okay um we will talk about habit reversal which i have i do have quite a bit of experience with and so um teaching it as well as i've done a little bit of it and it's an extremely effective procedure um in aba that has been shown great with some ocd tendencies so habit research reversal procedure is a four part process the first is we work on awareness training then we work on a competing response then we build motivation and then we do a generalization training so first and this is all for really small behaviors that are look like habits so a lot of the ocd behaviors do fall and then tourette's which is um very comorbid with anxiety all those ticks there's lots of research supporting habit reversal with those ticks so first you bring attention to the ticker the behavior so the person has to somehow monitor their behavior and this helps them gain self-control awareness is usually carried out in really small steps so while watching himself in the mirror the person describes in detail each time they have the behavior so pulling hair and trichotillomania which is pulling out hair um kind of obsessively and it it's you know it's kind of surprising how common it is in you'll see it when you work in high school you'll probably come across it more than once and so what happens is they lose hair in one area and so i mean it's not pulling out hair you know it is considered a type of self-harm but it's not we're not like cutting ourselves or doing something that's gonna could really harm ourselves however it's so embarrassing for these kids because they're losing their hair in certain areas so it really helps you can use habit reversal to help them with it and i found it super effective and it's um you know you really help them you really help you know relieve their anxiety and to stop that whole embarrassment stuff so um i found it just great that's how i got into it is because i was working in a high school and a lot of the it was typically girls were pulling their hair out for whatever reason related to anxiety and it was causing them so much distress at school and embarrassment so i started doing these habit reversal procedures with them and they really did work so well um or like rubbing eyes is another one that um we were going to do research on touching face with this during covid but we kind of got too busy to do but we're going to do a remote application of habit reversal to reduce face touching which face touching is not so much an anxiety i think it can be you can do it so much that's kind of related to anxiety but a lot of people just do it naturally but because of kovid we were telling you know people the cdc was saying let's try to touch our face less so we were thinking we could create a procedure for people to touch their face less and i haven't seen anyone publish that but i still think it would be a great study and this could help with that so you identify and describes in detail the therapist will point out to the person when he carries out the tick um so they can notice it and the person learns to identify the earliest warnings that a tick or impulsive behaviors are about to take place these warning signs signs can be urges sensations or thoughts and the person identifies all the situations during which the tick or impulsive behavior occurs so when i did this part i had them self-monitor on a momentary time sample so every hour for about a minute they think like did i do that during that minute and then they'd also identify kind of the feelings they had if they did do it and they would do that throughout the day it only took a couple seconds every hour so it was easy and they'd put a timer on and they'd do this momentary time sampling on how much it's occurring that also provided us baseline for to determine if this was effective so it kind of served two purposes um competing response so you need once you have good awareness of when you're doing it and how it feels and what it looks like you need a competing response so it's a replacement behavior so it's supposed to replace the behavior um if it can be functional that's great but sometimes you don't know the functions of these so it does have to be incompatible though so it's just something that um it's usually the opposite so when i was doing the hair pulling one we did a fidget toy with their hands so they wouldn't um be able to pull their hair um the face i was also gonna went touching face i was also gonna do a fidget toy for that one but you just have to figure out something that they cannot do their tick with um at the same time their tick and it's not um harming them then i wouldn't really do much with it like the motivation has to be internal to a certain extent like i want to change this because of this and those girls i was working with they really wanted to change it they were super motivated they just didn't know how to stop and they didn't they wanted a full head of hair it was high school and that you know how you look is so important so um but i would definitely not do this without pretty clear ascent on what we're doing why we're doing it and the person being like i want to do this so what you can use it on tick disorders motor tics vocal tits tourette's nervous habits like nail biting hair pulling twirling thumb or finger sucking head to hand to head habits lip mouth tongue biting grinding repetitive moment movement such as scratching stuttering there's been a lot of studies on sittering a lot of people really want to