Psych 282 - Chapter 21 - Habit Reversal Procedures PDF

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Chapter 21 – Habit Reversal Procedures Introduction  Habit Reversal: A procedure for treating habit disorders – it component procedures include awareness training, competing response training, social support, generalization strategies, and motivational strategies o Research has shown that awareness...

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Chapter 21 – Habit Reversal Procedures Introduction  Habit Reversal: A procedure for treating habit disorders – it component procedures include awareness training, competing response training, social support, generalization strategies, and motivational strategies o Research has shown that awareness training and competing response training are the most crucial components for treatment effectiveness o Used to decrease the frequency of undesirable habit behaviors  Habit behaviors often do not interfere to any great extent with the person’s social functioning; they tend to be more of an annoyance to the person or to significant others in the person’s life o However, in some cases, the frequency or intensity of the habit behavior can become extreme and lead to negative perceptions of the person or decrease the person’s social acceptability  Habit Disorder: A repetitive behavior that is distressing to the person o Include nervous habits, motor and vocal tics, and stuttering Defining Target Behaviors  Habit Behaviors: A repetitive behavior o Three types – nervous habits, motor ties, stuttering Nervous Habits o Nervous Habits: Repetitive, manipulative behaviors that are most likely to occur when a person experiences heightened tension – nervous habits do not typically serve any social function for the individual o Involve repetitive, manipulative behaviors that are believed to be most likely to occur when the person experiences heightened nervous tension o i.e. Twirling or stoking hair, tapping a pencil, chewing on a pen or person, cracking knuckles, and other repetitive manipulation of objects or body parts o Nervous habits do not typically serve any social function for the person; for example, they are not reinforced by others in the person’s life o In most cases, nervous habits involve the use of the hands or oral behaviors (lip-biting, bruxism) o Many nervous habits do not cause any problems for the person unless the frequency or the intensity of the behavior becomes extreme o i.e. Biting your nails isn’t problem unless it causes pain or bleeding o “Body-focused repetitive behavior problems” – refer to nervous habits that result in physical damage or negative social evaluations Motor and Vocal Tics  Motor Tics: Repetitive, jerking movements of a particular muscle group in the body o Usually involve muscles in the neck or face but many also involve shoulders, arms, hands, legs, or torso  Motor tics are believed to be associated with heightened muscle tension o Sometimes the development of a tic is related to an injury or an event that increases the tension in a particular muscle group, but tic movements continue to occur once the original injury or event has passed  It is not uncommon for children to develop simple motor tics and then grow out of them  Motor tics are a problem when they are long-standing or extreme in frequency or intensity – in such cases, people often seek treatment  Vocal Tic: A repetitive vocal sound of word uttered by an individual that does not serve any communicative function o Repetitive vocal sound does not serve a social function o Examples include throat clearing, coughing, sounds, or words  Tourette’s Disorder: A tic disorder involving multiple motor and vocal tics that have occurred for at least 1 year o Tic disorder involving multiple motor and vocal ties o A child is diagnosed with Tourette’s disorder when two or more tics (including at least one vocal tie) occur for at least 1 year o Tourette’s disorder and other tic disorders are currently believed to be caused by a complex interaction of genetic and neurobiological factors, as well as environmental events Stuttering  Stuttering: A speech disfluency in which the individual repeats words or syllables, prolongs a word sound, and/or blocks on a word (makes no sound for a period of time when trying to say a word) o Type of speech dysfluency in which the person repeats words or syllables, prolongs the sound of a word or syllable, or blocks on a word (makes no sound for a period of life while trying to say a word)  Stuttering may occur in young children are they are first learning to use language, but most children grow out of it without a problem  Stuttering sometimes persists in children and adults in various degrees of severity – in some cases, it is barely noticeable; in others, it interferes with speech production Habit Behaviors Examples Nail-biting, hair-pulling Nervous Habits Hand-jerking, facial grimacing Motor Tics Word repetitions, prolongations Stuttering Habit Reversal Procedures  The habit reversal procedure is implemented in a therapy session with the client who exhibits the habit disorder  The client then implements the procedures that are taught in session to control the habit as it occurs outside the session

