Journal of Applied Behavior Analysis 2021, 9999, 1–13 NUMBER 9999 ()

Using brief habit reversal and an interdependent group

contingency to reduce public-speaking speech disfluencies
Christopher J. Perrin , Sarah A. Hensel, Durie L. Lynch, Lisa R. Gallegos,
Kendall Bell and Kristen Carpenter
Department of Psychology and Counseling, Georgian Court University

This study replicated and extended previous research on the effectiveness of brief habit reversal,
consisting of awareness training and competing response training (silent pause) in reducing the
rate of speech disfluencies during public speaking. Nine university students, divided into
3 groups, delivered short speeches on a novel topic. Brief habit reversal combined with an
interdependent group contingency resulted in a meaningful reduction in speech disfluencies
with only 1 group requiring booster sessions. Relative to baseline, competing responses increased
for all participants but only remained high for 1 participant following training. Reductions in
speech disfluencies maintained during follow-up when participants presented in front of a small
audience.
Key words: awareness training, brief habit reversal, competing response training,
interdependent group contingencies, public speaking

Public speaking is a valuable skill used in
school, careers, and job interviews (Montes
et al., 2019; Spieler & Miltenberger, 2017).
However, presenting can elicit anxiety and
evoke speech disfluencies, reducing the effec-
tiveness of the presentation (Bell, 2011;
Clark & Tree, 2002; Henderson, 2007) and in
some cases result in a diagnosis of public speak-
ing anxiety (PSA). The DSM-5 (Diagnostic and
Statistical Manual of Mental Disorders; Ameri-
can Psychiatric Association, 2013) classifies
PSA as a social anxiety disorder. According to
Tejwani et al. (2016), PSA affects 15% to 30%
of the general population, with similar percent-
ages among university students. Furthermore,
PSA has been found to impact success in both
educational and employment settings (e.g., Stein
et al., 1996). Given both the importance of pub-
lic speaking and the prevalence of PSA, several
We have no known conflicts of interest to disclose.
This research was funded by a Georgian Court Univer-
sity Faculty Development Mini-Grant.
Address correspondence to: Christopher J. Perrin,
Georgian Court University, Department of Psychology
and Counseling, 900 Lakewood Ave, Lakewood, NJ
08701. E-mail: cperrin@georgian.edu
doi: 10.1002/jaba.867
© 2021 Society for the Experimental Analysis of Behavior (SEAB).
1
recent studies have evaluated interventions to
reduce such speech disfluencies (Mancuso &
Miltenberger, 2016; Montes et al., 2019, 2021;
Pawlik & Perrin, 2020; Spieler &
Miltenberger, 2017). As speech disfluencies dur-
ing public speaking have many commonalities
with other habit behaviors, this research consists
of applications of brief habit reversal (BHR).
Common components of BHR include
response description and detection (i.e., awareness
training) followed by competing response training.
As an intervention for public-speaking speech
disfluencies, participants are trained on the topog-
raphy of their speech disfluencies (i.e., response
description), and then they practice identifying
their speech disfluencies (i.e., response detection)
from both recordings of their baseline speeches
and while delivering speeches. During competing
response training, participants are taught to emit
an often-incompatible response as a replacement
behavior and then practice emitting the competing
response while delivering speeches. Previous studies
have shown BHR to be effective at reducing
public-speaking speech disfluencies when it con-
sists of awareness training and competing response
training (Mancuso & Miltenberger, 2016),
2 Christopher J. Perrin et al.
awareness training and an instructed, as opposed
to trained, competing response (Pawlik &
Perrin, 2020), and awareness training alone
(e.g., Montes et al., 2019, 2021; Spieler &
Miltenberger, 2017).
Although each of these variations of BHR
were effective, the individual format of the pro-
cedures may reduce the practicality of BHR as
a treatment given the length of time necessary
to implement BHR. Implementing BHR in a
small group format may improve efficiency,
resulting in more widespread adoption in set-
tings such as universities. We know of two
studies that have evaluated group-based habit
reversal training, both in the treatment of
Tourette’s Syndrome (Nissen et al., 2019;
Yates et al., 2016). Although data supported
the efficacy of group-based habit reversal, both
studies used group designs and relied on indi-
rect measures of habit behaviors. In addition,
Nissen et al. (2019) combined the procedure
with exposure and response prevention.
A possible limitation of group-based habit
reversal training is the complexity of monitoring
concurrent individual contingencies. One solu-
tion to this would be an interdependent contin-
gency in which treatment decisions are based on
the performance of the group as opposed to indi-
vidual participants. Interdependent group contin-
gencies have been successfully applied to a
variety of target responses including disruptive
classroom behavior (e.g., Barrish et al., 1969),
engagement in physical activity (Hirsch
et al., 2016), participation in a college course
review game (Neef et al., 2011), staff attendance
at a residential treatment facility (Brown &
Redmon, 1989), and smoking abstinence
(Meredith & Dallery, 2013). In one application,
Dixon and Holcomb (2000) used an
interdependent group contingency to teach self-
control to dually diagnosed adults. Like BHR,
progressive delay procedures can be time con-
suming when implemented in a one-on-one for-
mat. To increase efficiency, the authors arranged
the participants into two groups of three.
The group contingency required all participants
to both choose to work for the larger reinforcer
as opposed to the smaller one, and then remain
engaged for the entire delay interval to earn the
larger reinforcer. If any group member selected
the smaller reinforcer or stopped working early,
the entire group earned the small reinforcer. The
group contingency resulted in both groups
increasing choice of the delayed reinforcer and
their work duration by seven times the natural
baseline duration. The group format meant that
the same resources needed to improve the self-
control of two individuals in this case resulted in
improvements for six individuals. If similar
improvements are observed when implementing
BHR in a small group format, it may improve
the likelihood of more widespread adoption.
In addition to evaluating group-based BHR,
the use of an instructed competing response
requires additional investigation. Pawlik and
Perrin (2020) is the only study we found that
examined the effectiveness of instructing the
use of a competing response to reduce public-
speaking speech disfluencies. Also, all previous
studies evaluating BHR to reduce public-
speaking speech disfluencies used a non-
concurrent multiple-baseline design, which is
subject to historical confounds. As such, the
purpose of this present study was twofold; to
evaluate the effectiveness of small-group BHR
with an interdependent group contingency, and
to further evaluate the efficacy of instructing a
competing response using a concurrent multi-
ple baseline design.
Method
Participants and Setting
Thirteen students attending a small Catholic
University were recruited to participate in the
study. Based on their availability, four partici-
pants were excluded from the study, three par-
ticipants were assigned to Group 1 (Pamela,
Jonathan, Hailey), and the remaining six partic-
ipants were randomly assigned to Groups
 Brief Habit Reversal and a Group Contingency
