What is a Body-Focused Repetitive Behaviour?
Skin picking (excoriation disorder/dermatillomania) and hair pulling (trichotillomania) are commonly discussed body-focused repetitive behaviours and have been classified as OCD related disorders. Individuals who experience these symptoms will sometimes seek out a therapist for trichotillomania or cognitive behavioral therapy for skin picking.
During body focused repetitive behaviours (BFRBs), individuals will use their fingers or some type of tool in order to engage in repetitive body focused behaviours, such as hair pulling, skin picking, lip and cheek biting, nose picking and nail biting.
You might wonder, why might I be engaging in body-focused repetitive behaviours? There are many factors that might lead to someone engaging in these behaviours. As with many behaviours and mental health conditions, research has found a combination of genetics and environment to play a role.
For example, it has been found that within a family there might be more individuals with BFRBs than would be expected in the general population, suggesting that genetics may play a role. Stressors might also exist within a person’s environment that, in addition, to genetic predispositions, allow for the emergence of the behaviour.
However, we never want to engage in blaming such specific factors within a person’s world. We know these behaviours can serve to relieve tension or stress, alleviate boredom or serve as a self-soothing coping mechanism. We also want to be kind to ourselves when we recognize we engage in behaviours that we might not appreciate or want to change. The road to recovery often begins with a compassionate awareness.
Although many individuals engage in these types of behaviours, therapy may be warranted if these behaviours are significantly impacting your daily functioning. People will also find these behaviours to leave them with scars or uncomfortable physical appearances, scars or infections. These are also reasons why individuals will seek out a therapist for hair pulling or dermatillomania treatment.
It has been said that as many as 1 in 20 individuals actually have a BFRB. Sometimes they are wrongly dismissed as “bad habits”. Although BFRBs have some symptoms that overlap with obsessive-compulsive disorder (OCD), they are not the same.
Therefore, it is important that you receive treatment that has been developed for BFRBs and is evidence based. CBT for dermatillomania and CBT for trichotillomania are evidence-based and will be discussed in more detail below.
If you find that you often engage in any of these body focused repetitive behaviours and want to learn more then reach out to Forward Thinking Psychological Services ®; our team offers treatment for OCD and dermatillomania, hair pulling or trichotillomania treatment as well as treatment for other BFRBs.
What Happens During Hair Pulling or Trichotillomania Treatment?
Therapy for trichotillomania often uses an evidence-based approach that falls under the umbrella of Cognitive Behaviour Therapy. Cognitive Behaviour Therapy (CBT) for skin picking or any other mental health disorder focuses on helping an individual to identify awareness and connections between thoughts, feelings and behaviours. In doing so, one can understand how our thoughts and behaviours can sometimes be problematic.
We learn that it is important to modify our behaviours and reframe our thoughts in order to gain perspective and live our lives in a different manner. It is always important to work with a therapist who can take an individualized approach within CBT for trichotillomania or any other presenting issue in order to ensure treatment is meaningful for your presenting issues.
The Comprehensive Behavioural Treatment (ComB) is an excellent CBT approach, with research demonstrating its effectiveness. Within this approach are important behavioural strategies and cognitive techniques.
Acceptance and Commitment Therapy along with Dialetical Behaviour Therapy may also help to amplify the effectiveness of dermatillomania treatment and hair pulling/ trichotillomania treatment.
There are many techniques within the ComB framework. It is important that treatment is delivered in a manner that is unique to each individual and helps them in an individualized recovery plan.
CBT for trichotillomania and CBT for dermatillomania begin with an evidence-based assessment approach. During such an assessment, your therapist will help you to understand both internal and external factors that are impacting the maintenance of the BFRB. This would be following an initial assessment in which your therapist will more fully understand the history of your BFRB as well as any other mental health issues in addition to a more fulsome discussion of your psychosocial history.
Understanding these internal and external factors is often done through awareness logging in the ComB model. This typically follows what is called the SCAMP model.
Specifically, you will learn about:
Sensory:
Experiences within this domain, you will explore sensory needs that a person has and better understand how to meet those needs. For example, if an individual loves feeling surfaces that are smooth then the therapy for skin picking could involve using a face mask or pimple covers that allow for the skin to feel quite smooth even when a pimple is present. Individuals might also like to carry and touch smooth stones in their pocket to satisfy that sensory need.
Cognitive:
As with many mental health disorders, there are important cognitions and belief systems that we want to discuss within the context of therapy. These will be examined during therapy. For example, “Maybe I can pick just one and stop” or “My skin will look much smoother after I remove this scab”. During hair pulling/ trichotillomania treatment, you will create reframing thoughts with your therapist, such as “But I never actually stop after just one so I shouldn’t start” or “But the scab that grows back always feels worse than before”. Your therapist for hair pulling will help you to restructure these thoughts and insert reminders in your home to help when some of the desire to pick or pull arises.
