pile V, Lau JYF, Topor M, Hedderly T, Robinson S. Interoceptive accuracy in youth with tic disorders: Exploring links with premonitory urge, anxiety and quality of life. J Autism Dev Disord. 2018;48(10):3474-3482. doi:10.1007/s10803-018-3608-8 Nissen JB, Kaergaard M, Laursen L, Parner E, Thomsen PH. Combined habit reversal training and exposure response prevention in a group setting compared to individual training: a randomized controlled clinical trial. Eur Child Adolesc Psychiatry. 2019;28(1):57-68. doi:10.1007/s00787-018-1187-z By Owen Kelly, PhD Owen Kelly, PhD, is a clinical psychologist, professor, and author in Ontario, ON, who specializes in anxiety and mood disorders. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? 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