Navigating Therapy Options for BFRB: Effective Approaches for Skin Picking and Hair Pulling
Body-focused repetitive behaviors (BFRBs), such as skin picking (dermatillomania) and hair pulling (trichotillomania), can be challenging to manage and often require a multifaceted treatment approach. These behaviors frequently arise as coping mechanisms for underlying issues such as anxiety, emotional distress or childhood traumas. Fortunately, various therapeutic modalities offer effective strategies for addressing and overcoming these behaviors.
Let’s explore some of the most effective forms of therapy for BFRBs, including Cognitive-Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), Acceptance and Commitment Therapy (ACT), Habit Reversal Training (HRT), Eye Movement Desensitization and Reprocessing (EMDR), Brainspotting, and Internal Family Systems (IFS).
1. Cognitive Behavioral Therapy (CBT)
Overview: CBT is one of the most widely utilized therapies for treating BFRBs. It focuses on changing unhelpful thought patterns and behaviors.
How It Helps:
Habit Reversal Training (HRT): Often integrated into CBT, HRT helps individuals increase awareness of their behavior and replace it with a competing response. For instance, individuals may learn to engage in a different activity that occupies their hands when they feel the urge to pick or pull.
Cognitive Restructuring: Assists in identifying and challenging distorted thoughts and beliefs that may perpetuate the BFRB, such as negative self-talk or unrealistic expectations.
2. Dialectical Behavioral Therapy (DBT)
Overview: DBT, originally developed for borderline personality disorder, has been adapted for various conditions, including BFRBs. It focuses on balancing acceptance with change and improving emotional regulation.
How It Helps:
Emotion Regulation: DBT equips individuals with skills to manage intense emotions that might trigger BFRBs. Techniques such as mindfulness and distress tolerance help individuals handle emotional stress without resorting to repetitive behaviors.
Interpersonal Effectiveness: Helps improve communication and relationships, which can reduce stress and the urge to engage in BFRBs.
3. Acceptance and Commitment Therapy (ACT)
Overview: ACT is designed to help individuals accept their thoughts and feelings rather than trying to change or avoid them, and to commit to actions that align with their values.
How It Helps:
Mindfulness: ACT incorporates mindfulness techniques to help individuals observe their urges and thoughts without judgment, making them less likely to act on the compulsion to pick or pull.
Value-Based Living: Encourages individuals to set and pursue goals that are meaningful to them, thereby providing a sense of purpose and reducing the focus on the BFRB.
4. Habit Reversal Training (HRT)
Overview: A specific behavioral intervention, HRT is often used as part of CBT but can be utilized independently. It focuses on increasing awareness of the behavior and replacing it with alternative responses.
How It Helps:
Awareness Training: Helps individuals recognize the contexts and triggers for their BFRB.
Competing Response Training: Teaches alternative behaviors that can be performed instead of the BFRB, such as using fidget toys or engaging in different hand activities.
5. Eye Movement Desensitization and Reprocessing (EMDR)
Overview: EMDR is a therapy designed to help individuals process and integrate traumatic memories. It is often used for post-traumatic stress disorder (PTSD) but can be effective for BFRBs when related to past trauma.
How It Helps:
Processing Trauma: EMDR helps individuals process unresolved trauma that may be contributing to the BFRB. By addressing these past experiences, individuals can reduce the emotional triggers for their behavior.
Desensitization: The therapy can reduce the emotional charge associated with memories or thoughts that lead to BFRBs, helping to decrease the compulsion to engage in the behavior.
6. Brainspotting
Overview: Brainspotting is a relatively newer therapeutic technique that involves identifying and processing traumatic experiences or emotional distress by focusing on specific eye positions.
How It Helps:
Targeting Emotional States: Brainspotting helps individuals access and process deep-seated emotional states that may contribute to BFRBs. By focusing on specific eye positions, individuals can work through emotional triggers and reduce the intensity of their urges.
Enhanced Awareness: Facilitates deeper self-awareness and connection to the bodily sensations associated with the BFRB.
7. Internal Family Systems (IFS)
Overview: Internal Family Systems therapy views the mind as composed of distinct parts or "subpersonalities," each with its own perspective and role. IFS aims to harmonize these parts and address inner conflicts.
How It Helps:
Understanding Parts: Helps individuals understand the different parts of themselves that may be involved in or contributing to the BFRB. For instance, a part of the self may be engaging in the behavior as a way to cope with underlying feelings.
Healing Internal Conflicts: Facilitates healing by working with these parts to address and resolve internal conflicts, leading to a reduction in the BFRB behaviors.
Therapy tailored to BFRB
Addressing body-focused repetitive behaviors requires a comprehensive and individualized approach. Each therapy offers unique benefits and can be used alone or in combination to effectively manage and reduce these behaviors. Cognitive-Behavioral Therapy, Dialectical Behavior Therapy, Acceptance and Commitment Therapy, and Habit Reversal Training provide foundational techniques for managing BFRBs. For individuals with trauma or deep-seated emotional issues, Eye Movement Desensitization and Reprocessing, Brainspotting, and Internal Family Systems can offer additional layers of support.
If you or someone you know is struggling with BFRBs, consulting with a mental health professional who specializes in these therapies can provide tailored guidance and support on the journey to recovery. With the right strategies and support, overcoming BFRBs is entirely achievable.
If you’re currently struggling with dermatillomania, trichotillomania or other Body Focused Repetitive Behaviors, check out our Heal BFRBs blog for helpful resources. Get The Dragonfly Journal and start using journaling today as a tool on your BFRB healing journey. Learn more about 1:1 Premium Trauma Informed Coaching.