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In the habit reversal procedure, the person with the habit (or tic or stuttering) is first taught to describe the behaviors that are involved in the habit o After learning the behavioral definition of the habit, the client learns to identify when the habit occurs or when it is about to occur o These procedures constitute the awareness training component of habit reversal  Awareness Training: A component of the habit reversal procedure in which the person is taught to identify each instance of a particular habit behavior as it occurs o The client then learns a competing response and practices the competing response in session after each occurrence of the habit  Competing Response: An alternative behavior that occurs in place of another target behavior  Typically, the competing response is physically incompatible with the target behavior, so its occurrence competes with the occurrence o the target behavior  A behavior incompatible with the habit behavior o Next, the client imagines situations in which he or she will use the competing response outside the session to inhibit the habit o Finally, the client is instructed to use the competing response outside the session whenever the habit occurs or is about to occur  Competing Response Training: A component of the habit reversal procedure in which the client is taught to engage in a competing response contingent on the occurrence of the habit behavior or contingent on the urge to engage in the habit behavior Significant others are instructed to promote the client to use the competing response when the habit occurs outside the session o They are also instructed to praise the client for not engaging in the habit and for using the competing response successfully o Social Support: A component of the habit reversal procedure in which a significant other praises the client for the correct use of the competing response and prompts the client to use the competing response when the habit behavior occurs  In general, social support occurs when significant others are involved in complementing contingencies in the natural environment to help a person reach a self-management goal Finally, the therapist reviews with the client all the situation in which the habit occurs and how the habit may have caused inconvenience or embarrassment o Motivation Strategy: Part of the habit reversal procedure used to increase the likelihood that the client will use the competing response outside the treatment sessions to control the habit  Increases the likelihood that the client will use the competing response outside the treatment session to control the habit In the habit reversal therapy session, the client learns two basic skills: to discriminate each occurrence of the habit (awareness training) and to use the competing response contingent on the occurrence of the habit or in anticipation of the occurrence of the habit (competing response training) o Awareness of the habit is a necessary condition for the use of the competing response o The client must be trained to become aware of each instance of the habit so that he or she can institute the competing response immediately o The competing behavior typically is an unobtrusive behavior (not easily identified by others) that the person engages in for 13 minutes Habit Reversal Components  Awareness Training  Competing Response Training  Social Support  Motivation Procedures

Applications of Habit Reversal  The main difference between the habit reversal procedures for different types of habit disorders is the nature of the competing response  A different competing response must be chosen specifically for the particular habit, tic, or stuttering problem that the client exhibits Nervous Habits  The nervous habits treated with habit reversal procedures including fingernail biting, hair pulling, thumb-sucking, skin-picking, and oral habits such as lip biting and bruxism  In each case, the competing response was a behavior that the subject could perform easily but that was physically incompatible with the nervous habit  Nail-biting – grab a pencil or clench fists for 1-3 minutes o As soon as the nail-biting behavior was detected, they would immediately terminate the behavior and grab a pencil or clench fists, or anything that occupies hands in a way that physically prevents nail-biting o Because these are natural behaviors in a classroom (or any other place), the competing response does not draw any attention to the student  For an oral behavior, a competing response might be to hold the top and bottom teeth together lightly for a couple minutes, which would be incompatible with either behavior  When habit reversal is taught with children, the parent might use physical guidance to get the child to engage in the competing response (social support) Motor and Vocal Tics

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The competing response used in habit reversal procedures with motor tics involves tensing the muscles involved in the tic such that the body part involved is held motionless o i.e. A baseball player who engages in head snapping, would tense this neck muscles to a moderate degree as he held his head in a forward position o i.e. Someone with vocal tics (coughing, throat clearing, barking noises) would practice rhythmic breathing – deep breathing through the nose while keeping the moth closed, exhalation should be slightly longer than inhalation

Tic Head-shaking

Response Definitions and Competing Responses Response Definition Competing Response Any back and forth lateral movement of the head Tensing the neck muscles while holding the chin down and in toward the neck

Rapid eye-blinking

Any eyeblink occurring less than 3 seconds after the previous blink

Opening eyes wide and blinking deliberately every 5 seconds while shifting gaze about every 10 seconds

Facial tic

Any outward movement of the lip

Tightly pursing or pressing the lips together

Facial tic

Pulling back either or both corners of the mouth

Clenching the jaw while pressing the lips together with upward movement of the cheek(s)

Head-jerking Shoulder-jerking

Any downward motion of the head Any jerking motion of either shoulder or arm with the arm moving upward or toward the body

As for head-shaking Pressing arms tightly against the sides of the body while pulling the shoulders downward

