Habit Reversal

Habit Reversal
Ron Allen and Jeff Kupfer
Simmons University (Boston) and University of Colorado (Denver)

The publication of the initial analog Functional Analysis study (Iwata et al., 1982/1994) marked a quantum change in applied behavior analysis. The standard strategy of decreasing the probability of challenging behaviors by replacing them with socially-sanctioned (and hopefully functionally-equivalent) behaviors could now proceed in a function-informed fashion. It has been suggested that this quantum change also marked the true transition from Behavior Modification to Behavior Analysis for our science. Rightly so.

Like any shift in scientific practice, the adoption of FA as standard procedure was accompanied by the drifting away from previously common interventions (e.g., punishment procedures). In retrospect, however, the field may have also drifted away from some highly successful practices during the quantum change. One such less-used practice may be what is termed Habit Reversal. Habit Reversal, first introduced by Azrin & Nunn (1973), refers to a focused collection of behavioral procedures implemented to reduce the frequency of challenging behaviors (nervous habits) which are collectively characterized by un-identified function. Such behaviors include tics, nervous habits (including nail biting, hair pulling (trichotillomania) or twirling, and thumb or finger sucking, lip, mouth, or tongue biting and teeth grinding, and other repetitive movements such as scratching and object manipulation), and stuttering (Miltenberger, Fuqua, & Woods, 1998). These habit behaviors were frequently defined by topography, rather than function. Habit Reversal is generally conceptualized as having four treatment components: Awareness Training, Competing Response Training, Motivation Procedures, and Generalization Training.

In their seminal 1973 study, Azrin and Nunn treated 12 individuals, 10 adults and 2 children, ranging in age from 5 to 64 years. None of the volunteer participants presented with intellectual limitations, but each participant reported engaging in undesired nervous habits including head and shoulder tic movements, lisping, plucking eye lashes, thumb, hand, and gum sucking, and finger-nail biting. In a one-day counseling session all participants completed each component of the Habit Reversal intervention. During Awareness Training participants worked to fully describe the topography of the habit, identifying each occurrence of the habit, and identifying the earliest component of each habit response. In competing Response Training each participant was trained to perform a response whose topography was incompatible with the target response. For example, an individual engaging in head-jerk tics was trained to tense their neck muscles, making head tics impossible. The clients were instructed to engage in the competing response for approximately 3 minutes either in anticipation or occurrence of the target behavior. Under Motivation Procedures individuals reviewed the embarrassment and limitations their habits created in their lives. Additionally, family and friends were instructed to praise efforts at target control, as well as periods without target occurrence. Under Generalization Training participants engaged in Symbolic Rehearsal Procedures where they discussed and imagined scenarios in which target behaviors were often evoked. When such scenarios were imagined, participants were prompted to engage in the Competing Response.

Azrin and Nunn reported that the one counseling session resulted in self-reported 95% reduction in target responding (averaged across the 12 participants) after 1 day, 97% reduction after 1 week, and approximately 99% reduction after three weeks. Profound social significance following a single session.

In 1974, Azrin and Nunn extended Habit Reversal procedures to target stuttering. The participants were 14 individuals with ages ranging from 4 to 67 years of age. None of the volunteer participants presented with intellectual challenges, but each presented with significant stuttering. Each participant was exposed to the four general sets of procedures described above. Under Awareness Training each individual worked to describe in detail the topography of their stuttering, the situations and words that evoked stuttering, and any body movements associated with stuttering. During Incompatible Response Training participants were taught a combination of controlled breathing and speech-pausing, along with relaxation training. Under Motivation procedures individuals reviewed the embarrassment and limitations that stuttering created in their lives. Additionally, family members and other stakeholders were instructed to prompt and reinforce incompatible behaviors along with non-stuttering speech. Finally, under Generalization Procedures individuals reviewed and imagined situations typically evoking stuttering while practicing incompatible responses. Similar to the results noted above, after one counseling session participants self-reported a 94% reduction in stuttering after 1 day, 95% after 2 weeks, 97% after one month, and 98% after 4 months.
The results reported by Azrin & Nunn (1974) have been replicated and extended with variations in the treatment components originally proposed for Habit Reversal (Miltenberger, Wagaman, & Arndorfer, 1996; Wagaman, Miltenberger, & Arndorfer, 1993; Wagaman, Miltenberger, & Woods, 1995).

In one of the authors own lab, a doctoral candidate, already a Licensed Speech/Language Pathologist and a BCBA, completed a dissertation (Nostin, 2020) treating stuttering of two adolescents with Habit Reversal procedures. Under a multiple baseline across settings design, both applicants were taught to detect stuttering (from an audio recording of themselves), to define the topography of the stuttering, and to match the identified topography with an incompatible response under a gamified contingency. The frequency of stuttering decreased progressively across settings with such awareness training. One might wonder why behavior analysis in the form of habit reversal is not noted at the forefront of the treatment of stuttering and other challenging disorders (e.g., tic disorders).

Both the maturation of our science, with innovations such as function-informed treatment provided by functional analysis procedures, and the overwhelming focus on treatment of autism spectrum disorders has been very successful for behavior analysis. However, our current focus may be at the cost of broader application and less frequent “treatment miracles” such as those seen in some of the early habit reversal literature.


Azrin, N. H., & Nunn, R. G. (1973). Habit reversal: A method of eliminating nervous habits and tics. Behaviour Research and Therapy, 11, 619-628. DOI: 10.1016/0005-7967(73)90119-8

Azrin, N. H., & Nunn, R. G. (1974). A rapid method of eliminating stuttering by a regulated
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Iwata, B. A., Dorsey, M. F., Slifer, K. J., Bauman, K. E., & Richman, G. S. (1994). Toward a functional analysis of self injury. Journal of Applied Behavior Analysis, 27, 197–209. (Reprinted from Analysis and Intervention in Developmental Disabilities, 2, 3–20, 1982) DOI: 10.1901/jaba.1994.27-197.

Miltenberger, R. G., Fuqua, R. W. & Woods, D. W. (1998). Applying behavior analysis to clinical problems: review and analysis of habit reversal. Journal of Applied Behavior Analysis, 31, 447-469. DOI: 10.1901/jaba.1998.31-447

Miltenberger, R. G., Wagaman, J. R., & Arndorfer,R. E. (1996). Simplified treatment and long-term follow-up for stuttering in adults: A study of two cases. Journal of Behavior Therapy and Experimental Psychiatry, 27, 181–188. DOI: 10.1016/0005-7916(96)00016-x

Nostin, S. (2020) Use of Habit Reversal in the Treatment of two Adolescents Who Stutter. Submitted Dissertation to the College of Natural, Behavioral, and Health Sciences of Simmons University (December, 2020).

Wagaman, J. R., Miltenberger, R. G., & Arndorfer, R. E. (1993). Analysis of a simplified
treatment for stuttering in children. Journal of Applied Behavior Analysis, 26 (1), 53-61. https://doi.org/10.1901/jaba.1993.26-53

Wagaman, J. R., Miltenberger, R. G., & Woods, D. W. (1995). Long-term follow-up of a
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