2 (Madison, Cora, Veronica) and 3 (Opal,
Alice, Stanley). All participants stated an inter-
est in improving their public speaking skills. As
compensation for their time, participants
received extra credit for one of their psychology
courses and a $50 prepaid VISA gift card after
completion of the study.
Sessions occurred in one of two empty class-
rooms at the university. The rooms were
equipped with a podium, desks with chairs, a
computer to record the session, white and red
laminated cards (21.6 cm by 27.9 cm) to be
used as signals during speeches, and a digital
timer. Lined paper, pencils, and highlighters
were also available for the participants to use to
prepare for their speeches.
Target Behaviors
Frequency data were collected on three types
of speech disfluencies: filled pauses, tongue
clicks, and inappropriate word use. Operational
definitions were identical to those described by
Spieler and Miltenberger (2017) and Pawlik
and Perrin (2020) with one exception. In addi-
tion to collecting data on the inappropriate use
of the word “like,” data were also collected on
inappropriate use of the phrase “you know.”
This was defined as emitting the phrase “you
know” as a filler or added to a sentence for
emphasis (e.g., “I have, you know, brown hair”
or “I have brown hair, you know”). The use of
the phrase “you know” in a grammatically and
systematically appropriate way was not consid-
ered inappropriate (e.g., “You know that I have
brown hair”). Data for the three response forms
were combined into a single measure: speech
disfluencies. As in Pawlik and Perrin, the com-
peting response was a silent pause defined as at
least a 3 s period of silence from the offset of
one speech sound until the onset of the next
speech sound. Using the same methodology as
Pawlik and Perrin, competing response data
were collected from the video recordings using
the silence finder function in the audio
3
analyzing and editing software, Audacity® 2.3.0
(Audacity Team, 2018). Frequency measures
were converted to a rate by dividing the fre-
quency by the speech duration, calculated by
recording the time elapsed between the
researcher stating, “Start” and either the partici-
pant or the experimenter holding up a red card.
During BHR, frequency data were also col-
lected for response identification, defined as the
speaker raising their hand upon emitting a
speech disfluency. These data were converted
to a percentage by dividing the number of
responses identified by the total number of
speech disfluencies.
For group level analysis, speech disfluencies
for each group member were added together to
form a group total frequency which was then
converted to a rate by dividing the group’s total
frequency by the sum of each group member’s
speech duration. Also, responses identified by
each group member were added together to
form a group response identification, which
was then converted to a percent identified by
dividing the group’s total frequency by the
group’s total frequency of speech disfluencies
and multiplied by 100.
Interobserver Agreement
A second observer collected data from the
video recordings for approximately 33% of ses-
sions for each condition. Exact agreement was
calculated for speech disfluencies by dividing
the session into 15 s intervals and dividing the
number of intervals with agreement by
the number of intervals with agreement plus
disagreement and multiplying by 100. Mean
agreement for baseline, post-BHR, and general-
ization was 93% (range, 83% to 98%) for filled
pauses, 96% (range, 90% to 100%) for tongue
clicks, and 94% (range, 85% to 100%) for
inappropriate use of the phrases “like” and
“you know.” During BHR, mean agreement
was 95% (range, 88% to 100%) for speech
disfluencies and 95% (range, 93% to 100%)
for response identification.
4 Christopher J. Perrin et al.
To assess the reliability of the Audacity® 2.3.0
silence finder function, an experimenter collected
data from the video recordings for approximately
21% of sessions. The sample included sessions
from all participants and conditions, and com-
peting responses occurred in 64% of sessions
assessed. Mean exact agreement for competing
responses was 97% (range, 91% to 100%).
Procedure
A concurrent multiple baseline design across
groups was used to evaluate the effectiveness of
small-group BHR and an interdependent group
contingency to decrease speech disfluencies dur-
ing public speaking. The procedures were similar
to those described by Pawlik and Perrin (2020)
with several exceptions. First, video recordings
were used as opposed to audio recordings. Sec-
ond, rather than meeting with each participant
individually, BHR was conducted in a small
group format using an interdependent group
contingency. Third, to clearly indicate the con-
clusion of their speech, participants were asked
to hold up a card when finished. Fourth, partici-
pants were provided 3 min to prepare for a
speech as opposed to 5 min.
Public-Speaking Abilities Rating Scale
Prior to the beginning of baseline and after
completion of the study, all participants com-
pleted a public-speaking abilities rating scale
(Mancuso & Miltenberger, 2016; Pawlik &
Perrin, 2020). The scale was a five-point Likert-
type self-rating scale about their current comfort,
confidence, and self-efficacy regarding their pub-
lic speaking abilities. The posttreatment self-
rating assessment scale included questions about
the participants’ abilities prior to and after the
study, as well as questions regarding their per-
ceived use of each specific target behavior.
Baseline
During baseline, the experimenters met with
each group of participants separately and reviewed
the session procedures. Although sessions were
conducted in a small group format, each member
delivered their own speech, and members in the
audience were instructed to refrain from
responding during or providing feedback after a
speech. All speeches were conducted in the fol-
lowing sequence. The experimenter randomly
selected two speech topics from a container of
25 possible topics. If a speech topic had already
been used, it was replaced with a new topic.
Speech topics were (a) identical to those used
during both Spieler and Miltenberger (2017) as
well as Perrin and Pawlik (2020) and (b) based
on opinion or personal experience (e.g., my first
job, my dream place to live). The group was then
asked to choose one of the topics. Next, partici-
pants were instructed to each prepare a speech on
the selected topic and to use the provided writing
utensils and paper for note taking, but not to
write a script. After 3 min, writing utensils were
collected and a participant was randomly called to
the front of the room to deliver their speech. The
experimenter counted down from three, then told
the participant to begin while starting the timer.
When 4 min elapsed, the experimenter held up a
white card indicating that 1 min remained. After
5 min, the experimenter held up a red card indi-
cating the allotted time was finished. At any point
during the speech, the participant could raise a
second red card to signal the end of their speech.
If the participant stopped speaking for 15 s or
raised the red card prior to 3 min, the experi-
menter stated, “Please continue.” This procedure
was then repeated for the remaining participants
in the group.
Brief Habit Reversal
At the start of BHR, the experimenter opera-
tionally defined each defined form of speech
disfluency and described instances emitted by
group members. For example, during an initial
BHR session, the experimenter stated, “One
common speech disfluency is what we refer to
as a filled pause. We have defined filled pauses
as speech sounds including ‘uh,’ ‘er,’ and ‘um’
 Brief Habit Reversal and a Group Contingency
that are not grammatically or semantically