Stuttering  The competing response used with stuttering is quite different from the competing response used with nervous habits or tics  Because stuttering involves interrupted airflow through the vocal cords that interferes with the protection of fluent speech, a competing response would involve relaxation and uninterrupted airflow over the vocal cords during speech  The competing response in the habit reversal procedure with stuttering is also called regulated breathing o Regulated Breathing: The competing response that is used in the habit reversal treatment for stuttering  Clients are first taught to detect each instance of stuttering  The clients learn to describe the types of stuttering as they speak in session  Once the clients are aware of most occurrences of stuttering, the therapist teaches the regulated breathing  Diaphragmatic Breathing: A type of relaxation exercise in which one engages in slow, rhythmic breathing, using the diaphragm muscle to pull air deep into the lungs o First component is a quick relaxation procedure o The client learns to breath in a rhythmic pattern using the muscles of the diaphragm to pull air deep into the lungs o As the client is breathing smoothly and rhythmically, the therapist instructs the client to say a word as they start to exhale o Because the client is relaxed and the air is flowing over the larynx in an exhalation, the client does not stutter the word o This speaking pattern is incompatible with the pattern involved in stuttering o If the client stutters at any time, the client stops talking immediately, breathes diaphragmatically, starts the airflow, and continues speaking  The success of the treatment depends on whether the client practices every day, detects most instances of stuttering, and used regulated breaking method reliably Why Do Habit Reversal Procedures Work?  Researchers have demonstrated that the components of the habit reversal procedure most responsible for its effectiveness in decreasing nervous habits, motor and vocal tics, and stuttering are awareness training and the use of a competing response  Awareness training is a critical component because the client must be able to discriminate each instance of the nervous habit, tic, or stuttering to implement the competing response  The use of the competing response than serves two possible functions: o Inhibits the habit behavior and provides an alternative behavior to replace it o Competing response may serve as a punisher, as in the application of aversive activities such as overcorrection and contingent exercise  The competing response does serve as a punisher in the case of motor tics and nervous habits o The competing response was effective is decreasing habits and tics when it was contingent on the habit or tic o If the client engaged in some moderately effortful behavior contingent on the instance of the habit or tic, the habit or tic would decrease whether the behavior was related to the behavior or tic  The increase in awareness of the habit or tic that is responsible for the success of the habit reversal procedure  In the case of stuttering, awareness training and the use of a competing response appear to inhibit the stuttering and provide an alternative behavior to replace stuttering o With stuttering, the competing response is not a simple motor behavior involving the tensing of a muscle group; rather it is an alternative speech pattern o Clients practice this speech pattern each time they speak, as an alternative to the pattern involved in stuttering  With habits and tics, the competing response is used contingent on the behavior; with stuttering, but contrast, the competing response is used each time the person speaks, in addition to being used contingent on each instance of stuttering

Other Treatment Procedures for Habit Disorders  Habit reversal procedures have been demonstrated consistently to be effective in treating habit disorders and are the preferred treatment approach  Some researchers have shown that the habit reversal may not be effective for habit disorders exhibited by young children or people with intellectual disabilities  Habit reversal is not effective for hair-pulling, thumb-sucking, and nail-biting exhibited by adults with intellectual disabilities o Use of a device that sounds an alarm when arms/hands move to do one of the undesirable habits and silences when the hand is returned to a normal position  DRO and response cost will not eliminate behaviors in these adults either  Response prevention has been found to eliminate hair-pulling and finger-sucking in children o i.e. Putting gloves on so they cannot twirl hair or suck on fingers Chapter Summary  Habit behaviors are repetitive, automatically reinforced behaviors that often occur outside of the person’s awareness; that is, the person does not discriminate each instance of the behavior o When the frequency of intensity of a habit becomes extreme, it may be considered a habit disorder  Nervous habits, tics, and stuttering are three categories of habit behaviors  Habit reversal procedures consist of a number of treatment components, including awareness training to teach the person to discarnate each instance of the habit behavior, the use of a competing response contingent on the habit behaviors, and social support procedures that motivate the person to continue using the competing response to eliminate the habit behavior  For each category of habit behavior, the competing response is different, for motor tics, the person engages in an incompatible behavior using the muscles used in performing the behavior o i.e. Holding an object to compete with nail biting o In a competing response for stuttering, the person engages in an incompatible pattern of breathing and speaking called “regulated breathing”  The effectiveness of habit reversal procedures is related to the use of the competing response, which functions as a punisher (for habits and tics) or as an alternative behavior to replace the habit behavior (in the case of stuttering) o The effectiveness of increased awareness by itself has not been fully investigated

Practice Test – Chapter 21 1.

What is a habit disorder?

2.

What are nervous habits? Provide examples of various nervous habits.

3.

What are motor tics? What are vocal tics? How do tics differ from nervous habits? Provide examples of various types of motor tics.

4.

Describe the different types of speech dysfunction involved in stuttering.

5.

Describe the habit reversal procedure.

6.

Describe the competing response that would be used for a nervous habit of knuckle cracking.

7.

Describe the competing response that would be with bruxism.

8.

Describe the competing response that would be used with a motor tic that involves head-jerking. What competing response would be used with a vocal tic such as throat-clearing?

9.

Describe regulated breathing, the competing response that is used with stuttering.

10. What is involved in the social support component of habit reversal procedure?

11. Describe awareness training. What is its purpose?

12. What are the two possible functions of the competing response in the habit reversal procedure? How does the function of the competing response for nervous habits and tics differ from its function for stuttering?

13. Name some of the other reinforcement and punishment procedures that have been used to eliminate habit disorders....