Consultant Psychiatrist


“Behaviour” commonly means what we see people doing. As a behaviour modification technique, habit reversal can be used to tackle nail biting, thumb sucking or scratching that have become troublesome habits.

Habits start as conscious behaviours associated with specific triggers. With sufficient repetition the behaviour can later occur relatively unconsciously, or automatically, and the triggers can multiply – by association with other related factors. Thus, a habit is formed.

Not only can an action become a habit. The process can apply to feelings and thoughts – also seen in psychology as behaviours – just as it works with actions. If an experience is repeated sufficiently and is associated with a typical emotional response, and a particular train of thought, a habitual attitude can emerge. If this is then a problem, the principles of habit reversal can be used to tackle it.

It is easy to understand how living with longstanding troublesome eczema can make anyone pessimistic. Repeated previous experiences of unsatisfactory clinic visits and treatment failures are commonly reported by chronic atopic eczema sufferers, and these experiences do not encourage optimism. Along with pessimism also comes passivity, a sense of helplessness, created by the repeated experience of failure.

Fortunately for most with chronic atopic eczema we have found that the habit of passive pessimism can be reversed by following The Combined Approach. The active nature of the treatment programme requires repeated practice of positive behaviours to which the skin responds favourably in a relatively short period of time. The experience is therefore quickly rewarding: active optimism soon emerges and is established as a new habit, and the benefits of living without eczema maintain the new positive attitude.



Dr Christopher Bridgett (DrB) is a specialist in Adult General Psychiatry who has also worked in Dermatology since being first introduced to Psychodermatology by Arthur Rook in 1971. Together with dermatologists Richard Staughton (London) and Peter Norén (Uppsala) he co-authored Atopic Skin Disease - A Manual for Practitioners, which sets out a behavioural approach for the successful management of atopic eczema. Now retired from both NHS and private practice, he continues to teach and advise at Chelsea & Westminster Hospital, London and runs an online community for both practitioners and patients interested in The Combined Approach to the treatment of atopic eczema: