Habit reversal training
Encyclopedia
Habit reversal training is a "multicomponent behavioral treatment package originally developed to address a wide variety of repetitive behavior disorders".

Behavioral disorders treated with HRT include tic
Tic
A tic is a sudden, repetitive, nonrhythmic, stereotyped motor movement or vocalization involving discrete muscle groups. Tics can be invisible to the observer, such as abdominal tensing or toe crunching. Common motor and phonic tics are, respectively, eye blinking and throat clearing...

s, trichotillomania
Trichotillomania
Trichotillomania, which is classified as an impulse control disorder by DSM-IV, is the compulsive urge to pull out one's own hair leading to noticeable hair loss, distress, and social or functional impairment. It is often chronic and difficult to treat....

, nail biting
Nail biting
Onychophagia, or nail biting, is a common oral compulsive habit in children and adults.-Classification:Nail biting is considered an impulse control disorder in the DSM-IV-R; the ICD-10 classifies it as "other specified behavioral and emotional disorders with onset usually occurring in childhood and...

, thumb sucking
Thumb sucking
Thumb sucking is a behavior found in humans, chimpanzees, captive Ring-tailed Lemurs, and other primates. It usually involves placing the thumb into the mouth and rhythmically repeating sucking contact for a prolonged duration...

, and skin picking
Dermatillomania
Dermatillomania is an impulse control disorder characterized by the repeated urge to pick at one's own skin, often to the extent that damage is caused...

. It consists of five components:
  1. awareness training,
  2. competing response training,
  3. contingency management,
  4. relaxation training, and
  5. generalization training.

For tic disorders

In the case of tics, these components are intended to increase tic awareness, develop a competing response to the tic, and build treatment motivation and compliance. HRT is based on the presence of a premonitory urge, or sensation occurring before a tic. 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 reduces the severity of vocal tics, and results in enduring improvement of tics when compared with supportive therapy. HRT has been shown to be more effective than supportive therapy and in some studies medication (for review see ). HRT is not yet proven or widely accepted, but large-scale trials are ongoing and should provide better information about its efficacy in treating TS. 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 disorder
Tic disorder
Tic disorders are defined in the Diagnostic and Statistical Manual of Mental Disorders based on type and duration of tics...

s.
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