The Use of Habit Reversal Techniques on Eliciting Changes - Essay Example

? THE USE OF HABIT REVERSAL TECHNIQUES ON ELICITING CHANGES AND REDUCTION OF UNWANTED BEHAVIOUR The Use of Habit Reversal Techniques on Eliciting Changes and Reduction of Unwanted Behaviour In the field of psychology, interventions are often used in assisting patients to discard unnecessary or potentially harmful behaviours. These interventions are rooted in the belief that the persistence of such behaviours and their enforcement without focusing on the underlying causes allow the behaviour’s repetition, continuation and habituation (Adams, et al., 2009). Various methods are used to modify the behaviours of parents, and one of these is the use of habit reversal techniques (HRT). HRT was designed to be non-invasive and without side-effects, as well as develop positive behaviour through reinforcement in order to counteract habits that were learned out of anxiety or nervousness of the patients. Its effectiveness lies in its five-step components: awareness training; competing response training; contingency management; relaxation training; and generalisation training (Adams, et al., 2009). The components are done step-wise to allow the patients to get acquainted with their behaviours, understand why these are undesirable, and to help them address their anxieties and develop new behaviours that would replace the disruptive ones, and aside from behavioural modification methods, stimuli are also used to further instil desirable behaviours among patients (Michelotti, et al., 2005). The effectiveness of HRT has been proven by the numerous published studies with regards to the use of various techniques in addressing a wide variety of undesirable manners. Numerous studies supported the effectiveness of HRT among children and adolescents, and were reported to have successfully improved unwanted behaviour such as nail biting, Tourette’s syndrome and other tic disorders, trichotillomania, rumination syndrome, tip-toeing among others, which is important to recall since there is a high possibility that any one of these disorders has another behavioural problem that also occurs at the same time (Adams, et al., 2009). Thus before undertaking the daunting task of instilling or teaching replacement behaviours for disruptive behaviour, the extent of behavioural problems must first be addressed in order to choose the appropriate behaviour to enforce. A study was able to prove that any one of the disruptive behaviours occurred in combination with other unwanted behaviours, and reported that aside from the problem of nail-biting, patients were also afflicted with other behavioural problems such as hair-pulling and skin biting (Ghanizadeh, 2007). In addition, the parents of the sample population (n=63) were also found out to have mild psychiatric disorders themselves, suggesting that the children’s behaviours were somehow enforced by parental actions. The study implied that patients can greatly benefit from HRT and its overall effects, especially since the nail biting is just one symptom and could possibly mask other behavioural or psychological problems (Ghanizadeh, 2007). Most of the studies that utilise HRT as a behavioural intervention were able to observe that most patients were of normal intelligence, and they were able to benefit from the behaviour modifications due to motivation and reinforcement (Adams, et al., 2009). Patients with variable repetitive observed behaviours were subjected to a series of sessions that involved behavioural therapy and HRT for reinforcing new behaviours (n=12), and the research was able to prove that combining multiple therapy and behavioural change sessions with motivation and encouragement was effective in the reinforcement process, and helped children adopt new behaviours better, faster, and for longer periods of time than without an form of support (Miller, et al., 2005). The awareness and relaxation training components of HRT were able to encourage behavioural changes among children by removing sources of anxiety and positively reinforcing their good behaviour. However, it was also implied that learning how to detect when one is doing the undesired behaviour is a challenge, and takes a longer time to be learned and be accustomed with. HRT is mainly used to condition patients to change or modify their behaviours once they detect themselves unconsciously doing it, and so as to strongly instil the new behaviours, actions that were suggested to replace the unwanted habit utilize similar muscle groups so as to prevent doing the unwanted behaviour at the same time (Adams, et al., 2009). In a study on rumination syndrome where patients regurgitate food for at least an hour after meals, it was found out that performing diaphragmatic breathing techniques could prevent patients from having the urge to regurgitate (Papadopoulos & Mimidis, 2007). This was made possible by the fact that the diaphragm is responsible for pushing ingested material upward, and if the muscle is being used in another action, the urge to regurgitate becomes satiated. The behaviour can be successfully modified by addressing the problem early and using any kind of positive reinforcement to instil desired behaviour among patients. Aside from rumination, hair-pulling or trichotillomania is another condition that has been proven to subside under HRT use (Adams, et al., 2009). In a study that assessed the emotional stability as well as self-reported improvements in anxiety and depressive symptoms among trichotillomaniacs, it was found out that undergoing psychoeducation, learning a competing response, undergoing mindful training, learning how to regulate emotions, increasing tolerance to distress, relapse prevention, and undergoing maintenance sessions were effective in preventing the reoccurrence of hair-pulling within a controlled population (n=10) (Keuthen, et al., 2010). The researchers were also able to establish a strong connection between the severity of the hair-pulling and of the anxiety levels, thus they concluded that by addressing how to manage emotions through learned habits, the frequencies of hair-pulling can be managed and reduced. HRT can also be used in combination with other therapy methods to strengthen desirable behaviours, especially among persons with obsessive compulsive disorders (OCD) or developmental disorders. The techniques can also be used to treat more than one patient at a time, thus allowing