meaningful to the speech.” The experimenter
then pointed out how certain group members
said either “uh,” “er,” or “um” while delivering
their first speech. Next, participants watched a
video containing a 1-min sample of each of the
participants’ baseline speeches, which contained
representative examples of their speech
disfluencies. Participants were instructed to
raise their hand each time they heard a speech
disfluency or if the experimenter raised her
hand indicating a participant had missed a
speech disfluency. After the video ended, if any
of the participants failed to identify a speech
disfluency, the experimenter replayed that part
of the video, stated that “not all participants
had identified the speech disfluency,” identified
the type of speech disfluency, and described
why it was a speech disfluency. For instance,
while meeting with one group, the experi-
menter showed a clip of a speech in which the
speaker emitted a tongue click that the group
did not originally identify. The experimenter
then paused the video, stated “not everyone
identified this tongue click,” explained that the
sound heard was a type of speech disfluency
referred to as a tongue click, and replayed the
clip once more for the group. At the conclusion
of the video review, the participants were asked
if they felt comfortable detecting speech
disfluencies or wanted further practice. If any
participant wanted to practice further, the
group reviewed the video one additional time.
Participants then practiced identifying speech
disfluencies while giving speeches. Speeches were
conducted in the same manner as baseline; how-
ever, the same speech topic was used for the
entirety of BHR. Before the groups began deliver-
ing their individual speeches, the participants were
told to raise their hand upon emitting a speech
disfluency or if the experimenter raised her hand.
In addition, the experimenter instructed a compet-
ing response by stating,
A 3-s pause can serve as a competing response,
which can replace the speech disfluency making
5
it less likely to occur. While speaking, if you feel
yourself about to emit a speech disfluency, stop
talking and count to three silently.
During each speech, the experimenter raised
her hand for the first five speech disfluencies,
after which she only raised her hand if the par-
ticipant failed to detect a speech disfluency.
While other group members were giving their
speech, participants were asked to discreetly
practice identifying speech disfluencies by
recording tally marks on a sheet of paper. Prac-
tice speeches continued until one of the follow-
ing occurred: (a) all group members identified
100% of their own speech disfluencies during
their speech, (b) all group members identified
at least 85% of their own speech disfluencies
during two consecutive speeches, or (c) a group
member identified 84% or fewer speech
disfluencies for three consecutive speeches. Par-
ticipants were not informed of these criteria or
progress toward meeting them. Rather, partici-
pants were told they were going to “continue
practicing speeches” or, if the group met a cri-
terion, they were told they were going to “do
something different.”
Post-BHR
Post-BHR was conducted at least 24 hr, but
no longer than 3 days, after completion of
BHR. Post-BHR procedures were identical to
baseline. Participants were informed that they
no longer needed to raise their hand to identify
speech disfluencies, nor would the experimenter
raise her hand. Post-BHR was complete when
groups maintained a decreasing or stable trend
of speech disfluencies with at least an 80%
reduction from baseline rates.
Booster Sessions
Booster sessions were conducted if a group
did not collectively meet an 80% reduction in
speech disfluencies from baseline within the
first two post-BHR sessions. The first booster
session occurred at least 24 hr after the previous
post-BHR session. Booster sessions followed
6 Christopher J. Perrin et al.
the same procedures and criteria as BHR with
the exception that participants did not practice
identifying speech disfluencies while watching
the video.
Follow-up
Follow-up probes were conducted 28 days
after post-BHR for Group 1, 21 days after
post-BHR for Group 2, and 20 days after post-
BHR for Group 3. Procedures were identical to
those during baseline, except speeches were
delivered in front of a 14-person audience con-
sisting of members from all three groups and
the researchers.
Treatment Rating Scale
At the completion of the study, social validity
was assessed using a rating scale similar to that
described by Mancuso and Miltenberger (2016)
and Pawlik and Perrin (2020). The scale used a
five-point Likert-Type scale to measure the par-
ticipants’ perception of the acceptability, advan-
tages, disadvantages, difficulties, and effectiveness
of the BHR aspect of the study.
Results
Figure 1 depicts the rate of speech disfluencies
and the percentage of responses identified across
treatment conditions for each participant. During
baseline, all participants demonstrated moderate
to high rates of speech disfluencies. When
summed, this resulted in an increasing trend for
Groups 1 (top panels, M = 5.8 per minuteute;
range, 4.7 to 7.7) and 2 (middle panels, M = 7.4
per minuteute; range, 6.7 to 7.8), and stable rates
for Group 3 (M = 9.6 per minuteute; range, 1.9
to 11.5).
During BHR, speech disfluencies immediately
decreased for all participants in Groups 1 (M = 1
per minuteute; range, 0.3 to 2.7) and 3 (M = 3.1
per minuteute; range, 1.0 to 4.6). Rates of speech
disfluencies for participants in Group 2 demon-
strated a slow decreasing trend (M = 2.1 per
minuteute; range, 0.8 to 3.1). By the end of the
condition, rate of speech disfluencies was low for
all participants. All groups met an 80% reduction
from baseline in rates of speech disfluencies.
Levels of response identification varied across
participants. In Group 1, Pamela and Jonathan
immediately demonstrated high, but variable
levels of response identification, whereas
Hailey’s levels of response identification
occurred at moderate levels. Collectively, the
group’s response identification occurred at
moderately high levels (M = 69.2%; range,
57.1% to 77.8%). In Group 2, Cora and
Veronica demonstrated moderate levels of
response identification, while Madison’s levels
of response identification remained low
throughout BHR. Collectively, response identi-
fication occurred at moderate levels with high
variability for Group 2 (M = 43.3%; range,
33.3% to 55.6%), In Group 3, Opal identified
all of her speech disfluencies in the second
BHR session, after which levels of response
identification reduced to a moderate level. For
Alice, response identification increased from
moderate to high levels across the condition.
Stanley’s response identification occurred at
moderately low levels initially and decreased
across the condition. As a whole, Group 3 dem-
onstrated the lowest level of response identifica-
tion (M = 23.6%; range, 14.7% to 42.9%).
All groups had at least one member who did
not identify 100% of speech disfluencies in one
session or 80% of speech disfluencies in two
consecutive sessions (Group 1, Hailey; Group
2, Madison; Group 3, Alice and Stanley). As a
result, the other five participants were required
to complete on average 3.6 speeches (range,
1 to 7) after meeting one of the criteria. Total
time to complete BHR, including booster ses-
sions, ranged from 180 to 220 min per group.
During post-BHR, all participants in Group
1 demonstrated low and stable rates of speech
disfluencies, with the group’s combined rate
remaining below criterion (M = 0.9 per
minuteute; range, 0.5 to 1.2). Similar response
patterns were observed for all participants in
 Brief Habit Reversal and a Group Contingency 7

