Habit_Reversal
Habit_Reversal
Habit_Reversal
Hypnotherapy Toolkits
Habit Reversal
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HABITS
DEFINING THE PROBLEM
A habit is a behaviour that people have You can use what you learn to help
learned through continued repetition people develop healthy behaviours such
We all have them. People will often as eating well. You can also use the
think of seeing a therapist for stopping protocol for a once functional behaviour
an unwanted habit, and they may not be that has now become dysfunctional, such
aware that a therapist can help them as during Coronavirus touching your face.
build healthy habits. Therapy is also
about creating healthy habits; explaining The techniques for habits have broad
this to your client can help them in their application if you consider that all we are,
journey. are habits then any behaviour could
potentially be dealt with using these
According to Salter, all we are is habits, techniques, though some techniques may
which can be a helpful psychoeducation be suited to motor habits like habit
point for your client. We develop reversal.
conscious habits, such as healthier
eating habits, but we may also create Key Points
unhealthy ones such as nail-biting, skin
picking, nervous ticks, hair twirling, lip
biting,hair plucking and nose picking. The four most common classes of habit
dealt with are nailbiting, hair pulling,
stuterring and nervous tics.
Habits can seem unconscious, but it is
Examples of other habits nose-picking,
better to view them more as automatic itch-scratch cyle, knuckle cracking,
ways of coping or automatic things we smoking
have learned. Notably, with habit Habits are dealt with by increasing self
reversal, an empowering principle is that awareness , installing a counter habit,
practice and social support., aversion
what has been learned can be
therapy and negative practice.
unlearned. Very key to habit reversal is awareness
raising if you raise awareness and bring the
In this toolkit, we focus on the protocol habit within a persons control they will find
it easier to stop.
for unwanted habits, but you will be able
Remember habits can also be a habit of
to use our suggestions in other areas. worry but this would be dealt with using
another protocol such as thought stopping.
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HABITS
TYPICAL FEATURES AND APPROACH
Aversion therapy
Would be used for harder habits like
smoking. Please see our Smoking CPD
Course. The simple principle is
something aversive is paired with the
desired object, for example, imagining
wriggling worms when imagining
chocolate.
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HABITS
TYPICAL FEATURES AND APPROACH
Thought Stopping
Useful for unhelpful habits of thinking that
may well be connected to a physical habit
for example a client may begin a habit of
Assessment and treatment are
ruminating in response to difficult work
interwoven and a second session may
and then start twiddling their hair or
well be a follow-up to reinforce their
clenching their jaw in response to the
learning.
anxiety created by an unhelpful thinking
pattern. It can be used across client issues
However, there may be some clients
for example stopping thinking trains
where assessment reveals more
associated with being alone and unhelpful
widespread anxiety. In these situations,
thinking about the behavior of a boss.
it is appropriate to consider a longer
treatment plan with habit reversal being
Typical Number of Sessions included in the treatment plan.
We think for habit reversal one to two Start with a careful assessment.
sessions will be all your client requires for
a simple habit if they come to the session
with a completed diary.
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HABITS
ASSESSMENT CONSIDERATIONS
Remember
You will complete a two part
assessment one for habit reversal and
one general assessment.
It might not seem relevant to do a general You may need tools such as a mirror
assessment for a client coming in for a on hand to help your client start to
simple habit problem. However, as you become aware of their habit.
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EXAMPLE TREATMENT PLAN
ASSUMING NO COMPLICATED FACTORS
Session 2: Optional
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HABITS
TYPICAL FEATURES AND APPROACH
Maintaining Behaviours
Typical features of a client
They are unaware of all the
.What are some reasons for the behaviour
maintaining behaviours.
and how is it maintained? They are unaware of all the
behaviours leading up to doing the
A habit is a behaviour that people have habit
learned through continued repetition and They are unaware of the negative
reinforcement. effects of their habit.
