Habit Reversal Treatment Manual for Trichotillomania

Abstract

This chapter describes the use of habit reversal for the treatment of trichotillomania in children, adolescents, and adults. Azrin and Nunn developed habit reversal in 1973 for the treatment of a variety of habits including hair pulling (Azrin, Nunn, & Frantz, 1980). A number of studies have shown habit reversal to be an effective procedure for trichotillomania (for a review see Chapter 8 and Elliott & Fuqua, 2000). Habit reversal is comprised of three main treatment components: awareness training, in which the client learns to become aware of each instance of hair pulling; competing response training, in which the client learns to engage in an incompatible behavior contingent on hair pulling or antecedents to hair pulling; and social support, in which a significant other helps the client successfully use the competing response to control the hair pulling (e.g., Rapp, Miltenberger, Long, Elliott, & Lumley, 1998). The protocol outlined below describes the details of habit reversal applied to trichotillomania.