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Habit reversal training: catch the habit early and give your hands another job

Halfway through a meeting, your thumbnail is between your teeth again, and you don't remember putting it there. Habit reversal training (HRT) is a behavior therapy for repetitive habits like nail biting, hair pulling, skin picking and tics: you learn to notice the habit early and answer it with a competing response, an action your body can't easily do at the same time. Its best results come from trials where a therapist taught it, and a self-help version has done less well.

Reviewed by our editors~8 min read

What habit reversal training is, and where it comes from

Habit reversal goes back to a 1973 paper by Azrin and Nunn in Behaviour Research and Therapy, which presented it as a way to stop nervous habits and tics. A 2019 review by Lee and colleagues lists the parts of that original method: recording the habit, awareness training, practicing a competing response, building motivation to stop and carrying the practice into everyday settings. Later versions trimmed the package. In a 2003 nail-biting trial, the habit reversal group got awareness training, competing response training and social support, about two hours in all across three sessions.

Awareness training means learning to catch the habit early, including the places where it shows up and the signs that come right before it, like a rough nail edge or an itch on your scalp. A competing response is a deliberate action that's hard to do at the same time as the habit, such as pressing your fingertips together instead of biting. Social support means bringing in someone who knows the plan and can help you notice.

A 2011 meta-analysis of 18 studies found habit reversal helped with tics, nail biting, thumb sucking and stuttering, among other repetitive habits. It has since been tested on hair pulling (trichotillomania) and skin picking. Researchers group these with lip and cheek biting as body-focused repetitive behaviors. For tics and Tourette syndrome, habit reversal is the core of CBIT, a behavioral program for tics that trained therapists deliver over several sessions.

How to choose a competing response

The competing response does most of the work, so it's worth choosing carefully. In the CBIT trial for children, a good one was described as incompatible with the tic but compatible with whatever the child was already doing. A child with a neck-jerking tic, for example, might look forward with the chin slightly down and gently tense the neck muscles. For hair pulling, picking or biting, examples include clenching a fist, sitting on your hands or pressing your fingertips together. Pick one you could hold in a meeting or on a video call without anyone noticing, or you'll skip it exactly where you need it.

Hold it for about a minute, or until the urge fades. The CBIT trial used one minute, and a 2022 self-help study gave instructions of one to three minutes while noting that shorter holds have worked too. The response may not need to be a perfect physical block either. In a 1999 study of 26 children with nail-biting and similar mouth-and-finger habits, a competing response that resembled the habit worked as well as one that didn't, and some programs use a stress ball or clay. If your first choice feels awkward after a week or two, swap it for another one.

You can also change your surroundings so the habit is harder to start, a move behavior therapists call stimulus control. Filing rough nails, wearing a bandage on the finger you bite most or keeping tweezers out of the bathroom are examples. CBIT pairs habit reversal with relaxation training and a look at the situations that keep tics going. On a tense day, progressive muscle relaxation can sit alongside your competing response.

Illustrative example: nail biting in meetings

Jordan is made up, and the example shows how the steps might go, not a result to expect. He's a project manager who finds his nails bitten down by Friday most weeks. For a week, he makes a tally mark on a sticky note every time he catches himself, even halfway through. The pattern surprises him. Most marks come in long meetings where he's listening rather than talking, with his elbow on the table and his thumb rubbing a rough edge on a nail.

That rubbing becomes his warning sign. His competing response is pressing his fingertips flat against his notepad for a minute, which nobody on the call can see. He files his nails on Monday morning and keeps a pen in his hand during calls. His partner agrees to say "hands" quietly when she sees him biting at home and to mention it when she sees him press his fingers instead. After two weeks, his tally is lower on most days, and on a few days it isn't. He looks at those days and finds they're the ones with back-to-back calls, so he adds a stretch break between them.

Habit reversal steps

Pick a single habit to work on and run these steps for two weeks before you judge them. Write the plan on a card or in your phone so you don't have to remember it mid-urge.