Maintaining Beliefs
Maintaining Affect
Clients may think they have no control
over their habit because it appears to The habit is rewarding find out how and
happen unconsciously. This may maintain give the client a replacement
beliefs of hopelessness about the behaviour. As an example, if the client
behaviour. Check self efficacy. does the behaviour when nervous
doing the behaviour allows relief which
They may assume that because the is rewarding but it doesn't fix the
behaviour is negative/unwanted they will problem.
be unable to take charge of it, they may
have tried being overcontrolling which Doing the behaviour results in a short
has the effect of the habit growing. term reduction of feelings but a long
term issue because they will then judge
They might engage in all sorts of themselves and engage in lots of
unhelpful thinking around the habit, such unhelpful thinking around doing the
as berating themselves for not giving the behaviour
habit up, making it more likely their stress
will rise and they are more likely to do Maintaining environment
their habit if it is used in a self soothing Overly harsh correcting of the
way. client's habit is unhelpful.
Stressful sitatiations or people
Replace with social support.
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HABITS
HYPNOSIS APPLICATIONS
Raising Motivation
You can take clients through a very vivid
script helping them to experience all the
negative consequences of doing their habit
as a way to unhook them from it and draw
their attention to missed opportunities to
use their energy well.
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HABITS
STARTING OUT WITH YOUR CLIENT
This can be done at a first assessment too, however, a phone screening is a good
opportunity to set expectations about the therapy, reassure the client, build rapport
and assess whether this client is suitable for therapy.
Assess motivations Check who wants them to give up the habit. Clients may
come in because someone else has asked them to or because they fear the social
consequences of the habit. Smokers for example will often turn up because
someone else asked them to.
Assess expectations Clients may expect to turn up and have magic wand therapy.
When clients seek hypnosis for a habit they may expect that one session can fix
them, in many cases this can be true but it needs to be emphasized to them that
they can only stop their habit with practice and through being an active participant.
Clients may need a couple of sessions to stop their habit. Prevent rupture by being
clear about the time commitments, they will need to practice after the treatment
session and complete work prior to it.
Educate Consider the importance of normalising what your client is going through
clients might find their habit or not being able to give up their habit embarassing, it
can help here to tell stories of other clients you saw or helped.
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HABITS
STARTING OUT WITH YOUR CLIENT
Anticipate any fears about hypnosis or their ability to stop the habit. Clients may
feel that habits are very hard to break, address this by saying that the way we deal
with stopping a habit is by creating a new more powerful one. You can ask for
previous attempts to stop and gather data on what helped and use this to help
them. Mention elements of the treatment that make it successful and that are
different from usual hypnosis or other therapies such as relapse prevention which
is often a missing step in other therapies. (add in this may come up at any point
from first contact to in therapy)
Raise expectancy - this happens throughout therapy but initially, to inspire your
client you can mention that the protocol for example habit reversal is evidenced
based with a very high success rate. You can also raise expectancy by talking
about your own habits you have overcome or tell stories of your client's successes
while still, of course, observing confidentiality.
Raise motivation by telling clients the key to the approach is to practice every day
just like they practiced their other habit they will practice this new habit while we
unpick the other one. They will practice taking control of their habit.
Send out
1. ego strengthening track
2. information about hypnosis and explain to your client the importance of motivation
and self-belief.
3. Client therapist roles plus rational
4. Contract
5. Habit Reversal Diary with an explanation of its purpose.
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HABITS
ASSESSMENT TOOLS
Habit Diary
Give this to the client so they can begin to
build an awareness of the situations that
trigger their habit, frequency of the habit
and different thoughts and behaviors
they note happening. It is also an
introduction to working in the Hypno-CBT
way.
Imaginal recall
In habit reversal this can be used for
assessment purposes and it is also a tool
for awareness raising with the client.
When the client goes through a past
.episode where the habit occurred they BASIC ID
will learn to spot the early signs that they Multimodal assessment of the client's
are about to do their habit, how it feels issue.
and the steps and stages of them PHQ-9
performing the habit from start to finish. Assessing for depression which is
They will also be able to find any triggers unlikely but it is still worth having a
client complete it to check they are not
for the behaviour in the situation and start contraindicated for treatment.
to address these.