Figure 1
Speech Disfluencies and Response Identification Across Conditions
BL BHR Post-BHR BL BHR Post-BHR BL BHR Post-BHR
24 100 24 100 24 100
20 80 20 80 20 80
16 16 16
60 60 60
12 Pamela 12 Jonathan 12 Hailey
40 40 40
8 8 8
4 20 4 20 4 20

0 0 0 0 0 0
5 9 13 17 21 25 5 9 13 17 21 25 5 9 13 17 21 25

Percentage of Responses Identified

BL BHR Post-BHR BL BHR Post-BHR BL BHR Post-BHR
Responses Per Minute

24 100 24 100 24 100

20 80 20 80 20 80
16 16 16
60 60 60
Madison Cora Veronica
12 12 12
40 40 40
8 8 8
4 20 4 20 4 20

0 0 0 0 0 0
5 9 13 17 21 25 5 9 13 17 21 25 5 9 13 17 21 25

BL BHR Post-BHR BL BHR Post-BHR BL BHR Post-BHR

24 100 24 100 24 100
20 80 20 80 20 80
16 16 16
60 60 60
Opal Alice Stanley
12 12 12
40 40 40
8 8 8
4 20 4 20 4 20

0 0 0 0 0 0
5 9 13 17 21 25 5 9 13 17 21 25 5 9 13 17 21 25

Sessions
Note. Dashed lines represent an 80% reduction from the group’s baseline rate of speech disfluencies. Inverted closed tri-
angles represent speech disfluencies during the follow-up probes. BL = baseline, BHR = Brief Habit Reversal, Post-
BHR = Post Brief Habit Reversal.

Group 3 (M = 1.5 per minuteute; range, 1.0 speech disfluencies during the first session but
to 2.0). For Group 2, rates of speech was required to complete two additional sessions
disfluencies were low for Cora and Veronica; as the group did not meet a mastery criterion.
however, Madison immediately demonstrated Following booster sessions, speech disfluencies
increased rates. As such, the group’s combined maintained at low rates for all participants in
rate of speech disfluencies occurred above an Group 2 (M = 1.3 per minuteute; range,
80% reduction from baseline for two consecutive 0.6 – 1.7).
sessions (M = 2.6 per minuteute; range, 2.3 to During the follow-up probe, speech
2.9) resulting in the need for booster sessions. disfluencies remained low and within the range
During booster sessions, speech disfluencies of those during post-BHR for seven of nine
immediately decreased for all participants participants. Rates of speech disfluencies for
resulting in a combined rate below criterion Pamela and Madison increased to levels similar
(M = 0.7 per minuteute; range, 0.4 to 1.0). to those at the start of BHR; however,
Response identification occurred at levels compa- remained below baseline. Collectively, rate of
rable to those during BHR (M = 28.4%, range; speech disfluencies occurred below the criterion
16.7% to 40.0%). Cora identified 100% of level for Group 1 (1.4 per minuteute) and
8 Christopher J. Perrin et al.

