Habit reversal training
Habit reversal training (HRT) is a "multicomponent behavioral treatment package originally developed to address a wide variety of repetitive behavior disorders".
HRT consists of five components:
- awareness training,
- competing response training,
- contingency management,
- relaxation training, and
- generalization training.
Research on the efficacy of HRT for the aforementioned behavioral disorders have produced consistent, large effect sizes (approximately 0.80 across the disorders). It has met the standard of a well-established treatment for stuttering, thumb sucking, nail biting, and TMJ.
For tic disorders
In the case of tics, these components are intended to increase tic awareness, develop a competing response to the tic, and build treatment motivation and compliance. HRT is based on the presence of a premonitory urge, or sensation occurring before a tic. HRT involves replacing a tic with a competing response—a more comfortable or acceptable movement or sound—when a patient feels a premonitory urge building.
Controlled trials have demonstrated that HRT is an acceptable, tolerable, effective and durable treatment for tics; HRT reduces the severity of vocal tics, and results in enduring improvement of tics when compared with supportive therapy. HRT has been shown to be more effective than supportive therapy and in some studies medication. HRT is not yet proven or widely accepted, but large-scale trials are ongoing and should provide better information about its efficacy in treating TS. Studies through 2006 are "characterized by a number of design limitations, including relatively small sample sizes, limited characterization of study participants, limited data on children and adolescents, lack of attention to the assessment of treatment integrity and adherence, and limited attention to the identification of potential clinical and neurocognitive mechanisms and predictors of treatment response". Additional controlled studies of HRT are needed to address whether HRT, medication, or a combination of both is most effective, but in the interim, "HRT either alone or in combination with medication should be considered as a viable treatment" for tic disorders.
References and notes
- Piacentini JC, Chang SW (2006). "Behavioral treatments for tic suppression: habit reversal training". Advances in neurology 99: 227–33. PMID 16536370.
- Azrin NH, Nunn RG (November 1973). "Habit-reversal: a method of eliminating nervous habits and tics". Behav Res Ther 11 (4): 619–28. doi:10.1016/0005-7967(73)90119-8. PMID 4777653. As reported in Piacentini JC, Chang SW. PMID 16536370
- Bate, Karina S.; Malouff, John M.; Thorsteinsson, Einar T.; Bhullar, Navjot (2011-07-01). "The efficacy of habit reversal therapy for tics, habit disorders, and stuttering: A meta-analytic review". Clinical Psychology Review 31 (5): 865–871. doi:10.1016/j.cpr.2011.03.013.
- Lombroso PJ, Scahill L (April 2008). "TOURETTE SYNDROME AND OBSESSIVE-COMPULSIVE DISORDER". Brain Dev 30 (4): 231–7. doi:10.1016/j.braindev.2007.09.001. PMC 2291145. PMID 17937978.
- Singer HS (March 2005). "Tourette's syndrome: from behaviour to biology". Lancet Neurol 4 (3): 149–59. doi:10.1016/S1474-4422(05)01012-4. PMID 15721825.
- Michael B. Himle, Christopher A. Flessner & Douglas W. Woods (2004): Advances in the Behavior Analytic Treatment of Trichotillomania and Tourette’s Syndrome. JEIBI 1 (1),58-65 BAO
- Swain JE, Scahill L, Lombroso PJ, King RA, Leckman JF (August 2007). "Tourette syndrome and tic disorders: a decade of progress". J Am Acad Child Adolesc Psychiatry 46 (8): 947–68. doi:10.1097/chi.0b013e318068fbcc. PMID 17667475.