GAD-7
Your client's habit could be part of a
Hierarchy forms
larger anxiety issue such as health
Could be adapted to form a hierarchy of anxiety or social anxiety at a clinical
situations in which the client thinks there level in which case your client will need
is a low, medium or high risk of their habit to seek alternative support.
being triggered so they can practice The form for these two forms are
coping at the lower levels and then build available here .
confidence for the higher levels
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HABITS
OPTIONAL SCRIPTS
1.Ego strengthening
It can be useful to give this to all
clients to help build their self-belief
initially and as an introduction to
hypnosis.
TRB Principles
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Oddball Imaging Studio
HABITS
GUIDELINES AND TIPS
Raise Self-Efficacy Tell stories of how other clients have succeeded. This allows a client to
be persuaded that they can overcome their problem and it might help them to overcome
their issues through vicarious learning. It also prepares the client and raises response
expectancy..
Prepare for relapse Their habit will reoccur but not at the rate it was before. You need to
prepare clients to expect that it will happen and help them with appropriate attitudes for
handling it. Help clients to see their habit and stop it is a different thing to them doing their
habit mindlessly and frequently. As long as they use their protocol they are taking action in
the right direction. If clients have learned other coping tools (as they will in smoking
cessation) part of relapse prevention can include reminding clients they have these tools if
needed. You can also set up a session for after therapy has finished in case clients need it
which can help them feel more secure. In using all the approaches it is important to
emphasize that relapse or the desired behavior reoccurring is expected and normal the
most important thing for your client to understand is that their ability to stop and redirect
the behavior is key and their practice. We want the behavior to reoccur so it can stop.
What kind of therapist? (link to assessment toolkit) Your ability to role model includes
demonstrations that are planned but also remembering everything within an hour is
therapy. You need to role model helpful attitudes and also build and maintain rapport.
Examples of role modeling that could be relevant to habit reversal are self-assertiveness,
showing an ability to be self-supporting and nip behaviors in the bud. Being assertive with
your client too is important. Another example of helpful role modeling is an attitude of
compassionate curiosity, particularly when a client is being self recriminating. or a mistake
happened and providing verbal reinforcement to yourself or the client. For a full list of
helpful therapist, qualities see our assessment toolkit.
Provide a rationale to the client If you are using hypnosis then this also includes the
rationale for hypnosis and why the habit reversal protocol works. Explain initially why their
habit exists. Then explain that even just knowing why their habit occurs or when is a step
towards breaking the unawareness and hooks of their habit that appears to happen
automatically and out of awareness. The method works because we provide a competing
response that cannot be done at the same time as their habit. We are retraining their
bodies with this competing response and increased awareness which means that habit will
be less likely to occur. Even if the habit does occur it doesn't matter because we won't
reinforce it instead we will see it as a sign to practice stopping the habit. We will stop future
occurrences by replacing negative self-talk with positive reinforcement and stress
reduction. We notice and self-reward when we have stopped and changed our behavior
making it more likely we will stick to building the new healthy habit.
Raise Expectancy Draw on anything that helps raise a client's belief that they will respond
to hypnosis or have a good outcome in therapy. As an example telling previous smokers
that have already quit a few times that this makes it even more likely they will stop this
time.
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HABITS
GUIDELINES AND TIPS
If using hypnosis choose the correct induction. for the client and the goal Choose an
induction that fits with the client's expectations of hypnosis, that isn't overly long if you are
doing a single session for habit reversal and that is easy for the client to use and practice.
Eye induction may well be the best choice.
Use relaxation and explain that relaxation weakens habit strength we can't do a habit if
relaxed and learning to be more relaxed overall will help decease their habit. Explain that
relaxation will build beliefs they are managing their habit with confidence as when we are
more relaxed we feel more confident. Explain relaxation as a reward they can look forward
to after stopping their habit so they will no longer need their habit.
Coach clients in relaxation. Clients will use TRB in the habit reversal protocol which should
help build the client's awareness of doing their habit (muscular tension) and letting it go
(relaxation)/release). Clients may want to use another method in which case you could use
some of our other ways of relaxing such as progressive muscle relaxation but teach clients
how to practice it so that they can apply it quickly and across multiple different settings.
