Skip to main content
PMC home page
Journal of Applied Behavior Analysis logoLink to Journal of Applied Behavior Analysis
. 1998 Fall;31(3):447–469. doi: 10.1901/jaba.1998.31-447

Applying behavior analysis to clinical problems: review and analysis of habit reversal.

R G Miltenberger 1, R W Fuqua 1, D W Woods 1
PMCID: PMC1284131  PMID: 9757583

Abstract

This article provides a review and analysis of habit reversal, a multicomponent procedure developed by Azrin and Nunn (1973, 1974) for the treatment of nervous habits, tics, and stuttering. The article starts with a discussion of the behaviors treated with habit reversal, behavioral covariation among habits, and functional analysis and assessment of habits. Research on habit reversal and simplified versions of the procedure is then described. Next the article discusses the limitations of habit reversal and the evidence for its generality. The article concludes with an analysis of the behavioral processes involved in habit reversal and suggestions for future research.

Full Text

The Full Text of this article is available as a PDF (172.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allen K. D. The use of an enhanced simplified habit-reversal procedure to reduce disruptive outbursts during athletic performance. J Appl Behav Anal. 1998 Fall;31(3):489–492. doi: 10.1901/jaba.1998.31-489. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Altman K., Grahs C., Friman P. Treatment of unobserved trichotillomania by attention-reflection and punishment of an apparent covariant. J Behav Ther Exp Psychiatry. 1982 Dec;13(4):337–340. doi: 10.1016/0005-7916(82)90081-7. [DOI] [PubMed] [Google Scholar]
  3. Azrin N. H., Nunn R. G. A rapid method of eliminating stuttering by a regulated breathing approach. Behav Res Ther. 1974 Nov;12(4):279–286. doi: 10.1016/0005-7967(74)90002-3. [DOI] [PubMed] [Google Scholar]
  4. Azrin N. H., Nunn R. G., Frantz-Renshaw S. E. Habit reversal vs negative practice treatment of self-destructive oral habits (biting, chewing or licking of the lips, cheeks, tongue or palate). J Behav Ther Exp Psychiatry. 1982 Mar;13(1):49–54. doi: 10.1016/0005-7916(82)90035-0. [DOI] [PubMed] [Google Scholar]
  5. Azrin N. H., Nunn R. G., Frantz-Renshaw S. Habit reversal treatment of thumbsucking. Behav Res Ther. 1980;18(5):395–399. doi: 10.1016/0005-7967(80)90004-2. [DOI] [PubMed] [Google Scholar]
  6. Azrin N. H., Nunn R. G., Frantz S. E. Comparison of regulated-breathing verses abbreviated desensitization on reported stuttering episodes. J Speech Hear Disord. 1979 Aug;44(3):331–339. doi: 10.1044/jshd.4403.331. [DOI] [PubMed] [Google Scholar]
  7. Azrin N. H., Nunn R. G., Frantz S. E. Habit reversal vs. negative practice treatment of nailbiting. Behav Res Ther. 1980;18(4):281–285. doi: 10.1016/0005-7967(80)90086-8. [DOI] [PubMed] [Google Scholar]
  8. Azrin N. H., Nunn R. G. Habit-reversal: a method of eliminating nervous habits and tics. Behav Res Ther. 1973 Nov;11(4):619–628. doi: 10.1016/0005-7967(73)90119-8. [DOI] [PubMed] [Google Scholar]
  9. Azrin N. H., Peterson A. L. Habit reversal for the treatment of Tourette syndrome. Behav Res Ther. 1988;26(4):347–351. doi: 10.1016/0005-7967(88)90089-7. [DOI] [PubMed] [Google Scholar]
  10. Baer D. M., Wolf M. M., Risley T. R. Some current dimensions of applied behavior analysis. J Appl Behav Anal. 1968 Spring;1(1):91–97. doi: 10.1901/jaba.1968.1-91. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Blum N. J., Barone V. J., Friman P. C. A simplified behavioral treatment for trichotillomania: report of two cases. Pediatrics. 1993 May;91(5):993–995. [PubMed] [Google Scholar]
  12. Bullen J. G., Hemsley D. R. Sensory experience as a trigger in Gilles de la Tourette's syndrome. J Behav Ther Exp Psychiatry. 1983 Sep;14(3):197–201. doi: 10.1016/0005-7916(83)90048-4. [DOI] [PubMed] [Google Scholar]