Figure 2
Competing Responses Across Conditions
BL BHR Post-BHR BL BHR Post-BHR BL BHR Post-BHR
3.5 3.5 3.5
3.0 3.0 3.0
2.5 2.5 2.5
2.0 Pamela 2.0 Jonathan 2.0 Hailey
1.5 1.5 1.5
1.0 1.0 1.0
0.5 0.5 0.5
0.0 0.0 0.0
5 9 13 17 21 25 5 9 13 17 21 25 5 9 13 17 21 25

BL BHR Post-BHR BL BHR Post-BHR BL BHR Post-BHR

Responses Per Minute

3.5 3.5 3.5

3.0 3.0 3.0
2.5 2.5 2.5
2.0 Madison 2.0 Cora 2.0 Veronica
1.5 1.5 1.5
1.0 1.0 1.0
0.5 0.5 0.5
0.0 0.0 0.0
5 9 13 17 21 25 5 9 13 17 21 25 5 9 13 17 21 25

BL BHR Post-BHR BL BHR Post-BHR BL BHR Post-BHR

3.5 3.5 3.5
3.0 3.0 3.0
2.5 2.5 2.5
2.0 Opal 2.0 Alice 2.0 Stanley
1.5 1.5 1.5
1.0 1.0 1.0
0.5 0.5 0.5
0.0 0.0 0.0
5 9 13 17 21 25 5 9 13 17 21 25 5 9 13 17 21 25

Sessions
Note. Inverted closed triangles represent competing responses during the follow-up probes. BL = baseline, BHR = Brief
Habit Reversal, Post-BHR = Post Brief Habit Reversal.

