The Way Doctors Break Bad Habits

April 24th, 2009

When I set out to break my nail biting habit once and for all, I came across a lot of advice. I looked at much of it with contempt; a long-time habit can’t be broken with tips alone. I knew there were experts who dedicated their lives to studying habits and finding cures. I knew there were regular people who conquered their habits as a result. So after I studied the basal reasons people have bad habits, I decided to troll even the dustiest medical journals and find a once-and-for-all, tried-and-true, real-deal solution. I set out to find how academics who specialize in breaking habits, break habits themselves.

Nail biting is a good example for study. This habit has been around forever, isn’t age or finance restricted like smoking or drinking, and involves both oral and muscular habits. This article will use the nail-biter’s perspective; however, the lessons can be broadly applied.

Although statistical studies of habits can be tracked back to pre-WWII texts, the challenge of actually correcting habits has only been undertaken more recently. Here are some of the keynote studies in the area:

• Smith (1957) explored negative practice therapy. This technique reported 39% of clients cured and 47% unimproved.
• Bucher (1968) analyzed self-administered shock procedures. This technique resulted in a 65% success rate; however, there were many relapses after therapy was discontinued.
• Azrin and Nunn (1973, 1974) developed habit reversal training (HRT). Today, HRT is the preferred procedure and its efficacy has been proven in a number of scenarios.

Habit Reversal Facts

• Pioneered by two Illinois researchers, N. H. Azrin and Dr. R. Gregory Nunn
• Studied mostly between 1973 and 1980
• Refined and simplified in the 80s
• Has shown a 99% habit improvement rate throughout a five month follow-up
• Outperformed a placebo in a 2003 study, meaning it has been proven effective, even recently

While there have been up to nine components used in Habit Reverstal Training, three are important, and two are essential:

Important Components

Relaxation Training: Using breathing and visualization techniques to promote muscle and mental relaxation; promotes self control.

Contingency Management: Encouragement of the improved behaviour by friends and family; engaging in activities that benefit from the bad habit being broken.

Generalization Training: Practical maintenance of skills learnt from HRT in everyday life; helps to prevent relapse when training is weaned.

Essential Components

Awareness Training: Involves bringing the habit to the forefront of the mind. It includes some or all of the following:

• Recording occurrences consistently
• Performing the action in an observable way (before a mirror or video recorded)
• Examining the details of each occurrence (the muscles, thoughts, and movements used)
• Having others draw attention to your action
• Drawing attention to the action oneself (clapping, saying a phrase)

Competing Response Training: Involves replacing the action with another one. The competing response should be:

• Opposite to the habit (eg. fist clenching rather than nail biting)
• Preventing the habit action from occurring
• Socially inconspicuous
• Performed for more than a moment (one to three minutes, per occurrence)
• Performed upon urge or action of the bad habit

Creating a daily routine based this training framework can help you overcome even the most deeply rooted habits. It’s a proven system. Nevertheless, as with most major endeavours in life, HRT can succeed or fail based on dedication alone. Undertaking a lengthy training regimen, along with the support your family or friends, requires enthusiasm, stick-to-itiveness, and consistency. HRT is no miracle solution, it’s a quintessential “no pain, no gain” venture.

When it comes to breaking a bad habit, there’s no shortage of cheap advice and cheaper products to “help” you do so. They don’t work. Our sense of hope persuades us into believing otherwise, but we all know it’s not true. The bottom line is that correcting years of habit repetition takes hard work and the right tools. HRT offers the right tools, but only you can provide the hard work.