  13. Carr J. E., Taylor C. C., Wallander R. J., Reiss M. L. A functional-analytic approach to the diagnosis of a transient tic disorder. J Behav Ther Exp Psychiatry. 1996 Sep;27(3):291–297. doi: 10.1016/s0005-7916(96)00025-0. [DOI] [PubMed] [Google Scholar]
  14. Christenson G. A., Pyle R. L., Mitchell J. E. Estimated lifetime prevalence of trichotillomania in college students. J Clin Psychiatry. 1991 Oct;52(10):415–417. [PubMed] [Google Scholar]
  15. Côté C., Ladouceur R. Effects of social aids and the regulated breathing method in the treatment of stutterers. J Consult Clin Psychol. 1982 Jun;50(3):450–450. doi: 10.1037//0022-006x.50.3.450. [DOI] [PubMed] [Google Scholar]
  16. Davidson A. M., Denney D. R., Elliott C. H. Suppression and substitution in the treatment of nailbiting. Behav Res Ther. 1980;18(1):1–9. doi: 10.1016/0005-7967(80)90063-7. [DOI] [PubMed] [Google Scholar]
  17. Evers R. A., van de Wetering B. J. A treatment model for motor tics based on a specific tension-reduction technique. J Behav Ther Exp Psychiatry. 1994 Sep;25(3):255–260. doi: 10.1016/0005-7916(94)90026-4. [DOI] [PubMed] [Google Scholar]
  18. Foster W. S. Adjunctive behavior: an under-reported phenomenon in applied behavior analysis? J Appl Behav Anal. 1978 Winter;11(4):545–546. doi: 10.1901/jaba.1978.11-545. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Foxx R. M., Azrin N. H. Restitution: a method of eliminating aggressive-disruptive behavior of retarded and brain damaged patients. Behav Res Ther. 1972 Feb;10(1):15–27. doi: 10.1016/0005-7967(72)90003-4. [DOI] [PubMed] [Google Scholar]
  20. Friman P. C. Concurrent habits. What would Linus do with his blanket if his thumb-sucking were treated? Am J Dis Child. 1990 Dec;144(12):1316–1318. doi: 10.1001/archpedi.1990.02150360040016. [DOI] [PubMed] [Google Scholar]
  21. Friman P. C., Hove G. Apparent covariation between child habit disorders: effects of successful treatment for thumb sucking on untargeted chronic hair pulling. J Appl Behav Anal. 1987 Winter;20(4):421–425. doi: 10.1901/jaba.1987.20-421. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Friman P. C. Making life easier with effort: Basic findings and applied research on response effort. J Appl Behav Anal. 1995 Winter;28(4):583–590. doi: 10.1901/jaba.1995.28-583. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Friman P. C., McPherson K. M., Warzak W. J., Evans J. Influence of thumb sucking on peer social acceptance in first-grade children. Pediatrics. 1993 Apr;91(4):784–786. [PubMed] [Google Scholar]
  24. Friman P. C., Schmitt B. D. Thumb sucking: pediatricians' guidelines. Clin Pediatr (Phila) 1989 Oct;28(10):438–440. doi: 10.1177/000992288902801001. [DOI] [PubMed] [Google Scholar]
  25. Glaros A. G., Rao S. M. Bruxism: a critical review. Psychol Bull. 1977 Jul;84(4):767–781. doi: 10.1037/0033-2909.84.4.767. [DOI] [PubMed] [Google Scholar]
  26. Gramling S. E., Neblett J., Grayson R., Townsend D. Temporomandibular disorder: efficacy of an oral habit reversal treatment program. J Behav Ther Exp Psychiatry. 1996 Sep;27(3):245–255. doi: 10.1016/s0005-7916(96)00027-4. [DOI] [PubMed] [Google Scholar]
  27. Hansen D. J., Tishelman A. C., Hawkins R. P., Doepke K. J. Habits with potential as disorders. Prevalence, severity, and other characteristics among college students. Behav Modif. 1990 Jan;14(1):66–80. doi: 10.1177/01454455900141005. [DOI] [PubMed] [Google Scholar]
  28. Horne D. J., Wilkinson J. Habit reversal treatment for fingernail biting. Behav Res Ther. 1980;18(4):287–291. doi: 10.1016/0005-7967(80)90087-x. [DOI] [PubMed] [Google Scholar]
  29. Hunt G. M., Azrin N. H. A community-reinforcement approach to alcoholism. Behav Res Ther. 1973 Feb;11(1):91–104. doi: 10.1016/0005-7967(73)90072-7. [DOI] [PubMed] [Google Scholar]