Group 3 (0.4 per minuteute). For Group 3.0). Pamela (M = 0.3 per minute; range, 0 –
2, speech disfluencies occurred above criterion 0.6), Hailey (M = 0.6 per minute; range,
but remained below baseline (2.5 per 0 – 1.1) and Alice (M = 0.4 per minute; range,
minuteute; 66% reduction). 0 – 0.9) demonstrated low and variable rates of
Figure 2 depicts each participant’s rates of competing responses. For Opal, rates of com-
competing responses during each condition. peting responses were initially high, but
Except for Stanley (M = 0.74 per minute; decreased across the condition (M = 0.7 per
range, 0.3 – 1.0), all participants demonstrated minute; range, 0.3 – 1.3). Veronica and Cora
at or near zero rates of competing responses initially emitted competing responses, but rates
during baseline. During BHR, rates of compet- reduced to zero by the end of the condition.
ing responses increased for all participants. Jonathan only emitted competing responses in
Stanley emitted the highest rates of competing the final session. Following BHR, Veronica,
responses (M = 1.9 per minute; range, 1.2 – Alice, and Cora demonstrated zero rates of
 Brief Habit Reversal and a Group Contingency
Table 1
Summary of Responses on the Public Speaking Rating Scale
Mean Rating (Range)
Question Baseline
1. How comfortable (do/did) you feel 3.2 (3 – 5)
when engaging in public speaking
(BEFORE training)?
2. How comfortable do you feel when N/A
engaging in public speaking NOW
after training?
3. How would you rate your overall 3.2 (3 – 5)
ability as a public speaker
(BEFORE training)?
4. How would you rate your overall N/A
ability as a public speaker NOW
after training?
5. How confident (do/did) you feel 3.1 (3 – 5)
when engaging in public speaking
activities (BEFORE training)?
6. How confident do you feel NOW N/A
when engaging in public speaking
activities?
7. While publicly speaking, how 3.6 (3 – 5)
anxious (are/were) you (BEFORE
training)?
8. While publicly speaking, how N/A
anxious are you NOW after
training?
9. How often (do/did) you use fillers, 3.9 (3 – 4)
such as um, uh, or er, during
public speaking (BEFORE
training)?
10. How often do you use fillers, such N/A
as um, uh, or er, during public
speaking NOW after training?
11. How often (do/did) you 3.9 (2 – 5)
inappropriately use the words
“like” or “you know” during public
speaking (BEFORE training)?
12.How often do you inappropriately N/A
use the words “like” or “you
know” during public speaking
NOW after training?
13.How often (do/did) you use 1.6 (1 – 3)
tongue clicks during public
speaking (BEFORE training)?
14. How often do you use tongue N/A
clicks during public speaking
NOW after training?
Note. Scores range from 1 = not at all / poor to 5 = very/
excellent
competing responses. Rates of competing
responses for Pamela, Jonathan, Madison, and
Opal were initially low, but decreased to zero
across the condition. Hailey (M = 0.7 per
minute; range, 0 – 2.5) and Stanley (M = 1.0
per minute; range, 0.5 – 1.2) were the only
9
Table 2
Summary of Responses on the Treatment Acceptability Rating
Scale
Post-BHR Mean Rating
Question (Range)
2.4 (1 – 5)
1. How acceptable was the training? 4.8 (4 – 5)
2. How willing were you to participate in the 4.8 (4 – 5)
4.4 (4 – 5) training?
3. To what extent do you think there might 1.8 (1 – 2)
have been disadvantages in the training?
2.6 (1 – 5) 4. To what extent do you think there might 3.9 (2 – 5)
have been advantages in the training?
5. How difficult was it to participate in the 1.9 (1 – 4)
4.0 (3 – 5)
training?
6. How much did you like the training? 3.7 (3 – 4)
2.4 (1 – 5) 7. How effective was the training in terms of 4.1 (3 – 5)
reducing your use of filled pauses?
8. How effective was the training in terms of 4.0 (3 – 5)
4.0 (3 – 5) reducing your use of tongue clicks?
9. How effective was the training in terms of 4.2 (3 – 5)
reducing your inappropriate use of the
4.0 (2 – 5) words “like” or “you know”?
10. How effective was the training in terms of 4.3 (3 – 5)
improving your overall ability to publicly
2.1 (1 – 3) speak in front of an audience?
11. Would you recommend the training to 4.9 (4 – 5)
others who are also struggling with their
4.4 (3 – 5) public speaking?
Note. Scores range from 1 = not at all/ none to 5 = very/
3.0 (1 – 3) many. Items 3 and 5 were reverse coded.
4.4 (3 - 5)
participants to maintain moderate to low levels
of competing responses, though Stanley’s rates
2.6 (2 – 4) were similar to baseline by the end of the con-
dition. Further reductions in competing
responses occurred during follow-up probes
2.9 (1 – 5)
with all participants demonstrating zero rates
except Hailey (0.4 per minute), Madison (0.3
1.8 (1 – 4)
per minute), and Stanley (0.2 per minute).
Table 1 depicts the results of the public
speaking rating scale. On their baseline scales,
participants reported moderate levels of com-
fort, public speaking abilities, and confidence
with public speaking and moderately high
levels of anxiety and use of most topographies
of speech disfluencies. Following BHR, all par-
ticipants reported an increase in comfort, pub-
lic speaking abilities, and confidence. Also,
participants reported a decrease in anxiety and
usage of speech disfluencies from before BHR
10 Christopher J. Perrin et al.
to after BHR. In addition, most participants
rated their pretraining performance worse fol-
lowing BHR than they had prior to training.
Results of the treatment rating scale indicated
moderate to high social validity (see Table 2).
All participants positively rated BHR in the
areas of acceptability, willingness to participate,
advantages, likability, effectiveness, and willing-
ness to recommend to others. All participants
rated BHR as having little disadvantages and
low levels of difficulty.
Discussion
The results of this study showed that small
group BHR with an interdependent group con-
tingency was effective at reducing speech
disfluencies. Following BHR, levels of group
speech disfluencies reduced by at least 80%
from baseline levels for all groups. At the indi-
vidual level, eight of nine participants demon-
strated an 80% reduction in baseline levels of
speech disfluencies while the ninth participant
demonstrated a 72% reduction.
Whether small-group BHR was more effi-
cient than BHR implemented on an individual
basis is less clear. In the present study, none of
the groups met either of the response identifica-
tion criteria to progress to post-BHR due to
the performance of one or two members. As a
result, all groups contained at least one member
who remained in BHR longer than if an indi-
vidual contingency had been in effect. In addi-
tion, members of Group 2 were required to
participate in booster sessions as a result of
Madison’s increase in speech disfluencies. For
those participants, small-group BHR was less
time efficient. However, the group nature of
the intervention meant that nine participants
experienced BHR using the same resources
(e.g., therapists, materials, rooms) previously
used for three participants. In addition, based
on times reported in previous studies, the time
to complete small-group BHR was similar to
the time required to complete BHR with three
