Habit Reversal Training

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KEY POINTS

• Habit reversal training is a way to help children deal with unhealthy habits like hair pulling, nail biting, or thumbsucking.
• The first step is to help your child become aware of how her body moves and what muscles are being used when she does the habit.
• The next step is to find a new action that your child can do instead of the habit, such as squeezing a squishy ball. Praise your child when she uses the competing response instead of the old habit.

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What is habit reversal training?

Habit reversal training is a way to help children deal with unhealthy habits. It is based on the theory that children are often not aware of habits they have to relieve urges or feelings. For example, they may have a habit of pulling their hair when they feel stressed. Training helps your child be aware of what she is doing and to do something different.

When is it used?

This method can be used to help with habits like hair pulling, nail biting, or thumbsucking.

How is it done?

Help your child be aware of the habit.

• Have your child look in a mirror while doing the habit on purpose. Do this every day. Help your child become aware of how her body moves and what muscles are being used when she does the habit.
• Teach your child to raise her hand or say, "That was one," each time she notices that she has done the habit. If you see your child doing the habit and your child does not notice, signal her with a gesture or word that you have both agreed to use.
• Don’t let your child get frustrated. Help your child stay positive that she can change the habit.
• Keep track of how often the habit happens. Have your child make a note of each time she does the habit. This way you and your child can tell when she is making progress toward stopping the habit.

Practice a competing response.

• A competing response is something your child can do instead of the habit. The muscles used to do the new action should make it impossible to do the old habit. For example, instead of an eye blink tic, your child could very gently close her eyelids and hold them closed for 10 seconds.
• Have your child practice the competing response in the mirror. This helps her get used to it.
• Encourage your child to use the competing response whenever she feels the urge to start the habit and for 1 minute after each time she does the habit. If you know she will be in a situation where she might do the habit, encourage her to practice the competing response ahead of time.
• Praise your child or give a small reward when she uses the competing response and when you notice the old habit is starting to go away. Many children and teens will notice a decrease in their habit within a couple of days. However, the greatest change from habit reversal training takes place after 2 or 3 months. Don't give up after only a couple of days or weeks.

Because many habits are more common when your child is tense or under stress, it’s helpful for your child to learn relaxation skills. Relaxation skills include:

• Deep breathing: Focus on taking slow deep breaths.
• Mental imaging: Picture a calm place and let the muscles relax
• Mindfulness: Focus only on the present moment, without judging, and don’t think about the past or future
• Progressive muscle relaxation: Tense and relax the body, one muscle group at a time

Help your child find other ways to relax. For example, your child might be able to relax by taking up a hobby, listening to music, watching movies, or taking walks.