  30. Iwata B. A., Dorsey M. F., Slifer K. J., Bauman K. E., Richman G. S. Toward a functional analysis of self-injury. J Appl Behav Anal. 1994 Summer;27(2):197–209. doi: 10.1901/jaba.1994.27-197. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Jones K. M., Swearer S. M., Friman P. C. Relax and try this instead: abbreviated habit reversal for maladaptive self-biting. J Appl Behav Anal. 1997 Winter;30(4):697–699. doi: 10.1901/jaba.1997.30-697. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Joubert C. E. Incidence of some oral-based habits among college students and their correlations with use of oral stimulants. Psychol Rep. 1993 Jun;72(3 Pt 1):735–738. doi: 10.2466/pr0.1993.72.3.735. [DOI] [PubMed] [Google Scholar]
  33. Ladouceur R., Boudreau L., Théberge S. Awareness training and regulated-breathing method in modification of stuttering. Percept Mot Skills. 1981 Aug;53(1):187–194. doi: 10.2466/pms.1981.53.1.187. [DOI] [PubMed] [Google Scholar]
  34. Ladouceur R., Martineau G. Evaluation of regulated-breathing method with and without parental assistance in the treatment of child stutterers. J Behav Ther Exp Psychiatry. 1982 Dec;13(4):301–306. doi: 10.1016/0005-7916(82)90074-x. [DOI] [PubMed] [Google Scholar]
  35. Lahey B. B., McNees M. P., McNees M. C. Control of an obscene "verbal tic" through timeout in an elementary school classroom. J Appl Behav Anal. 1973 Spring;6(1):101–104. doi: 10.1901/jaba.1973.6-101. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Lerman D. C., Iwata B. A., Zarcone J. R., Ringdahl J. Assessment of stereotypic and self-injurious behavior as adjunctive responses. J Appl Behav Anal. 1994 Winter;27(4):715–728. doi: 10.1901/jaba.1994.27-715. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Leung A. K., Robson W. L. Stuttering. Clin Pediatr (Phila) 1990 Sep;29(9):498–502. doi: 10.1177/000992289002900901. [DOI] [PubMed] [Google Scholar]
  38. Miltenberger R. G., Fuqua R. W. A comparison of contingent vs non-contingent competing response practice in the treatment of nervous habits. J Behav Ther Exp Psychiatry. 1985 Sep;16(3):195–200. doi: 10.1016/0005-7916(85)90063-1. [DOI] [PubMed] [Google Scholar]
  39. Miltenberger R. G., Wagaman J. R., Arndorfer R. E. Simplified treatment and long term follow-up for stuttering in adults: a study of two cases. J Behav Ther Exp Psychiatry. 1996 Jun;27(2):181–188. doi: 10.1016/0005-7916(96)00016-x. [DOI] [PubMed] [Google Scholar]
  40. Nunn R. G., Azrin N. H. Eliminating nail-biting by the habit reversal procedure. Behav Res Ther. 1976;14(1):65–67. doi: 10.1016/0005-7967(76)90046-2. [DOI] [PubMed] [Google Scholar]
  41. Peterson A. L., Campise R. L., Azrin N. H. Behavioral and pharmacological treatments for tic and habit disorders: a review. J Dev Behav Pediatr. 1994 Dec;15(6):430–441. [PubMed] [Google Scholar]
  42. Peterson A. L., Dixon D. C., Talcott G. W., Kelleher W. J. Habit reversal treatment of temporomandibular disorders: a pilot investigation. J Behav Ther Exp Psychiatry. 1993 Mar;24(1):49–55. doi: 10.1016/0005-7916(93)90008-k. [DOI] [PubMed] [Google Scholar]
  43. Rapp J. T., Miltenberger R. G., Long E. S., Elliott A. J., Lumley V. A. Simplified habit reversal treatment for chronic hair pulling in three adolescents: a clinical replication with direct observation. J Appl Behav Anal. 1998 Summer;31(2):299–302. doi: 10.1901/jaba.1998.31-299. [DOI] [PMC free article] [PubMed] [Google Scholar]
  44. Riley G. D. A stuttering severity instrument for children and adults. J Speech Hear Disord. 1972 Aug;37(3):314–322. doi: 10.1044/jshd.3703.314. [DOI] [PubMed] [Google Scholar]
  45. Rincover A. Sensory extinction: a procedure form eliminating self-stimulatory behavior in developmentally disabled children. J Abnorm Child Psychol. 1978 Sep;6(3):299–310. doi: 10.1007/BF00924733. [DOI] [PubMed] [Google Scholar]
