Habit Reversal Training
HRT ( Habit Reversal Training ) is a proven behavioral therapy for reducing tics associated with Tourette syndrome. This treatment is also effective in the treatment of problematic behaviors associated with impulsive control disorders, such as trichotillomania. Tics, tourette syndrome, trichotillomania tend to start especially in children and are accompanied by other psychiatric disorders such as anxiety disorders. Therefore, a child-adolescent or adult psychiatrist should be supported for treatment. HRT can also be effective in correcting many repetitive behaviors from wounding, nasal confection, nail eating and finger sucking.
Many patients and relatives say thing like : I am not even aware /I find myself doing this… And show that they not aware of their behavior and the need for relaxation. When you postpone these behaviors or try not to do it, one can understand the distress that you experience (tics, plucking, sucking, sucking, finger sucking, etc.). Awareness training is beneficial for increasing attention to tic or other problem behaviors. Thus, the self-control skills of the affected person develops better. This training takes place in several steps.
Graph 1: The red line shows the increasing distress before the repetitive behavior (tick, plucking, nail eating, etc.) and the decreasing distress at the end point. The frequency and tendency increases if this behavior can’t get under control.
How does the Treatment Work?
The first task of the therapist is to inform the patient about the situation and to cooperate.
Then, the triggering factors should be revealed. Therefore, in the first sessions, the patient only focuses to determine its frequency and severity. This provides both an opportunity for the patient to become aware of the triggering factors and a guide for the therapist’s treatment plan.
In order to realize this distress, it is emphasized that they should first realize this behavior. For this reason, we usually avoid stimulating the patient in terms of his / her behavior. Instead, we tell them that they needs to realize it themselves, and we use some techniques for that.
In addition, as the patient proceeds to postpone these behaviors as the sessions progress, they also notice warning signs just before the behaviors appear. And there’s an opportunity to turn off these warning signals. These warning signals can be impulses, emotions, sensations or thoughts. Children may cry, scream. The most effective way to turn off these signals is to withstand the impulse that triggers these behaviors. This endurance time is started and advanced in short periods such as 1min.
Graph 2: If the distress is tolerated and the behavior (teak, hair plucking, nail eating, etc.) is postponed, the distress increases first and then gradually decreases (not fast). But if this repeats; it tends to decrease both frequency and severity of behavior.
Creating an opposite response:
Once the patient has acquired sufficient skill in recognizing tic or impulsive behavior, the next step is to create an opposite response to replace old tic or impulsive behavior. Generally, the counter-response is acceptable to tic or impulsive behavior, and it is preferable that this behavior lasts more than a few minutes. For example, nail files for a child who eats nails, chewing gum for a person with lip movements, applying a cream for a wounded person, these are behaviors that can be replaced.
In order to prevent recurrence of tic and impulsive behaviors, the patient can make a list of problems arising from these behaviors. Parents or relatives of the patient can also support and appreciate the patient for their success so far. It may also be useful to show others that they can suppress tic or impulsive behavior. It should be noted that every positive step is a very important step for treatment.
Dr. Halil Kara (Child and Adolescent Psychiatrist)