Treatment for Body-Focused Repetitive Behaviors
Cognitive Therapy – Clients learn to identify unhelpful, distorted thoughts that lead to pulling or picking and restructure them to be more rational and reasonable.
Habit Reversal Training (HRT) – A behavioral intervention for BFRBs involving several components, including building awareness of the urge to pick or pull, identifying situations, places and activities that trigger the behavior, and developing a competing response to use in place of the BFRB.
Common competing responses are using fidgets or touch toys that are interesting or soothing to touch, like silly putty or cush balls. Rather than pick or pull some clients might like to get creative using their hands to do art work, knit, crochet, embroidery, sew, make jewelry or play a musical instrument.
With practice and discovery of what competing responses work best, clients begin to feel more in control and have more choices for how to respond when an urge arises. When competing responses are used consistently the urges to pull or pick lessen and clients begin to feel the freedom that comes with recovery.
Comprehensive Behavioral Treatment (ComB) – This approach begins with a structured, in-depth assessment to identify the unique pattern of sensory (sensations), cognitive (thoughts), affective (feelings), motor (movements), and place (environmental) factors or domains that trigger and maintain the BFRB.
Following the assessment, the therapist and client develop an individual treatment plan with the goal of providing self-management techniques matched to the client’s needs, which allows them to have more control over their problem. The program is designed to interrupt problem behaviors and to provide effective alternative ways to help address the habits, emotions, thoughts and beliefs that drive individuals to damage their hair or skin.
Mindfulness Training – Increases awareness of thoughts, feelings, sensations and urges that lead to skin picking or hair pulling. Clients learn how to tolerate uncomfortable urges by “riding the wave of discomfort” without engaging in the BFRB.
Acceptance and Commitment Therapy (ACT) – A treatment approach using mindfulness tools to manage uncomfortable urges, along with a focus on taking action on activities clients find meaningful or important without giving in to the urge to pick or pull.