Encourage “as if now” imagining Clients are asked to imagine that visual scenes are "as if
now" and to "pretend they are real", to help counteract cognitive issues such as discounting,
i.e., "This doesn't count, it's just images they're not real."
Wait or help clients get “into” their scene Clients are given time to picture scenes to their
satisfaction, nodding their head to signal when they are ready to proceed. This may
improve the quality of visual imagery and reduce anxiety about being able to comply with
instructions.
Measure Self-efficacy may help measure accurate outcomes and. It also allows the client
to see and register the change making a more objective appraisal of the situation. Self-
efficacy ratings can be used for the application of copings skills. Clients need to be asked
how confident they feel 0-100 in gaining control of their habit.
Encouragement: Clients are given congruent verbal praise for improvement, based on the
principle of successive approximation by positive reinforcement. “You’re doing really well.”
Debriefing: After completion of the exercise, clients are asked about their responses in
detail to help identify and reinforce positive strategies, including appropriate spontaneous
changes made by the client to their thinking or imagery. Debriefing helps highlight any
issues too.
Support Let clients know they can come back for a follow-up session sometimes this can
really help clients have more confidence in the process when they know someone is there
if things do not go according to plan. Make sure clients have social support this is very key
for habit reversal as the people around them help them stop their habit.
Increase motivation Really look at how the habit is negative and costs them time and
energy without delivering. Show them and make real the cost of their behavior using either
forms or imagination exercises. look at how their values might be affected by their behavior.
EWS Don't worry if clients only have one, one is enough to stop the behavior.
Discourage Discounting
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HABITS
TREATMENT
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HABITS
TREATMENT
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HABITS
SESSION SKILLS TO CONSIDER
Cost-benefit analysis of keeping the habit Self-talk also includes not discounting experiences
REI rational-emotive imagery to come up with for example saying that hypnosis doesn't count
alternative coping because it isn't real or attributing success to you .
Emotional dial to practice increasing and
decreasing anxiety and yet still gaining control; Remember, their own chosen inner dialogue needs
of their habit or even as a way to experiment to be meaningful to them and realistic! Encourage
with making the connection for them between realistic, task appropriate or supportive dialogue.
anxiety and extreme stress and the need to do
the habit.
Self-talk and self-instruction addressing this
affects the way a client integrates their
experience, whether they stick to the
homework and whether they continue to do
their behaviour. Address self talk and make
sure clients are reinforcing their ability to
succeed in therapy and with stopping their
habit after therapy has ended. Remind them
how important their inner dialogue is to their
success.
Get them to address self-talk when they spot
the behaviour, during the protocol and after so
they can integrate the experience as a success
and stop maintaining the behaviour. When they
spot that they are doing their behaviour they
remind themselves that spotting the behaviour
is a sign treatment has been effective and they
are now taking control of the behaviour by Disputation Help clients to effectively
choosing to do the competing response and dispute faulty beliefs for example frowning
not getting caught up in it. helps me concentrate.
Relaxation there are many ways to apply
this and many tools. You may need to
choose something different for your client or
they may need something different, it is
perfectly fine to adapt what is taught on the
"I am spotting I am doing the behaviour! course.
I am taking a moment to enjoy relaxation. Assertiveness if the prob;em is other people
I am applying my competing response or difficulties being self-assertive.. Roleplay
I am feeling good about taking control of my and hypnosis.
behaviour and taking a moment to relax. Problem solving
General stress reduction skills maybe the
client needs to work in longer therapy and
build up a catalogue of skills to help them
work on things like their attention or time
management.
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HABITS
CLIENT TOOLS AND TIPS
Handouts
Home practice and clients taking an active role in their own therapy improves
outcomes, don't forget to mention this benefit to your client to encourage
them to do the home practice. Giving your client's homework handouts helps
to avoid any confusion over what they need to do at home.
We hope you have found this guide helpful. Don't forget that all materials in this
toolkit are available online along with other scripts and exercises and we have more
toolkits. You can access all of our resources in our professional development hub.
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This Phobia Toolkit was brought to you by ...
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Toolkit: Design and content
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Toolkit: Source material owner and creator
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