Body-Focused Repetitive Behaviors
Challenges such as hair-pulling (trichotillomania), skin-picking, or nail-biting (or chewing cuticles), are collectively referred to as "body-focused repetetive behaviors" (BFRBs). If you struggle with any of these, there are four aspects that we'll want to address in working together:
- Coping differently with the underlying stress, anxiety or even boredom that lead to the urges to pull, pick, bite, etc.
- Increasing your awareness of what you actually do, to allow you to intervene with yourself sooner and make the choice to do something else.
- Stopping or substantially reducing the behavior itself (and thereby limiting the physical damage being caused).
- Moving out of the shame and secrecy often associated with a habit you may have been engaged in for years.
The way we address these are through cognitive-behavioral therapy (CBT). CBT is one of the most effective therapies for body-focused repetitive behaviors (BFRBs). The interventions are targeted to the problem, and at the same time tailored to your personal experience and situation.
The "cognitive" part is learning to identify and change negative thought patterns associated with the BFRB. It also may include identifying the beliefs and values that you want to guide you day-to-day, rather than losing time to a compulsive (and sometimes mindless) habit.
The "behavioral" part may involve any or all of the following techniques:
- Self-Monitoring: Keeping track of the frequency and context in which the behavior occurs, to increase awareness and identify patterns.
- Habit Reversal Training (HRT): This involves increasing awareness of the behavior and replacing it with a competing response that is incompatible with the repetitive behavior. For instance, specifically training your hand to move to your lap rather than pulling or twirling your hair.
- Exposure and Response Prevention (ERP): This technique involves gradually increasing exposure to situations that trigger the BFRB, without engaging in the behavior (helped by CBT techniques).
- Mindfulness practices help individuals become more aware of their present-moment experiences and reduce automatic, habitual reactions. This approach improves recognition of urges to engage in repetitive behaviors, which leads to managing them more effectively and consistently.
- Stimulus Control: Altering the environment to reduce triggers for the behavior.
- Using "barriers" (such as gloves or mittens, bandaids on fingertips, wearing a scarf or swim cap, etc) temporarily to reduce the reinforcing feedback of the BFRB, as well as create a split second of greater mindfulness to facilitate shifting to an alternate, helpful action.
In some cases, it may be useful to consider medication, especially if you're "doing everything right" in terms of the CBT tools described above, yet the urges remain overwhelming. We can discuss finding a good potential prescriber for you to work with if needed.