* by Trudi Griffin, NCC Licensed Professional Counselor, and part of the TrichStop team *
Scientists do not have definitive cures for body-focused repetitive behaviors, such as skin picking and hair pulling, but there are effective treatment strategies that can help you manage behaviors.
The first step of effective treatment involves unlocking your awareness of the behaviors you desire to change. Keen by HabitAware is an innovative solution to increase your awareness, track your behavior, and take control in real-time.
Once you are aware of when you are doing the behavior, another helpful step is identifying the triggers associated with the habits. Triggers include locations, people, events, thoughts, or feelings. Perhaps being alone for a long time is a trigger, or maybe increased stress or strong emotions. If you know how those triggers impact the behaviors, you can start to address the triggers to prevent the behaviors. Tracking behaviors provides a measurable means of evaluating progress.
The next step of effective treatment includes adopting practices such as stimulus control and competing responses. The external factors associated with body-focused repetitive behaviors, or triggers, can be managed by considering those things that stimulate behaviors and changing them.
For example, maybe through tracking habits, you discover that a well-lit bathroom with a large mirror draws your attention to the imperfections in your skin. Noticing the imperfections inspires skin picking behavior. In this case, practicing stimulus control means changing the lighting in the bathroom environment and making the mirror harder to use. Lights can be adjusted by dimming or repositioning so they don’t shine on the mirror. Removal of the wall mirror and using a handheld mirror accomplishes two stimulus control goals by occupying your hands and changing the nature of well-lit large mirror. Either, or both of these changes will make it harder to see skin imperfections and you’ll be less likely to pick. The overall goal of stimulus control is to change the environment or cue from a comfortable one to something uncomfortable.
A competing response is similar to stimulus control and works in tandem with it. The goal is to proactively engage in a behavior that makes the body-focused repetitive behavior difficult or impossible to do. Since hands are necessary for pulling or picking behavior, a competing response such as clenching your fists, sitting on your hands, or playing with fidget toys keeps them occupied, making it difficult for you to pull or pick.
Another aspect to effective treatment is addressing the stress and emotional triggers related to body-focused repetitive behaviors. Most people who struggle with body-focused repetitive behaviors report that when stress and anxiety increase, so do the behaviors.
Participation in therapy will help you to identify the emotional issues and stressors that make the behaviors worse and to develop coping skills to manage. Social support is also crucial. Picking and pulling are solitary behaviors. Most people think they are alone on the journey. But in-person and online support groups connect us so that we can encourage each other. Positive social interaction, including sharing ideas and techniques for overcoming triggers is another way to boost mood and reduce stress.
Developing awareness and tracking the behavior by using a tool such as Keen serves as the foundation for effective body-focused repetitive behavior management. Combined with working through emotional issues and stress management, the practice of stimulus control and competing responses work together in opposition to the body-focused repetitive behavior. All are integral processes involved in habit reversal training, which is considered one of the most effective ways of managing body-focused repetitive behaviors.
There is no magic bullet, and it does take hard work. If you are ready to build your awareness, work through your negative emotion and stress triggers and practice controlling your environment and response to triggers, you can overcome your body-focused repetitive behavior.
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Together with Abbe Greenberg and Maggie Sarachek, of the Anxiety Sisters, and Lauren McKeaney of PickingME Foundation we recorded a podcast to share treatments for body focused repetitive behaviors like trichotillomania and dermatillomania, along with our mental health stories.
It's important that Keen fits snugly. Here's a quick guide to help you decide which bracelet size to order: