What is “habit reversal training” and how can it change my life?

1: Mandy walked into the counselling center at Mississippi State University.  She was 24 years old.  For as long as she could remember, she had bitten her nails.  

“Lots of people bite their nails,” Charles Duhigg writes in The Power of Habit.  “For chronic nail biters, however, it’s a problem of a different scale.  Mandy would often bite until her nails pulled away from the skin underneath.  Her fingertips were covered with tiny scabs.  The end of her fingers had become blunted without nails to protect them and sometimes they tingled or itched, a sign of nerve injury.”

Her raw fingers made Mandy feel embarrassed.  She often kept her hands in her pockets.  When she went on dates, she would ball her hands into fists.

“She had tried to stop by painting her nails with foul-tasting polishes or promising herself, starting right now, that she would muster the willpower to quit,” Charles writes.  “But as soon as she began doing homework or watching television, her fingers ended up in her mouth.”

Mandy was desperate.  

“What do you feel right before you bring your hand up to your mouth to bite your nails?” asked the psychologist, who was studying a treatment known as “habit reversal training.”

At first, Mandy had trouble coming up with reasons.  As they talked though, an answer became clearer:  “There’s a little tension in my fingers,” Mandy said.  “It hurts a little bit here, at the edge of the nail.  Sometimes I’ll run my thumb along, looking for hangnails, and when I feel something catch, I’ll bring it to my mouth.  Then I’ll go finger by finger, biting off the rough edges.  Once I start, it feels like I have to do all of them.”

2: The key to habit reversal training is identifying the three steps of the habit loop: Cue, Routine, Reward.  

The physical tension Mandy felt in in her fingers was the “cue.”  Biting her nails was the “routine.”  And, the completeness Mandy felt after biting all of her nails was the “reward,” a physical feeling she had come to crave.

The therapist gave Mandy some homework.  She was to carry around an index card and make a check mark each time she felt the “cue” or tension in her fingers.

Mandy returned to the clinic a week later with 28 checks on her index card.  She was now “acutely aware of the sensations that preceded her habit,” writes Charles.  “She knew how many times it occurred during class or watching television.”

3: Next, the therapist explained: whenever Mandy felt the tension in her fingertips, she was to grip a pencil or put her hands under her legs or some other action that made it impossible to put her hands in her mouth.  Then she was to rub her arm or rap knuckles on the desk or do anything that would produce a physical response.

“The cues and the rewards stayed the same,” Charles observes.  “Only the routine changed.”

They practiced for a half hour in the office.  The therapist suggested Mandy continue to make marks on her index card, but now she was to add a hash mark when she was able to successfully “override” her nail-biting habit.

“A week later, Mandy had bitten her nails only three times and had used the competing response seven times,” Charles writes.  She continued tracking her progress with her index card: “After a month, the nail-biting habit was gone. The competing routines had become automatic.”

A new habit had replaced the old one.  

“It seems like it should be more complex.  The truth is the brain can be reprogrammed.  You just have to be deliberate about it,” says Nathan Azrin, one of the developers of habit reversal training.  “Once you recognize the cues and rewards, you’re halfway to changing it.”

Habit reversal therapy is now used to treat depression, smoking, gambling problems, anxiety, bedwetting, procrastination, and obsessive-compulsive disorders.

The fundamental principle of habit reversal training?

We don’t truly understand the cravings driving our behaviors until we take the time to identify them.

More tomorrow.

______________________

Reflection:  What is a habit I would like to stop?  Take some time to identify the cue, the routine, and the reward.  What is the underlying craving that makes the reward so pleasing?  What changes can I make to interrupt the current process?  

Action:  Journal about it. Track my progress. Today.

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