Written by The Midtown Psychology Clinical Team
Midtown Psychology provides personalized therapy for adults and adolescents in New York City, helping clients develop practical skills to manage behavioral, emotional, and mental health concerns.
Updated: 10/23/26
Habit reversal training (HRT) is a behavioral treatment that helps people recognize unwanted repetitive behaviors and practice alternative responses. It is commonly used for body-focused repetitive behaviors (BFRBs), such as trichotillomania (hair-pulling disorder), skin picking, and nail biting. Habit reversal techniques are also used as part of specialized behavioral treatment for tic disorders. Through awareness training, competing responses, and consistent practice, HRT can help people better manage these behaviors in everyday life.
Key Takeaways
- Habit reversal training helps people recognize repetitive behaviors and practice alternative responses.
- HRT is commonly used for hair pulling, skin picking, nail biting, and other body-focused repetitive behaviors.
- Awareness training and competing responses are central components of HRT.
- Some strategies can be practiced at home, while a trained therapist can help personalize treatment.
- HRT and comprehensive behavioral intervention for tics (CBIT) are related but distinct; CBIT incorporates habit reversal techniques into a broader treatment for tic disorders.
- Exposure and response prevention (ERP), rather than HRT, is a first-line psychological treatment for OCD.
Table of Contents
- What Is Habit Reversal Training?
- What Conditions Can Habit Reversal Training Help Treat?
- How Does Habit Reversal Training Work?
- How Does HRT Help With Trichotillomania and Hair Pulling?
- Can You Practice Habit Reversal Training at Home?
- Is Habit Reversal Training Used for OCD?
- What Is the Difference Between Habit Reversal Training and ABA?
- How Does Habit Reversal Training Help With Tics and Tourette Syndrome?
- When Should You Consider Habit Reversal Therapy?
- Frequently Asked Questions
What Is Habit Reversal Training?
Habit reversal training is a behavioral treatment that helps people recognize repetitive behaviors and develop practical ways to interrupt them. These behaviors may happen automatically during activities such as reading, watching television, working, or experiencing stress. HRT helps people identify patterns and practice alternative actions to manage unwanted behaviors more easily.
HRT is commonly used within behavioral treatment approaches for body-focused repetitive behaviors, including hair pulling and skin picking. The International OCD Foundation’s overview of evidence-based treatments for body-focused repetitive behaviors describes behavioral strategies used to address these concerns, including awareness training and competing response training.
Rather than relying on willpower alone, HRT gives people specific skills to use when they notice an urge or recognize a situation in which a behavior is likely to occur. The goal is to improve awareness, practice alternative responses, and reduce the impact of repetitive behaviors over time.
What Conditions Can Habit Reversal Training Help Treat?
Habit reversal training can help address several repetitive behaviors, although the most appropriate treatment depends on the behavior, the person’s symptoms, and their treatment goals.
Common applications include:
- Trichotillomania: Also known as hair-pulling disorder, this condition involves repeated hair pulling that may lead to hair loss, distress, or difficulties in daily life.
- Skin-picking disorder: Also called excoriation disorder, this involves recurrent skin picking that may cause skin damage or interfere with daily activities.
- Nail biting: HRT can help people recognize when they bite their nails and practice alternative responses.
- Other body-focused repetitive behaviors: These may include repeated lip or cheek biting and similar behaviors that can be difficult to interrupt.
- Tic disorders: Habit reversal techniques are incorporated into specialized behavioral treatments for tics, including Tourette syndrome.
These behaviors can follow different patterns and have different triggers. For example, someone may pull their hair without fully noticing it while concentrating, while another person may experience a strong urge before pulling. Treatment should account for these differences instead of assuming that one strategy will work for everyone.
How Does Habit Reversal Training Work?
Habit reversal training uses several complementary techniques to help people recognize repetitive behaviors, practice alternative responses, and apply their skills in everyday situations.
Awareness Training
Awareness training helps people recognize when a behavior occurs and identify the situations, physical sensations, thoughts, or emotions associated with it. Some people notice the behavior only after it has started, while others recognize an urge or movement beforehand.
For example, someone who pulls their hair while working at a computer might begin by noticing where their hands go when they become absorbed in a task. Recognizing this pattern creates an opportunity to respond differently.
Competing Response Training
Competing response training involves practicing an alternative action that is incompatible with the unwanted behavior. The response depends on the specific habit and is practiced when an urge appears or the behavior is likely to occur.
Someone who pulls their hair might practice gently closing their hands, placing their hands on their thighs, or holding an appropriate object with both hands. A person who bites their nails might practice keeping their hands occupied in another way.
The goal is to make the alternative response easier to recognize and use through repeated practice. A therapist can help select an option that is practical, comfortable, and appropriate for the person’s circumstances.
Motivation and Reinforcement
Treatment may include identifying reasons for change, setting realistic goals, and recognizing progress. Positive reinforcement can help people stay engaged with practice, particularly when children are learning new skills.