people separately. A possible way to improve
efficacy and efficiency would be to increase the
saliency of the interdependent contingency.
Although various aspects of the procedures and
instructions indicated the interdependent
nature of the contingency (e.g., speech
disfluencies were reviewed if any member failed
to identify the disfluency), participants were
not explicitly informed that their progress was
dependent upon their team’s performance. As
such, some of the beneficial social contingencies
enacted by the group contingency may have been
absent. An alternative option would be to use an
independent group contingency. Comparisons of
independent and interdependent group contin-
gencies have found similar levels of efficacy
(e.g., Groves & Austin, 2017). Using an inde-
pendent group contingency, participants would
receive BHR in a group format, but individual
responding would determine when a participant
moves to post-BHR. In this arrangement, experi-
menters maintain the benefits of the group for-
mat while participants regain time savings
associated with individual mastery criteria.
The second purpose of this study was to fur-
ther evaluate the efficacy of instructing a compet-
ing response. During BHR, all participants
demonstrated an increase in competing responses,
replicating the finding from Pawlik and Per-
rin (2020) and providing further evidence that a
rule is effective at evoking a competing response.
Unlike Pawlik and Perrin, rates of competing
responses were much lower than those of speech
disfluencies during baseline. This is contrasted
with response identification, in which instruction
and feedback produced differentially higher rates
of hand raises than competing responses for six of
nine participants. Furthermore, similar to previous
research (Pawlik & Perrin, 2020; Spieler &
Miltenberger, 2017) anecdotal observations indi-
cated that some participants emitted unnecessary
hand raises during post-BHR. Collectively, these
findings suggest that teaching a competing
response is likely more effective than instruction
alone. Further, it raises questions about teaching
 Brief Habit Reversal and a Group Contingency
different responses for identification and competi-
tion with speech disfluencies. Rather, it may be
beneficial to teach the competing response during
the video review portion of awareness training.
One interesting aspect of the data was the
low level of response identification demon-
strated by four of nine participants during
BHR. Several components of the procedures
may have contributed to this result. First, the
descriptions and examples of speech
disfluencies provided during BHR reflected
those emitted by the group as opposed to a sin-
gle participant. Second, the video recording
only included a 1-min sample of each partici-
pant’s baseline speeches. Although this sample
was representative, the limited duration meant
it contained limited examples of some forms of
speech disfluencies and possibly none of others.
Third, groups were not required to meet a spe-
cific level of response identification while view-
ing videos of speeches before progressing to
practice speeches. Collectively, these procedures
may have reduced discrimination and subse-
quent acquisition of stimulus control during
BHR. Montes et al. (2021) demonstrated that
review of recorded speeches, though beneficial,
is not necessary to reduce speech disfluencies,
suggesting the importance of the description
and examples of speech disfluencies. In addi-
tion to issues with stimulus control, reductions
in speech disfluencies resulted in fewer oppor-
tunities for the occurrence of response identifi-
cation. Under such circumstances, failing to
identify even a single speech disfluency could
result in moderate to low levels of response
identification, such as those demonstrated by
Opal, Cora, and Hailey toward the end of the
condition.
In the present study, all participants demon-
strated reductions in speech disfluencies despite
low rates of competing responses and, in some
cases, low levels of response identification. It is
possible that BHR resulted in improved attend-
ing despite these responses remaining low. This
is supported by responses on the public
11
speaking rating scale (see Table 2), where all
participants’ ratings reported increased attend-
ing to all forms of speech disfluencies. Further-
more, participants rated their pretraining
performance worse following BHR than they
had prior to training, suggesting improved
awareness of their speech disfluencies. An alter-
nate explanation is that BHR involves punish-
ment. Some researchers (e.g., Miltenberger
et al., 1998) have suggested that competing
response training functions as positive punish-
ment, as the competing response does not need
to be incompatible with the habit response. It
is possible that prompting participants to raise
their hand when they failed to detect a speech
disfluency functioned as a mild punisher. Addi-
tionally, Mancuso and Miltenberger (2016)
extended BHR to public-speaking speech
disfluencies due to the similarities between
speech disfluencies and stuttering. However,
the competing response often used for
stuttering is regulated breathing to relax the
vocal musculature (Azrin & Nunn, 1974). In
the absence of regulated breathing, simply
pausing and counting is more topographically
similar to that of time-out from speaking
(James, 1981). For most participants in the
present study, BHR produced immediate and
large decreases in speech disfluencies after
which rates of competing responses decreased
across BHR and post-BHR conditions. These
response patterns are consistent with what
would be predicted if BHR functioned as pun-
ishment and speech fluency is strengthened
through negative reinforcement.
Despite the promising results of this study,
there are several limitations. One limitation is a
function of a small group size when
implementing an interdependent group contin-
gency. Since there were only three members in
a group, each member’s responses greatly
impacted the group’s data. This exacerbated the
issue mentioned above regarding the impact of
limited opportunities to identity speech
disfluencies. A group member failing to identify
12 Christopher J. Perrin et al.
even a single speech disfluency could result in
the group failing to meet criterion to progress
to post-BHR, especially if other group mem-
bers emitted zero speech disfluencies. Given the
impact of limited opportunities it may be bene-
ficial to limit mastery criterion to reductions in
speech disfluencies; especially if high levels of
response identification are not necessary for
reductions in speech disfluencies.
Another limitation was the lack of a question
specifically addressing the acceptability of the
interdependent group contingency on the treat-
ment acceptability rating scale. Although partic-
ipants indicated that they liked the treatment
and would recommend it to others, these ques-
tions addressed the treatment package as a
whole. As such, we are unable to draw conclu-
sions about either individual components of
BHR or the interdependent group contingency.
