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.     

Eliminating nail-biting by the habit reversal procedure

Fingernail-biting is prevalent among children and adults alike. About 43% of children bite their nails during the puberty ages (Wechsler, 1931); 25% of college students are nail-biters (Coleman and McCalley, 1948), and 10% of adults bite their nails (Pennington, 1945).A variety of treatments including negative practice, operant procedures and psychotherapy have been used in treating nail-biting but no single treatment has been generally effective in eliminating nail-biting. Smith (1957) using negative practice reported that 21 of 57 (39%) of his nail-biting clients were cured. 9 improved and 27 (47%) were unimproved. Bucher (1968) reported that 13 of 20 (65%) college students stopped nail-biting by using a self-administered operant shock procedure. However, he reported many relapses after the withdrawal of shock for nail-biting. No evaluation of psychoanalytic treatment for nail-biting appears to have been made.     

Exposure with response prevention versus habit reversal in Tourettes's syndrome: a controlled study

The intentional nature of tics provides the opportunity to apply behavioural interventions aimed at tic reduction through interruption of stimulus-response sequences. The aim of this study has been to evaluate the effect of exposure and response prevention (ER) versus habit reversal (HR) in 43 Tourette's syndrome (TS) patients. The three outcome measures were: the Yale Global Tic Severity Scale (YGTSS), 15-min tic frequency registrations monitored at the institute and 15-min home tic frequency registrations. Both treatment conditions resulted in statistically significant improvements on all outcome measures (p < 0.001). No significant differences were found between the treatment conditions on any of the outcome measures, although there was a tendency in favour of ER on the YGTSS (p = 0.05). These results suggest that, at least in the short term, TS tic symptoms can be treated effectively with both types of treatment.     

Behavioral and pharmacological treatments for tourette syndrome: A review

This article reviews the published treatment outcome research on pharmacological and behavioral treatments for Gilles de la Tourette syndrome (TS). Controlled group outcome studies of pharmacological treatments show about a 50–60% reduction in tics with haloperidol and pimozide and about a 20% reduction with clonidine. A controlled group outcome study and several within-subject design studies of behavioral treatments show about a 90% reduction in tics with habit reversal training. A large number of case studies generally confirm these results and also show benefits from other behavioral treatments such as relaxation training, self-monitoring, and contingency management. Clinical limitations of TS drugs are that they produce side effects in 50–85% of the patients and require continuous use, and long-term compliance with the medications is limited. The primary limitation of behavioral treatments is that they require a large initial time commitment. The methodological strengths of the controlled drug studies are the use of double-blind and group designs. For the behavioral studies, the strengths are rigorous recording and controlled within-subject designs.     

A systems analysis of a failure to test the effectiveness of waiting-list group therapy.

This nonexperimental effectiveness study attempted to evaluate the utility of a brief waiting-list group. The setting was a university clinic providing treatment for an inner-city population. Health delivery and staff dynamics made it difficult to conduct clinical research in this treatment-oriented setting. The nonrandom design allowed for patient choice, with few clients attending more than two group sessions, thus decreasing its impact. Managed-care pressures decreased staff cooperation with our research objectives, resulting in very low return rates in testing and follow-up data. A social systems analysis, highlighting staff and institutional ambivalence, is used to understand the failure to adequately test the effectiveness of waiting-list group therapy. Recommendations are offered to investigators who contemplate conducting clinical research with limited resources.     

A controlled evaluation of acceptance and commitment therapy plus habit reversal for trichotillomania

This randomized trial compared a combined Acceptance and Commitment Therapy/Habit Reversal Training (ACT/HRT) to a waitlist control in the treatment of adults with trichotillomania (TTM). Twenty-five participants (12 treatment and 13 waitlist) completed the trial. Results demonstrated a significant reduction in hair pulling severity, impairment ratings, and hairs pulled, along with significant reductions in experiential avoidance and both anxiety and depressive symptoms in the ACT/HRT group compared to the waitlist control. Reductions generally were maintained at a 3-month follow-up. Decreases in experiential avoidance and greater treatment compliance were significantly correlated with reductions in TTM severity, implying that targeting experiential avoidance may be useful in the treatment of TTM. Other implications and suggestions for future research are noted.     

Reducing risky behavior with habit reversal: A review of behavioral strategies to reduce habitual hand-to-head behavior

Habit reversal training (HRT) has been a mainstay of behavior analysts' repertoire for nearly the last 50 years. HRT has been effective in treating a host of repetitive behavior problems. In the face of the current coronavirus pandemic, HRT has practical public health importance as a possible intervention for reducing hand-to-head behaviors that increase the risk of viral infection. The current paper provides a brief review of HRT for hand-to-head habits that is designed for a broad audience and concludes with practical suggestions, based on HRT, for reducing face-touching behaviors.     

Relax and try this instead: abbreviated habit reversal for maladaptive self-biting.

We evaluated the effectiveness of an abbreviated habit reversal procedure to reduce mal-adaptive oral self-biting in an adolescent boy in residential care. Treatment involved a combination of relaxation and two competing responses. Results of a withdrawal design and two posttreatment medical evaluations indicated that the intervention eliminated the biting and the tissue damage it caused.     

Evaluating the duration of the competing response in habit reversal: a parametric analysis.

The effectiveness of habit reversal was compared across three different competing response (CR) durations. Results showed that 1‐min and 3‐min CR durations were associated with short‐term and long‐term increases in nail length for people who bit their nails. A 5‐s CR duration produced immediate increases in nail length that were not maintained. Social validity data were consistent with these findings.     

Breaking a habit: A further role of the phonological loop in action control

Recent research has suggested that keeping track of a task goal in rapid task switching may depend on the phonological loop component of working memory. In this study, we investigated whether the phonological loop plays a similar role when a single switch extending over several trials is required after many trials on which one has performed a competing task. Participants were shown pairs of digits varying in numerical and physical size, and they were required to decide which digit was numerically or physically larger. An experimental cycle consisted of four blocks of 24 trials. In Experiment 1, participants in the task change groups performed the numerical-size judgment task during the first three blocks, and then changed to the physical-size judgment task in the fourth. Participants in the continuation groups performed only the physical-size judgment task throughout all four blocks. We found negative effects of articulatory suppression on the fourth block, but only in the task change groups. Experiment 2 was a replication, with the modification that both groups received identical instructions and practice. Experiment 3 was a further replication using numerical-size judgment as the target task. The results showed a pattern similar to that from Experiment 1, with negative effects of articulatory suppression found only in the task change group. The congruity of numerical and physical size had a reliable effect on performance in all three experiments, but unlike the task change, it did not reliably interact with articulatory suppression. The results suggest that in addition to its well-established role in rapid task switching, the phonological loop also contributes to active goal maintenance in longer-term action control.     

Elaborative processing in the Korsakoff syndrome: context versus habit

Using a procedure of Hay and Jacoby [Hay, J. F., & Jacoby, L. L. (1999). Separating habit and recollection in young and older adults: Effects of elaborative processing and distinctiveness. Psychology and Aging, 14, 122–134], Korsakoff patients’ capacity to encode and retrieve elaborative, semantic information was investigated. Habits were created during initial training, whereupon cued-recall memory performance was examined, with habit opposing as well as facilitating recollection of earlier studied words. A first group of patients was instructed and tested in the same way as healthy controls and showed poor test performance. Nevertheless, when given more processing and response time, additional explanation, and explicit encouragement, a second group of patients performed similarly to healthy controls. The results suggest that, when given adequate support, Korsakoff patients are able to encode and make use of semantic, contextual, and sequential information. Word distinctiveness, however, only influenced performance of controls.