Progress does not require perfect consistency. Recognizing an urge earlier, using an alternative response, or identifying a previously unnoticed trigger can all provide useful information for refining the treatment plan.
Generalization and Practice
Generalization training helps people use their skills in different settings rather than only during therapy sessions. Depending on their needs, they might practice strategies while working, studying, relaxing at home, or participating in social activities.
As the skills become more familiar, people can work toward using them more consistently in situations where the behavior commonly occurs. Practice between sessions helps them identify what works and where adjustments may be needed.
How Does HRT Help With Trichotillomania and Hair Pulling?
Habit reversal training is an established behavioral approach for trichotillomania, also known as hair-pulling disorder. It helps people identify their pulling patterns, recognize warning signs, and practice alternative responses when pulling is likely to occur.
Hair pulling does not look the same for everyone. Some people pull automatically while reading, studying, driving, or watching television. Others notice an urge or physical sensation beforehand, or find that pulling occurs during boredom, tension, or other emotional experiences. Some experience a combination of these patterns.
Treatment begins by identifying when, where, and how hair pulling occurs. A person may track the activities, settings, sensations, or circumstances associated with pulling to identify opportunities to interrupt the behavior.
What Is a Competing Response for Hair Pulling?
A competing response is an alternative action that makes hair pulling more difficult in the moment. The most appropriate response depends on the person’s pulling pattern and the situation in which it occurs.
For example, someone who tends to pull while watching television might practice gently closing their hands or holding a cushion or suitable fidget with both hands. Someone who notices their hand moving toward their scalp while working might practice placing their hands on their thighs when they recognize the urge.
Treatment may also involve adjusting the environment, such as keeping the hands occupied during activities associated with pulling. The International OCD Foundation’s resources on comprehensive behavioral treatment for hair pulling and skin picking discuss competing responses and other behavioral strategies for addressing these concerns.
HRT does not require a person to blame themselves for pulling or expect every urge to disappear immediately. Instead, treatment focuses on building awareness and practicing skills that can make the behavior more manageable.
Can You Practice Habit Reversal Training at Home?
Yes, people can practice some habit-reversal strategies at home, and regular practice can reinforce skills learned in therapy. However, self-help may not be sufficient when repetitive behaviors are difficult to interrupt, cause significant distress, or result in physical damage.
A simple starting routine can help you recognize your habits and identify strategies worth practicing.
- Notice the behavior. Pay attention to when you pull your hair, pick your skin, bite your nails, or engage in another repetitive behavior.
- Identify patterns. Note the activity, setting, physical sensations, or emotions that tend to occur before or during the behavior.
- Choose a competing response. Consider a safe alternative action that is incompatible with the behavior and practical for the situation.
- Adjust your surroundings. If the behavior commonly occurs during a particular activity, consider keeping your hands occupied or changing your environment to support your goal.
- Review your progress. Notice when you recognize the behavior earlier or successfully practice an alternative response. Use these observations to refine your approach.
For example, if you frequently pull your hair while reading, you might keep a suitable fidget nearby and practice using it when you notice your hand moving toward your hair. If you tend to pick your skin while looking in the mirror, you could adjust that routine and practice an alternative response when you notice the urge.
These are examples of strategies to explore, not a complete treatment plan. A therapist trained in HRT can help you identify relevant patterns, choose appropriate responses, and adapt the strategies to your circumstances.
It is also important to approach setbacks with patience. Returning to a repetitive behavior does not erase the skills you have learned. Reviewing what happened can help you identify triggers and decide what to practice next.
Is Habit Reversal Training Used for OCD?
Habit reversal training and exposure and response prevention (ERP) are different behavioral treatments. Although both may be part of a broader mental health treatment plan, they address different patterns and should not be treated as interchangeable.
HRT is commonly used for body-focused repetitive behaviors, such as hair pulling and skin picking, and habit-reversal techniques are incorporated into behavioral treatment for tic disorders. ERP is a first-line psychological treatment for obsessive-compulsive disorder (OCD). It helps people face obsession-related fears while learning to reduce compulsions and avoidance behaviors.
For example, a person with OCD might repeatedly check a door because of an intrusive fear that it is unlocked. In ERP, the person works with a therapist to practice tolerating uncertainty without repeatedly checking. Someone experiencing trichotillomania might instead focus on recognizing the situations associated with hair pulling and practicing competing responses.
The International OCD Foundation’s guide to exposure and response prevention explains how ERP is used to treat OCD.
Some people experience both OCD symptoms and body-focused repetitive behaviors. A qualified clinician can help determine which concerns need attention and whether HRT, ERP, or another approach is appropriate.
What Is the Difference Between Habit Reversal Training and ABA?
Habit reversal training and applied behavior analysis (ABA) are both behavioral approaches, but they are not the same treatment. HRT focuses specifically on helping people recognize unwanted repetitive behaviors and practice alternative responses. ABA is a broader approach that applies principles of learning and behavior to individualized goals across different settings.
For example, HRT may help someone who repeatedly bites their nails recognize when the behavior occurs and practice an alternative action. An ABA-based intervention may address a broader range of behavioral or learning goals, depending on the individual’s needs and treatment plan.
