Applying Behavior Analysis to Clinical Problems: Review and Analysis of Habit Reversal

Abstract

This article provides a review and analysis of habit reversal, a multicomponent procedure developed by Nunn (1973, 1974) for the treatment of nervous habits, tics, and stuttering. The article starts with a discussion of the behaviors treated with habit reversal, behavioral covariation among habits, and functional analysis and assessment of habits. Research on habit reversal and simplified versions of the procedure is then described. Next the article discusses the limitations of habit reversal and the evidence for its generality. The article concludes with an analysis of the behavioral processes involved in habit reversal and suggestions for future research.DESCRIPTORS: habit reversal, habit disorders, tics, nervous habits, covariation, functional analysis, awareness training, competing response training, social supportThe early 1970s saw the development and evaluation of a number of new behavioral technologies. Azrin and colleagues were responsible for many applications of these behavioral procedures to treat clinical problems such as nervous habits (Azrin & Nunn, 1973), tics (Azrin, Nunn, & Frantz, 1980b), stuttering (Azrin & Nunn, 1974), alcohol abuse (Hunt & Azrin, 1973), enuresis (Azrin & Foxx, 1971), and aggressive and disruptive behaviors (Foxx & Azrin, 1972). Habit reversal, a procedure used to treat nervous habits, tics, and stuttering, was one of the successful treatments developed and evaluated in this era. Like many behavioral interventions at that time, habit reversal was a treatment package consisting of numerous individual treatment components implemented together to achieve maximum reductions in the targeted problem (Azrin & Address all correspondence to Raymond G. Miltenberger, Department of Psychology, North Dakota State University, Fargo, North Dakota 58105 (E-mail: miltenbe@badlands.nodak.edu). Nunn, 1973Nunn, , 1977. Because the goal of the early research on habit reversal was to produce immediate and lasting decreases in the occurrence of habit behaviors, analysis of the individual treatment components or elucidation of the behavioral mechanism responsible for the success of the procedure was not a focus of investigation at the time.More recently, researchers have investigated aspects of this robust treatment package, including simplified versions and variations

Bridging neuroscience and clinical psychology: cognitive behavioral and psychophysiological models in the evaluation and treatment of Gilles de la Tourette syndrome

“…The theoretical concepts need to be concretely explained to allow the active involvement of the child in the therapeutic process, such as direct role playing and other activities. Treatment and therapeutic activities must not appear to the child as a task or a punishment for his/her behavior, but rather as a way to develop himself/herself and to feel better, and enhance his/her quality of life [85]. Generally speaking, psychotherapy, even if unstructured, can prove to be an appropriate solution to the syndrome's impacts, addressing low self-esteem, lack of social skills or incomprehension toward his/her symptoms [86].…”

“…This technique tends to increase self-esteem by giving a certain empowerment over their behavior. In order to determine the most efficient components of this model, some researchers have assessed abridged versions of HR [46,85,92,99]. The results show that awareness and training of an incompatible answer are the most significant elements for the effectiveness of a HR treatment from childhood to adulthood.…”

Habit reversal training as a treatment for refractory OCD – A case study

“…Habit Reversal Training (HRT) has become the treatment of choice for habit disorders such as tics, Tourette Syndrome, and trichotillomania (Miltenberger, Fuqua, & Woods, 1998). First developed by Azrin and Nunn (1973), this comprehensive treatment protocol is firmly based on behavioural analytic principles and includes the following components: awareness training, competing response training, self-monitoring, social support, and generalisation training (see details below).…”

Evaluating the Duration of the Competing Response in Habit Reversal: A Parametric Analysis

“…Recent literature reviews have suggested that the competing response (CR) component, in which a person learns to engage in a physically incompatible behavior contingent on the repetitive behavior or its antecedents, is primarily responsible for the efficacy of habit reversal (Miltenberger, Fuqua, & Woods, 1998). Although Azrin and Nunn (1973) originally proposed a 3-min duration for the CR, shorter durations have been effective (e.g., 1 min; Woods et al, 1999).…”