DURING-THE-BEHAVIOR METHODS

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Substitute a new response to replace the unwanted habit: Habit Reversal Training.

 An old habit can be broken by replacing it with a new, more desirable habit. Azrin and Nunn (1977) use this approach to controlling habits (see chapter 4). A similar concept is used in two other situations: (l) more acceptable responses can replace unwanted habits, e.g. one could listen instead of give advice or chew gum instead of smoking, and (2) a better way of meeting one's needs could be found, e.g. one could handle loneliness by learning social skills rather than by watching TV or by joining a support group rather than merely complaining to relatives about having nothing to do.

Purposes

 Obviously, there is a similarity to method #2. This is more a simple substitution at the time the old response starts. There is a lot of advanced preparation in method #2.

Steps

STEP ONE: Become highly aware of the unwanted habit.

 Learn to recognize when the unwanted habit was about to begin. Watch the habit occurring, note which muscles move and how they move. Attend to when and under what conditions the habit occurs. Do this over and over and for a few days keep a record of every time the habit happens. You need to know the habit well, including its base rate.

STEP TWO: Select a substitute behavior and be prepared to use it.

 Think of a desirable substitute. Make the necessary arrangements to carry out the new behavior. Example: if you are going to eat celery instead of a regular meal or jellybeans instead of smoke cigarettes, the celery must be bought and cut and the jellybeans bought in advance.

 To overcome a habit, the new response should be (l) not distracting to others, (2) able to prevent the old response and ideally (3) something you can do for 3 minutes while carrying on normal activities. Examples: feel the change in your pocket instead of the bad habit of pulling your hair or pressing your foot against the floor instead of the habit of nervously shaking your leg (see chapter 4). Sometimes the substitute behavior can't be held for 3 minutes, for instance if one has an eye blink tic, the new behavior might be gently and discretely closing the eyelids for only a few seconds.

 As with any other well ingrained habit, it is difficult, in the beginning, to try to satisfy well established needs or behavior patterns in another way. Even when substitute activities are already organized and welcoming you to use them, it may be hard to change: it is considered so hard for alcoholics to go to Alcoholics Anonymous that many people believe they must "hit bottom" before they are desperate enough to join AA. Many of the same social needs for camaraderie and power and acceptance are satisfied in AA or in church as were met in the bars, but not all of them. It's still hard to go. Similarly, it is hard to seek out self-help groups, like a club for single parents, or a therapist. Although it's difficult, consider the consequences of not changing.

STEP THREE: The substitute response may need to be practiced. Exactly what competing behavior you intend to use must be well thought out.

 The overriding response, say pressing your foot against the floor (so no one notices), to an urge to perform a habit, such as anxiously bouncing your leg, may need to be done in front of a mirror until you look natural and can do other things, like talk, at the same time. Action designed to replace the bad habit must be so well planned and practiced, so it can be used immediately (before the unwanted habit occurs).

STEP FOUR: Make the substitution at every opportunity.

 Every time you feel the slightest tendency or urge to do the old habit, perform the new response. Be especially watchful when you are in the situation where the habit usually occurs, e.g. if you bite your nails while studying, be alert for the first tendency--say just touching your face--to bite the nails and immediately carry out your competing response which might be making your hands into a fist instead of extending your finger into your mouth.

 In many self-help projects to overcome a bad habit, it may be helpful for the person to continue the substitute behavior for a minute or two after it has overcome the unwanted urge. Try to stop the unwanted habit every time. Don't give up too quickly... habits do not die easily.

Time involved

 Relatively little time ordinarily is involved in this simple method, just thinking of an alternative, practicing it, and assuring that you faithfully substitute the alternative behavior. On the other hand, don't expect quick results in every case. Often the unwanted habit decreases in a few days but it ain't dead yet. If you stop the habit reversal at that point, the old habit is likely to come back. Don't be surprised if it takes two or three months to truly conquer the old habit. Remember old habits may never die completely--millions of smokers have gone back to smoking weeks or months after "breaking the habit."

Common problems with this method

 Sometimes the substitutes have unwanted consequences, e.g. eating instead of smoking may increase your weight (usually by only a few pounds--and that can be guarded against). Perhaps the most difficult aspect of this method involves the fact that many unwanted habits occur when we are occupied by some other activity...or when we are tired, sleepy, and not alert. Becoming aware enough to catch the onset of the bad habit may be hard, requiring special attention and effort until the habit weakens. Each relapse or failure is like dropping a ball of string you are winding; it is a challenge (but important) to keep the old habit from occurring at all.

Effectiveness, advantages and dangers

 Azrin and Nunn (1977) claim the method is very effective, successful over 90% of the time. This success rate was with people who completed a therapist-administered treatment of this kind. How many people actually complete a strictly self-help project, as recommended in the their book, is unknown. However, a 90+% success rate is impressive.

