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Habit Reversal Training (HRT)

Although tic disorders are commonly treated by medication, a growing body of research supports psychosocial treatments, particularly habit reversal training (HRT). Used alone or as part of a treatment plan, HRT helps by:

  • Becoming aware of cues or premonitory urges that indicate the habit or tic is about to happen.
  • Learning to replace the habit or tic with safe, non-habit forming and incompatible behaviors.

Commonly used techniques demonstrate considerable effectiveness, typically in 8-14 sessions: 

Awareness training with self-monitoring. Individuals increase their ability to detect tics or unwanted behaviors and their warning signs. When the behavior is about to happen, they might notice muscle sensations before a tic or mounting muscle tension that prompts, for example, the hair-pulling urge. 

Relaxation training. Building on awareness training, individuals learn and apply relaxation and breathing exercises when noticing urges to engage in the tic or habit.

Competing response training. Individuals learn and substitute the undesired behavior with a different, less interfering one. For example, prior to hair pulling, a teen might have a tendency to stroke her hair. Instead, she practices moving her hand from her hair to her ear or squeezing a rubber ball, which help ease stress and occupy her hands.

Social support. The individual enlists social support from family and friends to practice techniques and identify problems caused by the behavior. Prompts, praise and encouragement from friends and family may bolster the awareness training and competing response work. 

Generalization of skills. Individuals are encouraged and praised for adapting new skills to everyday life at home, school/work or in other public settings.

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