• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia
    • Books
    • eBooks
    • ABPN SA Courses
    • Social Work Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
    • Psychiatry News Videos
    • Medication Guide Videos
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
    • Psychotherapy and Social Work
  • FAQs
  • Med Fact Book App
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » Habit Reversal Training: Optimal Treatment for Tics

Habit Reversal Training: Optimal Treatment for Tics

June 1, 2011
From The Carlat Child Psychiatry Report
Issue Links: Learning Objectives | Editorial Information | PDF of Issue
Caroline Fisher, PhD, MD

Habit reversal training (HRT) is a form of Cognitive Behavioral Therapy that systematically targets tics. The idea behind HRT is that even though tics are generated neurobiologically, they are enhanced by conditioning. Specifically, the urge to have a tic is uncomfortable, and by having one, the discomfort is removed in the short term. The tic is therefore rewarding, and the behavior is reinforced. The more tics one has, the more difficult it becomes to stop having them. In HRT, the object is to refrain from having the tic until the urge passes. Below is a step by step guide to the basics:

  • First, the child is taught to recognize when a tic is coming, either by noting the premonitory
    urge or by the first muscle movements of the tic itself. This is practiced until the child learns to reliably predict tics. (An approach for children who find it difficult to recognize the premonitory urge is to time the frequency of the tics, and then challenge him or her to increase the time between tics, moving perhaps from having a tic every few seconds to having them several minutes apart.)

  • The child is taught to make a competing movement using the same muscle groups: for example, if the tic is to make a kissy noise, the child is taught to blow out or whistle. If the tic is to twist the head to the right, the child is taught to actively move the head left, or make circles with the head. This motion is continued for a few minutes until the urge to tic passes.

  • Often, the child is encouraged to keep a tic diary. Because tics can be worsened or induced by specific situations, this helps identify those situations, and strategies to reduce the influence of those situations are devised.

  • General relaxation and anxiety reducing strategies are also taught, because anxiety itself worsens tics.

  • When a child uses these skills—even when they are not immediately effective—he or she must be rewarded. To that end, therapists work with the family to increase the social support for the child’s use of the strategies in situations outside the therapy office.


The use of competing movements itself is not the therapeutic intervention. Rather, it is the consistent experience of not giving in to the urge to tic that reduces tics overall. Psychoeducation is particularly important, or you risk families thinking you have merely substituted one bizarre motion for another. Habit reversal has been shown to be effective in reducing tics in several studies (for a review, see Himle MB et al, J Child Neurol 2006;21(8):719–725). Although the studies are small and conducted in both children and adults, the outcomes were excellent. The majority of subjects experienced a 50% to 99% reduction in tics. The improvement was generally maintained over the length of the follow up period, the longest of which was six months.
Child Psychiatry
KEYWORDS child-psychiatry psychotherapy
    www.thecarlatreport.com
    Issue Date: June 1, 2011
    SUBSCRIBE NOW
    Table Of Contents
    An Evidence-Based Approach to OCD
    Meds to Treat OCD
    Tourette’s Syndrome: A Brief Summary
    Tic Disorders and Comorbid Conditions
    Habit Reversal Training: Optimal Treatment for Tics
    Which Treatments for Autism Spectrum Disorders Actually Work?
    DOWNLOAD NOW
    Featured Book
    • PB4e_Cover2.png

      Psychiatry Practice Boosters, Fourth Edition (2023)

      Teaches you the key points of 63 of the most clinically relevant studies in psychiatry.
      READ MORE
    Featured Video
    • KarXT (Cobenfy)_ The Breakthrough Antipsychotic That Could Change Everything.jpg
      General Psychiatry

      KarXT (Cobenfy): The Breakthrough Antipsychotic That Could Change Everything

      Read More
    Featured Podcast
    • shutterstock_2432683359.jpg
      Child Psychiatry

      Hidden Dangers: The Fentanyl Crisis and Teen Overdose Prevention

      The Fentanyl overdose crisis is now one of the leading causes of death among adolescents, and it is happening in every corner of the country. Stay with us as we talk about the...
      Listen now
    Recommended
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png

    About

    • About Us
    • CME Center
    • FAQ
    • Contact Us

    Shop Online

    • Newsletters
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN Self-Assessment Courses

    Newsletters

    • The Carlat Psychiatry Report
    • The Carlat Child Psychiatry Report
    • The Carlat Addiction Treatment Report
    • The Carlat Hospital Psychiatry Report
    • The Carlat Geriatric Psychiatry Report
    • The Carlat Psychotherapy Report

    Contact

    carlat@thecarlatreport.com

    866-348-9279

    PO Box 626, Newburyport MA 01950

    Follow Us

    Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

    © 2025 Carlat Publishing, LLC and Affiliates, All Rights Reserved.