psychologists to perform behavioural modification simultaneously among patients (Bate, et al., 2011). A study successfully intervened on tip-toeing habits of children (n=3) having mild autism using a combination of external stimuli (squeakers) and the reinforcement of positive behaviours using HRT (Marcus, et al., 2009). The squeakers were continually attached to the children’s feet and would only create sounds when walking on tip-toe and the sounds would decrease when walking from toe-to-heel, through continuous walks using the squeakers, the group were able to learn walking from toe-to-heel in avoiding hearing the squeaky noises. In another study, the combination of assistive strategies employing both the psychiatrists and the patients’ teachers helped in instilling desired behaviours by extending the behaviour modifications outside the therapy sessions (n=1) (Waller, et al., 2007). The HRT was proved successful in reversing nail-biting through the reinforcement of the psychiatrist and the teacher’s alternative method of giving a stress ball whenever the patient’s hands move closely to the mouth, and eventually not having to rely on the stress ball during periods of anxiety. While most of the published studies reported to have positive results with regards to using HRT to treat unwanted behaviours, there are also some questions with regards to the overall effectiveness of the methods in several kinds of behavioural disorders, such as the lack of quantifiable methods in assessing the effectiveness of the HRT, the small sample sizes used in each trial, few numbers of follow-up reports on previously-treated patients, methodological shortcomings, not testing for comparison between no-treatment and a superior treatment method, completely meeting well-established criteria for assessing the results, and of frequent non-reports of pre-treatment functional assessments (Bate, et al., 2011; Carr & Chong, 2005). HRT also has several limitations such as having high variability in responses among different individuals, the lack of proper follow-up procedures to assess therapy adherence, not fully considering the overall factors that could affect treatment adherence or effectiveness, or in fully assessing the therapist’s skills in performing HRT properly, effectively, and under ethical considerations (Adams, et al., 2009). Thus it would be hard to judge HRT solely on reports that show positive results, and that even if the methods are non-invasive in nature, it is possible that without sufficient knowledge, therapists could either enforce unwanted behaviours of patients, or aid them in developing new and even more potentially harmful habits (Carr & Chong, 2005). Before completely accepting the effectiveness of HRT, its universality must also be assessed, evaluating if the intervention was done according to what was necessary for the child and not through procedural ease, as well as finding out whether the studies that used it for therapy had wide scopes, sufficient sample populations, and long-term retention among patients. The number of studies and the varieties of methods employed in HRT are extensive, proving that it is a form of behavioural intervention that has merits to its effects, even though it is not the only method available for reducing unwanted behaviours among children and adolescents. Since it is non-invasive in nature, it has gained wide acceptance due to the lack of side-effects, as well as potential for long-term results. However, the fact that most of the sample sizes used for most studies were rather small, with the examples used for this review ranging from n=1 to n=63 shows that there is still a need to further conduct studies using other factors that could affect results such as wider scope of locations and comparing various HRT in similar behavioural conditions. Thus, while the number of studies that support the effectiveness of HRT in reducing undesirable and potentially dangerous behaviours among patients is sufficient enough, there must also be enough discrimination in judging the relevance of each one, so as not to create unmerited conclusions with regards to the use of HRT and its effects, especially since it is but only one of the many possible solutions in initiating positive changes both in the actions and mind-set of patients in need of behavioural interventions. References Adams, A., Adams, M., & Miltenberger, R. (2009). Habit reversal training. In W. O'Donohue, & J. Fisher, General principles and empirically supported techniques of cognitive behavior therapy (pp. 343-350). Hoboken, NJ: John Wiley & Sons, Inc. Bate, K., Malouff, J., Thorsteisson, E., & Bhullar, N. (2011). The efficacy of habit reversal therapy for tics, habit disorders, and stuttering: A meta-analytic review. Clinical Psychology Review, 31: 865-871. Carr, J., & Chong, I. (2005). Habit reversal treatment of tic disorders: a methodological critique of the literature. Behaviour Modification, 29(6): 858-875. Ghanizadeh, A. (2008). Association of nail biting and psychiatric disorders in children and their parents in a psychiatrically referred sample of children. Child and Adolescent Psychiatry and Mental Health, 2: 13-19. Keuthen, N., Rothbaum, B., Welch, S., Taylor, K., Falkenstein, M., Heekin, M., . . . Jenike, M. (2010). Pilot trial of dialectical behavior therapy-enhanced habit reversal for trichotillomania. Depression and Anxiety, 1: 1-7. Marcus, A., Sinnott, B., Bradley, S., & Grey, I. (2010). Treatment of idiopathic toe-walking in children with autism using GaitSpot Auditory Speakers and simplified habit reversal. Research in Autism Spectrum Disorders, 4:260-267. Michelotti, A., de Wijer, A., Steenks, M., & Farella, M. (2005). Home-exercise regimes for the management of non-specific temporomandibular disorders. Journal of Oral Rehabilitation, 32: 779-785. Miller, J., Singer, H., Bridges, D., & Waranch, R. (2005). Behavioral therapy for treatment of stereotypic movements in nonautistic children. Journal of Childr Neurology, 21(2):119-125. Papadopoulos, V., & Mimidis, K. (2007). The rumination syndrome in adults: A review of the pathophysiology, diagnosis and treatment. Journal of Postgraduate Medicine, 53:203-206. Waller, R. J., Kent, S., & Johnson, M. E. (2007). Using teacher prompts and habit reversal to reduce fingernail biting in a student with attention deficit hyperactivity disorder and a mild intellectual disability. TEACHING Exceptional Children Plus, 3(6): 3-12. Read More