Although the approaches can share behavioral principles, their methods, goals, and applications differ. The appropriate approach depends on the behavior being addressed and the person’s needs.
If you are searching for habit reversal training in an ABA context, ask a prospective provider about their training, the specific treatment they offer, and how it relates to your goals. HRT and ABA should be described as distinct services unless a provider confirms that both are available.
How Does Habit Reversal Training Help With Tics and Tourette Syndrome?
Habit-reversal techniques are used in behavioral treatment for tic disorders, including Tourette syndrome. A specialized treatment called Comprehensive Behavioral Intervention for Tics (CBIT) incorporates habit reversal along with other strategies to help people understand and manage their tics.
Some people experience a physical sensation or urge before a tic occurs. During treatment, they learn to recognize these sensations and identify situations in which their tics are more likely to happen. They then practice an appropriate competing response when they notice the warning signs.
For example, someone who experiences a head-rubbing tic may learn to use a different, compatible movement when they recognize the urge. A trained clinician helps select a response based on the specific tic and the person’s circumstances.
CBIT also includes education about tics and strategies for managing relevant environmental factors. Relaxation skills may be included when appropriate. The Centers for Disease Control and Prevention’s overview of Tourette syndrome treatment describes CBIT as an evidence-based behavioral treatment for Tourette syndrome and chronic tic disorders.
HRT and CBIT are related, but they are not interchangeable: habit reversal is one component of CBIT, which combines several behavioral strategies for tic management. You can learn more about therapy for Tourette syndrome and the treatment approaches used to help people manage tics.
When Should You Consider Habit Reversal Therapy?
Consider seeking professional support if hair pulling, skin picking, nail biting, tics, or another repetitive behavior is causing distress, interfering with everyday activities, or becoming difficult to manage independently.
You may also want to explore treatment if you have tried changing the behavior on your own but have difficulty identifying triggers or maintaining new habits. A therapist can help you understand the behavior, select appropriate strategies, and develop a plan for practicing skills outside sessions. Individual therapy in NYC can provide individualized support, with therapeutic approaches tailored to your needs and goals.
When looking for habit reversal therapy near you, consider asking a prospective provider:
- What experience do you have treating my specific behavior or concern?
- How do you assess the patterns and situations associated with the behavior?
- What treatment methods do you use, and how are they tailored to individual needs?
- How will we practice and review strategies between sessions?
- How will we evaluate progress and adjust treatment if needed?
Choosing a provider who understands the specific behavior you want to address can help ensure that the treatment approach fits your needs.
Frequently Asked Questions
What Is Habit Reversal Training Used For?
Habit reversal training is commonly used to address body-focused repetitive behaviors, including hair pulling, skin picking, and nail biting. Habit-reversal techniques are also incorporated into behavioral treatments for tic disorders. The approach helps people recognize patterns and practice alternative responses.
Does Habit Reversal Training Work for Hair Pulling?
HRT is an established behavioral treatment for trichotillomania. It helps people identify pulling patterns, recognize warning signs, and practice competing responses. Treatment is individualized, and progress varies according to the person’s needs, circumstances, and practice.
Can You Do Habit Reversal Training Without a Therapist?
You can practice basic awareness strategies and some alternative responses independently. However, a trained therapist can help identify patterns, select appropriate competing responses, and adjust the approach to your needs. Professional support can be particularly helpful when the behavior causes distress or physical damage.
Is Habit Reversal Training the Same as CBT?
HRT is a specific behavioral treatment that may be used within a broader cognitive behavioral therapy (CBT) approach. CBT includes a range of methods for addressing thoughts, feelings, and behaviors, while HRT focuses on awareness, competing responses, and practice to manage repetitive behaviors.
Is Habit Reversal Training Used for OCD?
HRT is not the primary psychological treatment for OCD. Exposure and response prevention (ERP) is a first-line treatment that helps people face obsession-related fears while reducing compulsions and avoidance. A clinician can help determine which approach is appropriate for the symptoms being treated.
How Long Does Habit Reversal Training Take?
Treatment length varies depending on the behavior, its frequency, the person’s goals, and their response to treatment. A therapist can discuss an individualized plan and review progress over time. Regular practice between sessions may help reinforce the skills learned during treatment.
About Midtown Psychology
Midtown Psychology provides therapy services for adults and adolescents in New York City. The practice works with individuals from a range of backgrounds and offers support for concerns including anxiety, depression, trauma, relationships, self-esteem, life transitions, and personal growth. Learn more about the Midtown Psychology team and the practice’s approach to personalized care.
Get Started With Habit Reversal Training at Midtown Psychology
If hair pulling, skin picking, nail biting, or another repetitive behavior is affecting your daily life, professional support may help you understand your triggers and explore practical strategies for managing the behavior. Treatment can be tailored to your concerns, circumstances, and goals.
Contact Midtown Psychology to discuss the repetitive behaviors you would like help managing and explore which treatment options may fit your needs in New York City.