  1. Count it for a week. Make a tally mark on a sticky note or in your phone every time you catch the habit, even halfway through. Jot down where you were and what you were doing. This is the awareness part, and it may show the habit starts earlier than you thought.
  2. Find the warning signs. Look at what comes right before the habit. It might be a rough nail edge, an itch, a hand drifting toward your face or a tense jaw, or a feeling like boredom or worry. These signs are your cue to act.
  3. Choose a competing response. Pick a movement that's hard to do while doing the habit and that you could hold in a meeting without anyone noticing. For biting, picking or pulling, a loose fist, pressing your fingertips together or holding a pen could work.
  4. Hold it for about a minute. When a warning sign shows up, start the competing response and hold it for about a minute, or until the urge fades. If you catch yourself mid-habit or only afterward, do it anyway and count the catch.
  5. Make the habit harder to start. Change the places where the habit happens most. File rough nails, put a bandage on the finger you bite, keep tweezers out of the bathroom or wear gloves while you watch TV.
  6. Bring one person in. Tell someone you trust what you're working on. Ask them for a quiet signal when they see the habit, and for a word of credit when they see you use the competing response.
  7. Review the week. Compare your tallies and find where the habit still slips through. Adjust the competing response or the setting there before you take on a second habit.

If you slipped, add it to the tally and look at what came right before it. A missed catch shows you where to watch next time.

Snags you'll probably hit

You only notice afterward. Expect that in the first week, since a long-running habit can happen without any decision you notice. In CBIT, people can start the competing response before, during or right after the tic. Do the same here, and log the catch, since a late catch still tells you where the habit shows up.

The urge comes back after the minute. Run the competing response again. In the 2022 self-help study, people who practiced habit reversal more tended to improve more. If urges keep arriving in waves, urge surfing gives you a way to ride them out while your hands stay busy.

It happens when you're zoned out. Reading, scrolling and driving are classic times, because there's no moment of choice to catch. Stimulus control helps most here, so put a barrier in the way, like gloves at night or a fidget object in the car. Chain analysis can show you what led up to a bad session, step by step.

A slip turns into a lecture. Harsh self-talk after a pulling or picking episode may leave you more tense, and tension can feed the next round. Try a self-compassion break instead of a lecture, then go back to your tally.

Self-help alone stalls. In the 2022 study, 113 people with body-focused repetitive behaviors used self-help instructions for four weeks. Only 57 percent finished the habit reversal version, and 10 percent of those improved by at least 35 percent. If you're stuck after a few weeks, a therapist trained in habit reversal is a reasonable next step.

When to get help instead of going it alone

Tics and Tourette syndrome need a clinician. Get tics diagnosed first, and treat CBIT as a therapist-led program, not a page to follow alone. In a 2010 trial of 126 children and teens, 52.5 percent of those who got eight CBIT sessions over 10 weeks were much or very much improved, compared with 18.5 percent who got supportive therapy and education. A 2012 trial in 122 adults found 38.1 percent versus 6.4 percent. Therapists delivered both programs, and the self-help study above, in a different group of people, found much less.

Damaged skin needs a doctor. If picking or biting leaves open wounds, or a spot turns red, warm, swollen or painful, or you get a fever, see a doctor soon, since those can be signs of infection. Hair pulling that leaves visible bald patches and picking that leaves scars are also reasons to see a clinician rather than going it alone. For trichotillomania, a 2014 meta-analysis of 11 trials found large effects for behavior therapy, larger with more therapist contact hours.

Watch for depression and OCD. If you're low most days, or you have intrusive thoughts and rituals that look like OCD, get those assessed, since habit reversal alone isn't built to treat them. If you pick or pull to hurt yourself on purpose, tell a clinician, and use the crisis contacts at the bottom of this page if you're in danger now. The STOP skill can help you pause in a hard moment, but it doesn't replace care.

Plan your competing response

The chat below runs with Helpy, the site's AI assistant. Tell it which habit you're working on and where it tends to show up, and it can help you pick a competing response that fits that setting and plan your first week of tallies.

Evidence and sources

When a habit needs a clinician

See a doctor or therapist if you have tics, since the strongest research on tics is on therapist-led programs, or if picking or pulling leaves wounds, scars or bald patches. Spreading redness, warmth, swelling or fever around a picked spot need a doctor soon. If the habit comes with low mood most days, obsessions or urges to hurt yourself, get help for those too, and if you're in danger now, use the crisis contacts below.

Important

This is educational self-help content, not a substitute for professional care. If anxiety is intense, sticks around for weeks, or makes daily life hard, reach out to a mental-health professional or doctor. If you’re in crisis or thinking about suicide, get help now: call or text 988 (988 Suicide & Crisis Lifeline), text HOME to 741741 (Crisis Text Line), or call 911 for emergencies. Available 24/7.

Read next

Urge Surfing Script: How to Ride Out a CravingRide out the urgeDBT Chain Analysis: How to Map What Led to a BehaviorMap what sets the habit offProgressive Muscle Relaxation: A Step-by-Step GuideRelease the tension behind it

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