fix their stuttering stuttering because it's so embarrassing um for them i don't think it's actually embarrassing so many people have it but people report like they're so embarrassed by it um i think definitely with kind of um who's in i've we've seen a lot of people in media say they had stutters and whatnot i think it's getting more normalized and maybe it will just be okay to stutter a little bit because it's really not a big deal but um you know if they're reporting embarrassment and want to work on it then yeah help them work on it and so um it works for that yeah i've seen it work i've seen some studies for thumb sucking um you can get a scent on a kid of thumb sucking you just tell them like hey do you want to stop this like this is what your parents are saying about it this is what your teacher are you embarrassed at school thumb sucking and see if they agree like okay yeah i want to stop this so let's work on it um it's sometimes with those little kids in ascent it takes longer like i have i have a three-year-old he just quit but he was on his bottle and i basically chose not to really handle it until he ascended and so we'd talk about it and why we don't need a bottle and you know you can't take your bottle to school and babies have bottles so i just kind of talked him through until he agreed to it and once he agreed to it was really easy to kind of help him move past the bottle to a sippy cup but yeah we can we can still get a scent when the child's little you just sometimes it takes a lot longer and you have to talk to them more about it and kind of put those ideas in their head they take longer to process those ideas so be sure you're grabbing a scent for all this observation so direct observation partial is best but video recording is of course the best you want self-monitor procedures or parent or caregiver monitoring and permanent product is great if you can if there is um some sort of permanent product produced i mean the hair pulling there was you we could see what their head looked like and that was part of our monitoring but some of these do produce some of these do produce permanent product okay so we'll go over the research on habit reversal this one was six female college students and it was a non-concurrent multiple baseline a cross participants and the target behaviors was saying like that is a problem i probably have that problem a little bit too so i don't know if you work with um female um it's not always females it can be either but if you work with teenagers or college students and they want to stop saying like this is a method tongue clicking a lot of teenagers do that in pausing so awareness training including response description and response deletion so they did a habit reversal on that and you can see it worked pretty well they stopped saying their likes and ton tongue clicking and all that so you can really see how effective that can be in this study they did a relaxed um oh that was the title relax and try this instead so it was for maladaptive cell biting this is an older study so again i don't know that they got a scent in this study but um biting self-binding's not great we do want to work on that um but yeah i would recommend getting a scent from the person so it's a 15 year old boy and they did use permanent product so number of spots of blood on a towel and then it was habit reversal so they did a competing response and a relaxation technique and you do want to pair these with mindfulness and relaxation if they're associated with anxiety so treat anxiety too this is a behavioral treatment we're fixing the behavior but if they have symptoms of anxiety they need um treatment for that too whether that's act cbt medication just something so that we can get their anxiety under control and that will help this as well but you can take this behavioral approach on top of it but not all of them are those girls saying like of course there's no reason someone who says like too much might have anxiety so in that case you could just do a habit reversal um so this was a number of blood um counted on the daily handkerchiefs and this worked really well and so he stopped doing his self biting you can see the baseline was all over the place and then we almost flatlined the um we almost took it down to zero completely in both of the treatment conditions okay so this one was a simplified habit reversal for chronic hair pulling i used this one to create my intervention for those girls i had about three girls over the course of working four or five years in high school um so it was three 12 year olds kiddos who were pulling hair so um hair pulling was identified as touching fingers to scalp eyebrow eyelashes for three participants that's the other one they love doing the eyebrows too i had one girl only doing eyebrows so it can be any hair on your face it's not just your head hair video recording for a non-concurrent multiple baseline so they did awareness training competing response training and social support and social support is defined as parents praise and um kind of just promoting the intervention um at the caregiver and teacher level and you can see that they were able to pull down that hair pulling so the girls did a lot better it was a two boys and a girl did a lot better with this habit reversal and you know again i think it really helps them with their self image when you can stop that little the picking of the hair so this is um kind of how that can be successful