 This is a simple way to break certain simple habits. Even in more complex situations you may find ways to meet pressing needs in more acceptable ways. This doesn't require a radical modification of one's needs. Yet, there is ample evidence that people resist learning new behaviors: many refuse to go to AA and psychotherapy. Consider how many marital problems and parent-child conflicts are never dealt with in counseling or marriage enrichment programs. Also, relatively few people seek help in helping themselves. We don't know why.

There are no known dangers.

Additional readings

Negative practice; satiate old response; paradoxical intention; stop suppressing unwanted thoughts.

 We can learn from intentionally making mistakes, called "negative practice." For instance, I often type ie instead of ei. This could be corrected by my practicing typing "wie ght" or "thie r" over and over (as long as I remained aware that I was doing it wrong). Tics (jerking muscles) have been cured by negative practice, i.e. doing it over and over willfully rather than against your will. A similar method is described next.

 If you are a compulsive house cleaner, being asked (by a therapist) to spend twice as much time cleaning can be taxing. If you do it, however, and the therapist then seriously suggests that you dust everything, wash all the dishes (clean ones too), and wax the floors twice a day, it becomes ridiculous--hopefully, you can even see how funny your cleaning needs are becoming. The procedure of asking the person, or yourself, to do the unwanted and already-too-frequent behavior even more often is called "paradoxical intention." This method is discussed in detail in chapter 14, method #6.

 Many unwanted habits become unpleasant when they are continued for a long time, i.e. satiated. Example: if one smokes too much it may become nauseating, even to the addicted smoker (especially in a very small room). Being required to bite your nails or to worry continuously for 5 minutes every hour may become unpleasant (see "aversive conditioning"--method #18). Thus, these behaviors should occur less frequently.

 In some instances, paradoxical behaviors result in the person saying "enough is enough" and learning a new behavior. In other instances, the continuation of the unwanted behavior becomes punishing and so we drop it. In other situations, an unwanted behavior that seems determined to occur in spite of your opposition will go away as soon as you start demanding paradoxically that the behavior occur more frequently (like a crying child, who hopes he/she is bothering you, stops when asked to cry harder and longer). In the opposite direction, Wegner (1989) contends that obsessions develop because we try to suppress them, which causes the thought to come on even stronger. Therefore, the solution is to "stop the stopping" and, instead, just let the thought occur or perhaps encourage it.

Purpose

Steps

STEP ONE: Determine how often the unwanted behavior is occurring.

 See method #8

STEP TWO: Set a goal of drastically increasing the frequency of the unwanted behavior.

 In many applications, the increased frequency eventually makes the situation unpleasant. For this to happen in some cases, the behavior has to be done in special circumstances--like smoking with your head in a box. In other cases, the habit just naturally produces discomfort if overdone.

 In the case of an obsession, say lusting for a coworker, or a worry, it is possible that this unwanted thought results from your repeatedly suppressing it and then letting it happen. When this is the history, it may help to let the fantasy or worry run its course. You could even insist that it occur frequently for a day or two. If the thought is dangerous, however, see a therapist.

STEP THREE: Continue the unwanted behavior until it is very unpleasant or disgusting or loses its strength.

 Hopefully at that point the habit will be punished enough that it is extinguished. Watching yourself in a mirror might increase your distaste for a habit, like nail biting. In other cases, the worry or obsession fades away when you demand that it continue. A strong habit or worry may not go away easily, however, so several attempts to satiate-to-exhaustion might be required.

 Most people are so busy fighting the habit that it doesn't occur to them to change sides and "go with this desperate need." See paradoxical intention in chapter 14. Also, most of us avoid self-punishment, even if it is for a good cause.

 Obsessions are hard to eliminate; success rates with these techniques are about 50% but this is with extreme cases. There is almost no research with common compulsions, such as perfectionism, indecisiveness, rule-boundness, stinginess, workaholism, etc.

 It is a simple idea, sort of "turning the tables." There are some dangers, especially with destructive obsessions. Therapists may encourage a person to dwell on and try to convince him/herself of the validity of ideas like "I'm going crazy" or "I'd be better off dead." The assumption (and hope) is that the contrary, rebellious part inside of us will suddenly start to oppose the dangerous idea instead of pushing it as before. That is too risky to do by yourself without professional help. Yet, the approach could be used with less dangerous thoughts, like "I'm going to fail" or "He/she is probably going out on me." By the way, sarcasm might help, for instance, the falsely accused partner could say, "Yes, I went to bed with three people last night." People have found that repeatedly denying the accusations and saying, "I love you, of course I don't have affairs, it's a silly idea, don't say such things, ..." are usually ineffective (Fay, 1978).

Additional reading


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