BHR is a multicomponent intervention and par-
ticipants may find some aspects more acceptable
than others. Furthermore, the interdependent
nature of the group contingency may result in
lower acceptability ratings. Previous research in
which participants experienced both independent
and interdependent contingencies have provided
mixed findings. For instance, ratings on the lik-
ability of an independent contingency for
smoking abstinence were significantly higher
than those of an interdependent contingency
(Meredith & Dallery, 2013) whereas Groves and
Austin (2017) found students voted to partici-
pate in an interdependent version of the Good
Behavior Game more often than an independent
version. Additional research on the conditions
under which interdependent contingencies are
preferred is needed, as well as information about
the acceptability of individual aspects of BHR.
This study provides data suggesting the
effectiveness of conducing BHR for public-
speaking speech disfluencies in a small group
format and provides future directions for incor-
porating group contingencies into BHR. In
addition, this study addressed experimental
design concerns from previous studies by using
a concurrent multiple baseline design. Also, this
study successfully addressed some of the sugges-
tions for future research by Pawlik and Per-
rin (2020). Participants in the current study
were not informed of booster sessions prior to
entering them and a reliable cue to signal the
conclusion of a speech was used. Future
research should continue to explore ways to
improve effectiveness and promote adoption of
BHR for public-speaking speech disfluencies.
REFERENCES
American Psychiatric Association (2013). Diagnostic and
statistical manual of mental disorders (5th ed.). https://
doi.org/10.1176/appi.books.9780890425596.529303
Audacity Team (2018). Audacity ®: Free Audio Editor and
Recorder (Version 2.3.0) [Computer software].
https://audacityteam.org/
Azrin, N. H., & Nunn, R. G. (1974). A rapid method of
eliminating stuttering by a regulated breathing
approach. Behaviour Research and Therapy, 12(4),
279-286. https://doi.org/10.1016/0005-7967(74)
90002-3
Barrish, H. H., Saunders, M., & Wolf, M. M. (1969).
Good behavior game: Effects of individual contingen-
cies for group consequences on disruptive behavior in
a classroom. Journal of Applied Behavior Analysis, 2
(2), 119-124. https://doi.org/10.1901/jaba.1969.
2-119
Bell, R. L. (2011, October). Is your speech filled with
um? 3 tips to eliminate filled pauses from your pro-
fessional presentation. Supervision, 72(10), 10-13.
Retrieved from www.supervisionmagazine.com.
Brown, N., & Redmon, W. K. (1989). The effects of a
group reinforcement contingency on staff use of
unscheduled sick leave. Journal of Organizational
Behavior Management, 10(2), 2-17. https://doi.org/
10.1300/J075v10n02_02
Clark, H. H., & Tree, J. E. F. (2002). Using uh and um
in spontaneous speaking. Cognition, 84(1), 73-111.
http://doi.org/10.1016/s0010-0277(02)00017-3
Dixon, M. R., & Holcomb, S. (2000). Teaching self-
control to small groups of dually diagnosed adults.
Journal of Applied Behavior Analysis, 33(4), 611-614.
https://doi.org/10.1901/jaba.2000.33-611
Groves, E. A., & Austin, J. L. (2017). An evaluation of
interdependent and independent group contingencies
during the Good Behavior Game. Journal of Applied
Behavior Analysis, 50(3), 552-566. https://doi.org/10.
1002/jaba.393
Henderson, J. (2007). There’s no such thing as public speak-
ing: Making any presentation or speech as persuasive as
a one-to-one-conversation. Prentice Hall Press.
 Brief Habit Reversal and a Group Contingency
Hirsch, S. E., Healy, S., Judge, J. P., & Lloyd, J. W.
(2016). Effects of an interdependent group contin-
gency on engagement in physical education. Journal
of Applied Behavior Analysis, 49, 975-979. https://doi.
org/10.1002/jaba.328
James, J. E. (1981). Behavioral self-control of stuttering
using time-out from speaking. Journal of Applied
Behavior Analysis, 14(1), 25-37. https://doi.org/10.
1901/jaba.1981.14-25.
Mancuso, C., & Miltenberger, R. G. (2016). Using habit
reversal to decrease filled pauses and nervous habits
in public speaking. Journal of Applied Behavior
Analysis, 49(1), 188-192. http://doi.org/10.1002/
jaba.267
Meredith, S. E., & Dallery, J. (2013). Investigating group
contingencies to promote brief abstinence from ciga-
rette smoking. Experimental and Clinical
Psychopharmacology, 21(2), 144-154. https://doi.org/
10.1037/a0031707
Miltenberger, R. G., Fuqua, R. W., & Woods, D. W.
(1998). Applying behavior analysis to clinical prob-
lems: Review and analysis of habit reversal. Journal of
Applied Behavior Analysis, 31(3), 447-469. https://
doi.org/10.1901/jaba.1998.31-447
Montes, C. C., Heinicke, M. R., & Geireman, D. M.
(2019). Awareness training reduces college student’s
speech disfluencies in public speaking. Journal of
Applied Behavior Analysis, 52(3), 746-755. https://
doi.org/10.1002/jaba.569
Montes, C. C., Heinicke, M. R., Guendulain, M. A., &
Morales, E. (2021). A component analysis of aware-
ness training for reducing speech disfluencies. Journal
of Applied Behavior Analysis, 54(2), 770-782. https://
doi.org/10.1002/jaba.795
Neef, N. A., Perrin, C. J., Haberlin, A. T., &
Rodrigues, L. C. (2011). Studying as fun and games:
Effects on college students’ quiz performance. Journal
of Applied Behavior Analysis, 44(4), 897-901. https://
doi.org/10.1901/jaba.2011.44-897
13
Nissen, J. B., Kaergaard, M., Laursen, L., Partner, E., &
Thomsen, P. H. (2019). Combined habit reversal
training and exposure response prevention in a group
setting compared to individual training: A random-
ized controlled clinical trial. European Child & Adoles-
cent Psychiatry, 28(1), 57-68. https://doi.org/10.
1007/s00787-018-1187-z
Pawlik, B., & Perrin, C. J. (2020). Reducing speech
disfluencies during public speaking using brief habit
reversal. Journal of Applied Behavior Analysis, 52(2),
1080-1088. https://doi.org/10.1002/jaba.627
Spieler, C., & Miltenberger, R. (2017). Using awareness
training to decrease nervous habits during public
speaking. Journal of Applied Behavior Analysis, 50(1),
38-47. https://doi.org/10.1002/jaba.362
Stein, M. B., Walker, J. R., & Forde, D. R. (1996). Pub-
lic-speaking fears in a community sample: Prevalence,
impact on functioning, and diagnostic classification.
Archives of General Psychiatry, 53, 169-174. https://
doi.org/10.1001/archpsyc.1996.01830020087010
Tejwani, V., Ha, D., & Isada, C. (2016). Observations:
Public speaking anxiety in graduate medical
education--A matter of interpersonal and communi-
cation skills? Journal of Graduate Medical Education,
8(1), 111. https://doi.org/10.4300/JGME-D-15-
00500.1
Yates, R., Edwards, K., King, J., Luzon, O., Evangeli, M.,
Stark, D., McFarlane, F., Heyman, I., Ince, _ B.,
Kodric, J., & Murphy, T. (2016). Habit reversal
training and educational group treatments for chil-
dren with Tourette syndrome: A preliminary
randomised controlled trial. Behaviour Research and
Therapy, 80, 43-50. https://doi.org/10.1016/j.brat.
2016.03.003
Received February 1, 2021
Final acceptance June 24, 2021
Action Editor, Jeanne Donaldson