Habit reversal training

Habit reversal training (HRT) is a "multicomponent behavioral treatment package originally developed to address a wide variety of repetitive behavior disorders".

Behavioral disorders treated with HRT include tics, trichotillomania, nail biting, thumb sucking, and skin picking. It consists of five components:
 * 1) awareness training,
 * 2) competing response training,
 * 3) contingency management,
 * 4) relaxation training, and
 * 5) generalization training.

In the case of tics, these components are intended to increase tic awareness, develop a competing response to the tic, and build treatment motivation and compliance. HRT is based on the presence of a premonitory urge, or sensation occurring before a tic. HRT involves replacing a tic with a competing response, a more comfortable or acceptable movement/sound, when a patient feels a premontory urge building. Controlled trials have demonstrated that HRT is an acceptable, tolerable, effective and durable treatment for tics.

In 2008, the Behavior Sciences Consortium of the Tourette Syndrome Association (TSA) released three procedural manuals on the evidence-based treatment protocol called the Comprehensive Behavioral Intervention for Tics (CBIT). CBIT combines habit reversal training with relaxation training, psychoeducation, social support, and functional interventions and has been shown to be as effective as medication in reducing tic symptoms.