Habit reversal training

History

Habit reversal training was developed by psychologists Nathan H. Azrin and Ronald G. Nunn, who first published a paper detailing the habit reversal technique in 1973.

For tic disorders

In case of a tic, these components are intended to increase tic awareness, develop a competing response to the tic, and build treatment motivation and compliance. 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 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 Tourette syndrome. 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.

Comprehensive Behavioral Intervention for Tics

Comprehensive Behavioral Intervention for Tics (CBIT), based on HRT, is a first-line treatment for Tourette syndrome and tic disorders. With a high level of confidence, CBIT has been shown to be more likely to lead to a reduction in tics than other supportive therapies or psychoeducation. Some limitations are: children younger than ten may not understand the treatment, people with severe tics or ADHD may not be able to suppress their tics or sustain the required focus to benefit from behavioral treatments, there is a lack of therapists trained in behavioral interventions, finding practitioners outside of specialty clinics can be difficult, and costs may limit accessibility. Whether increased awareness of tics through HRT/CBIT (as opposed to moving attention away from them) leads to further increases in tics later in life is a subject of discussion among TS experts.

References and notes

References

1. (2006). "Behavioral treatments for tic suppression: habit reversal training". Advances in Neurology.
2. Azrin, N.H.. (July 12, 1973). "Habit-reversal: A method of eliminating nervous habits and tics". Behaviour Research and Therapy.
3. (2011-07-01). "The efficacy of habit reversal therapy for tics, habit disorders, and stuttering: A meta-analytic review". Clinical Psychology Review.
4. (1982). "Habit reversal vs negative practice treatment of self-destructive oral habits (biting, chewing or licking of the lips, cheeks, tongue or palate)". Journal of Behavior Therapy and Experimental Psychiatry.
5. (2012). "Complementary medicine, self-help, and lifestyle interventions for Obsessive Compulsive Disorder (OCD) and the OCD spectrum: A systematic review". Journal of Affective Disorders.
6. Virues-Ortega, Javier. (January 7, 2021). "Nathan H. Azrin: A Case Study in Research Translation in Behavior Science". Perspectives on Behavior Science.
7. (April 2008). "Tourette syndrome and obsessive–compulsive disorder". Brain Dev.
8. 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 [http://www.bajournal.com BAO]
9. (August 2007). "Tourette syndrome and tic disorders: a decade of progress". J Am Acad Child Adolesc Psychiatry.
10. (April 2017). "Behavioral therapy for Tourette syndrome and chronic tic disorders". Neurol Clin Pract.
11. Fernandez, Thomas V.. (2018). "Tourette disorder and other tic disorders". Elsevier.
12. (May 2019). "Comprehensive systematic review summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders". Neurology.
13. (2017). "Tics in the Pediatric Population: Pragmatic Management". Mov Disord Clin Pract.