Habit Reversal Tip #23 Whatever Works

Habit reversal is a simple behaviour modification technique that is easy to understand. Once the principles have been grasped they can be adapted as necessary to the habit that needs treating.

The way habit reversal is used here for the habitual scratching of atopic eczema was first introduced in the 1980s in Uppsala, Sweden by Dermatologist Peter Norén and his colleague Psychologist Lennart Melin. They in turn adapted their technique from the method which was developed in the 1970s by psychologists Nathan Azrin and Gregory Nunn for treating nervous habits such as tics, stammering and skin-picking.

"One of the key ideas of habit reversal is to replace the harmful habit with another harmless habit that makes the bad habit impossible. This new behaviour is known as a competing response." 

It needs regular conscious practice.

For habitual scratching in atopic eczema Norén and Melin introduced clenching the fist for 30 seconds, followed by pinching or pressing the skin, but also used a variety of other tactics for those situations where the fist clench / skin pinch or press method is impractical. A wide variety of skin safe behaviours can be successfully used.  Planning ahead, doing things quickly and keeping one's hands busy are the main things to remember, and each person using habit reversal should write out their own behavioural prescription.

In practice the fist clench / skin pinch or press is used successfully by most people. But some adapt the method to suit themselves. This is fine, as long as it works. Some report a preference for mental imagery to actual physical action - and it works for them.

Others, like my patient in the picture above, immobilize their hands for 30 seconds by grasping one wrist with the other hand - and get very good results.

What works for you?