Habit reversal treatment for fingernail biting

A controlled experiment was carried out on 40 habitual fingernail biters to test the following: (1) Whether or not Nunn and Azrin's (1976) ‘habit-reversal’ programme could be simplified and still be effective. (2) Whether or not the use of a competing response is essential for successful outcome. (3) Whether or not a programme of ongoing goals can enhance outcome results.The subjects were equally divided into three experimental groups and a waiting list control group. The experimental groups were: habit reversal plus nail care; habit reversal, nail care plus programme of ongoing target goals; nail care instructions plus programme of ongoing target goals. The dependent variables were length of nails in millimetres and presence or absence of nailbiting. All experimental groups showed significantly greater increases in fingernail length than the control group, but there was no significant difference between the different treatments. However, at follow-up, the two groups incorporating ‘habit reversal’ showed much lower relapse rates than the other experimental group; thus, supporting the argument that use of a competing response is a key component in effective treatment of such compulsive, maladaptive habits.     

Habit reversal treatment of thumbsucking

About 40% of young children suck their thumbs, an action which is associated with dental problems and for which intra-oral devices have been the most effective treatment. The present study of 30 thumbsucking children evaluated the habit reversal treatment which included competing response training, parental support, and stimulus identification during a single session plus follow-up maintenance by the parent. Habit reversal training reduced thumbsucking by 92% in the first week, 95% in the fourth month, and 89% at the 20-month follow-up. A comparison treatment by a bitter tasting substance produced a reduction of about 35%.     

Habit reversal in the turtle

Two groups of mature “painted” turtles were trained in a T-maze. One group had five trials per day, with correct and incorrect turns reversed for each animal whenever it reached the criterion of five errorless trials on a given day. The second group had 10 trials per day, with correct and incorrect turns reversed daily, irrespective of the performance of the animals. Only in the data for the second group did there appear some indication of progressive improvement in habit reversal. The results are considered in relation to those obtained in analogous experiments with other species.     

Habit reversal vs. negative practice treatment of nailbiting

A previous study of the habit reversal treatment of nailbiting was extended by using more subjects (97) and a comparison with an alternative method (negative practice). Negative practice reduced nailbiting episodes by about 60% whereas habit reversal reduced nailbiting episodes by about 99% throughout the 5-month follow-up.     

Insights for treatment in Tourette syndrome from fMRI

In a recent American Journal of Psychiatry article, Wang and colleagues used functional MRI (fMRI) to examine cortico-striatal-thalamo-cortical circuitry in Tourette syndrome (TS), advancing the field's investigation of circuit level dysfunction in vivo in individuals with TS. Their results provide insight for interrogating neural mechanisms underlying different treatment methods.     

Treatment of vocal tics in children with Tourette syndrome: investigating the efficacy of habit reversal

Habit reversal was used to treat vocal tics in 5 children with Tourette syndrome. Vocal tics were reduced in 4 of the 5 children, the untreated motor tics did not increase, and treatment was acceptable to the children's parents.     

Habit reversal as a treatment for chronic skin picking in typically developing adult male siblings.

In this study, habit reversal was evaluated as a treatment for skin picking in typically developing adult male siblings using a nonconcurrent multiple baseline across participants design. Results showed socially valid decreases in reported picking as a result of treatment.     

Timing recalibration in childhood Tourette syndrome associated with persistent pimozide treatment

In this study, we have tested the effects of the dopamine D₂ receptor blocker pimozide on timing performance in patients with Tourette syndrome (TS). Nine children with TS were tested off‐medication and following 3 months of daily treatment with pimozide. Subjects completed a time reproduction and a time production task using supra‐second temporal intervals. We show that pimozide improves motor timing performance by reducing the patients' variability in reproducing the duration of visual stimuli. On the other hand, this medication has no effect on the reproduction accuracy and on both variability and accuracy of the performance on the time production task. Our results suggest that pimozide might have improved motor timing variability as a result of its beneficial side effect on endogenous dopamine levels (i.e., normalization).     

An evaluation of behavioral treatments for Tourette syndrome.

The present study evaluated the effectiveness of self-monitoring, relaxation training and habit reversal in the treatment of 6 Tourette Syndrome (TS) subjects with multiple motor and vocal tics. A counterbalanced design was employed and tic frequencies were measured in the clinic setting using videotapes taken through a one-way mirror. Tics were reduced by an average of 55% with habit reversal, 44% with self-monitoring, and 32% with relaxation training and each behavioral procedure was the most effective treatment for at least one subject. All three treatment approaches may have some utility in the behavioral treatment of TS.     

Dilemmas in diagnosis and treatment of Gilles de la Tourette syndrome.

Gilles de la Tourette syndrome (TS) is a neurological disorder which has an inordinate risk of being diagnosed as psychogenic in nature because of commonly shared behavioral symptomes with syndromes of psychological origin. An overview of TS is presented including its history, symptomatology, and treatment of choice. The problems and pitfalls inherent in the diagnostic process which lead to psychogenic misconceptions are discussed. Treatment considerations include the secondary emotional problems and the negative consequences of the medication for TS. The implications for training professionals are discussed, but the essential point is that without an adequate history of the onset of symptoms, the potential for misdiagnosis is dramatically increased.     

Habit reversal versus supportive psychotherapy in Tourette's disorder: a randomized controlled trial and predictors of treatment response

Tourette syndrome (TS) is characterized by chronic motor and vocal tics. Habit reversal therapy (HR) is a behavioral treatment for tics which has received recent empirical support. The present study compared the efficacy of HRT in reducing tics, improving life-satisfaction and psychosocial functioning in comparison with supportive psychotherapy (SP) in outpatients with TS. In addition, we investigated whether impairments in response inhibition in patients with TS predict response to HR treatment which specifically aims to inhibit tics. Thirty adult outpatients with DSM-IV TS were randomized to 14 individual sessions of HR (n = 15); or SP (n = 15). HR but not SP reduced tic severity over the course of the treatment. Both groups improved in life-satisfaction and psychosocial functioning during active treatment. Reductions in tic severity (HR) and improvements in life-satisfaction and psychosocial functioning (HR and SP) remained stable at the 6-month follow-up. The extent of pre-treatment response inhibition impairment in the HR group predicted reductions in tic-severity from pre- to post-treatment. Our results suggest that HR has specific tic-reducing effects although SP is effective in improving life-satisfaction and psychosocial functioning. Assessments of response inhibition may be of value for predicting treatment response to HR.