  46. Rosenbaum M. S., Ayllon T. The behavioral treatment of neurodermatitis through habit-reversal. Behav Res Ther. 1981;19(4):313–318. doi: 10.1016/0005-7967(81)90052-8. [DOI] [PubMed] [Google Scholar]
  47. Sharenow E. L., Fuqua R. W., Miltenberger R. G. The treatment of muscle tics with dissimilar competing response practice. J Appl Behav Anal. 1989 Spring;22(1):35–42. doi: 10.1901/jaba.1989.22-35. [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Silber K. P., Haynes C. E. Treating nailbiting: a comparative analysis of mild aversion and competing response therapies. Behav Res Ther. 1992 Jan;30(1):15–22. doi: 10.1016/0005-7967(92)90091-t. [DOI] [PubMed] [Google Scholar]
  49. Tarnowski K. J., Rosén L. A., McGrath M. L., Drabman R. S. A modified habit reversal procedure in a recalcitrant case of trichotillomania. J Behav Ther Exp Psychiatry. 1987 Jun;18(2):157–163. doi: 10.1016/0005-7916(87)90030-9. [DOI] [PubMed] [Google Scholar]
  50. Wagaman J. R., Miltenberger R. G., Arndorfer R. E. Analysis of a simplified treatment for stuttering in children. J Appl Behav Anal. 1993 Spring;26(1):53–61. doi: 10.1901/jaba.1993.26-53. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Wagaman J. R., Miltenberger R. G., Williams D. E. Treatment of a vocal tic by differential reinforcement. J Behav Ther Exp Psychiatry. 1995 Mar;26(1):35–39. doi: 10.1016/0005-7916(94)00068-w. [DOI] [PubMed] [Google Scholar]
  52. Wagaman J. R., Miltenberger R. G., Woods D. Long-term follow-up of a behavioral treatment for stuttering in children. J Appl Behav Anal. 1995 Summer;28(2):233–234. doi: 10.1901/jaba.1995.28-233. [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. Waterloo K. K., Götestam K. G. The regulated-breathing method for stuttering: an experimental evaluation. J Behav Ther Exp Psychiatry. 1988 Mar;19(1):11–19. doi: 10.1016/0005-7916(88)90005-5. [DOI] [PubMed] [Google Scholar]
  54. Watson T. S., Allen K. D. Elimination of thumb-sucking as a treatment for severe trichotillomania. J Am Acad Child Adolesc Psychiatry. 1993 Jul;32(4):830–834. doi: 10.1097/00004583-199307000-00019. [DOI] [PubMed] [Google Scholar]
  55. Watson T. S., Sterling H. E. Brief functional analysis and treatment of a vocal tic. J Appl Behav Anal. 1998 Fall;31(3):471–474. doi: 10.1901/jaba.1998.31-471. [DOI] [PMC free article] [PubMed] [Google Scholar]
  56. Woods D. W., Miltenberger R. G. Are persons with nervous habit nervous? A preliminary examination of habit function in a nonreferred population. J Appl Behav Anal. 1996 Summer;29(2):259–261. doi: 10.1901/jaba.1996.29-259. [DOI] [PMC free article] [PubMed] [Google Scholar]
  57. Woods D. W., Miltenberger R. G., Flach A. D. Habits, tics, and stuttering. Prevalence and relation to anxiety and somatic awareness. Behav Modif. 1996 Apr;20(2):216–225. doi: 10.1177/01454455960202005. [DOI] [PubMed] [Google Scholar]
  58. Woods D. W., Miltenberger R. G. Habit reversal: a review of applications and variations. J Behav Ther Exp Psychiatry. 1995 Jun;26(2):123–131. doi: 10.1016/0005-7916(95)00009-o. [DOI] [PubMed] [Google Scholar]
  59. Woods D. W., Miltenberger R. G., Lumley V. A. Sequential application of major habit-reversal components to treat motor tics in children. J Appl Behav Anal. 1996 Winter;29(4):483–493. doi: 10.1901/jaba.1996.29-483. [DOI] [PMC free article] [PubMed] [Google Scholar]
  60. Wright K. M., Miltenberger R. G. Awareness training in the treatment of head and facial tics. J Behav Ther Exp Psychiatry. 1987 Sep;18(3):269–274. doi: 10.1016/0005-7916(87)90010-3. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Applied Behavior Analysis are provided here courtesy of Society for the Experimental Analysis of Behavior

RESOURCES