Affective:
Of course our mood and emotions are essential components of how we view situations around us and how we navigate them. This part of the ComB model during dermatillomania treatment or treatment for trichotillomania may lead to the discussion of emotion regulation skills. This can be discussed to help relieve difficult emotions when an individual resists urges of picking or pulling or other types of BFRBs.
Motor:
Individuals soon realize that they often pick or pull when their bodies are in a certain position. This triggers an urge to pick or pull. Raising awareness around this can then lead to a discussion of how to make it more challenging to pick or pull by ensuring our hands might be in different positions. For an individual who uses their hands to pick or pull, changes to their nails might alter the experience and make it harder to engage in the behaviour. Discussions around manicures or painting nails in different ways are often incorporated into treatment.
Place:
Monitoring will show you that particular places within your world are more likely to lead to BFRBs. This could be when you are studying for a test, when you are in a classroom, driving or perhaps in the bathroom during a nightly routine. Once these are discovered then various strategies can be implemented, such as dimming the lights in your bathroom so you can not see things as clearly or possibly putting sharp tools in another room until the hairs grow out and might be less tempting to pull. These types of techniques will be discussed with your therapist for hair pulling or during dermatillomania treatment.
Interventions with the ComB model also include stimulus control and competing response training. These are components of habit reversal training. Stimulus control is often about changing the environment in which the BFRB occurs to make it more difficult for you to carry it out. This will be unique to the SCAMP model that is developed with your therapist.
Competing response training is about learning to interrupt or replace the picking or pulling behaviour with another type of behaviour. You want this behaviour to be incompatible with the way you engage in the BFRB. These competing responses are really important because they allow you to learn how you can decrease the urge to engage in the BFRB.
These aspects of treatment will support you in maintaining longer-term habit reversal by adding new behaviours and coping strategies into your toolbox, rather than the BFRB strategies. We spoke about some of them within the description of the SCAMP model. This is an important aspect of treatment that is discussed in detail during hair pulling/trichotillomania treatment as well as cognitive behaviour therapy for skin picking. These interventions are important across all of the BFRB presentations that people experience.
What Other Skills Might I Learn During Treatment for Trichotillomania?
In addition to everything discussed, there are other strategies that will also be incorporated during CBT for trichotillomania and as well as CBT for dermatillomania. These strategies and interventions will include:
Cognitive restructuring
understanding and reframing unhelpful thinking styles that might play a role in the maintenance of BFRBs
Present moment awareness
mindfulness strategies that can allow an individual to ground themselves within the present moment and defuse difficult thoughts or feelings
ACT techniques
these can include strategies of cognitive defusion, understanding self as context and being able to make space difficult thoughts and feelings in the services of following our values and doing what is important to us
Relaxation techniques
these may include strategies such as box breathing and progressive muscle relaxation. These can help to alleviate stress and decrease urges to engage in BFRBs as a way to manage and cope with stress
Distress tolerance strategies
these skills can help an individual to take the edge off of volatile emotions and learn to regulate their feelings using strategies other than the BFRBs
As you can see there are many evidence-based strategies that are available to help you! If you are looking for a comprehensive approach to therapy for skin picking and therapy for trichotillomania, look no further than Forward Thinking Psychological Services ®. We looking forward to working with you on the road to recovery.
Can you have OCD and Dermatillomania?
Yes, you can have both OCD and dermatillomania. As mentioned before, OCD and BFRBs do have some commonalities, but they are viewed as two distinct behaviours. Given that these conditions can co-occur, it is important to work with a therapist who is well-versed in both disorders. In doing so, you will ensure that you are receiving the correct assessment, diagnosis and treatment.
Both OCD and dermatillomania can also be treated through online therapy services. Online therapy for skin picking and online therapy for hair pulling would include all of the key components that have been discussed. However, the advantage to online services would be that you could also work with your therapist for hair pulling within triggering spaces within your home. This would allow you and your therapist to understand in real time the places within your home that are triggering. This can be highly beneficial in setting up stimulus control and competing responses. In this way, online therapy services can provide an extra benefit to treatment over in person sessions within a therapist’s office.
How Can I Find Trichotillomania Treatment or Dermatillomania Treatment?
Does FTPS provide BFRB therapy near me? We provide it throughout Ontario, Nova Scotia, British Columbia and New Brunswick. Our team works with adolescents, teens and adults who are experiencing these types of symptoms.
Please contact us to learn more and get started!