Guest Post: The Toolkit for BFRB Management

December 20, 2017

* 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.

Awareness is the key to behavior change:

Photo by Daryn Stumbaugh, UnsplashPhoto by Daryn Stumbaugh, Unsplash


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.

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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.

If you practice, you can gain control over skin picking, nail biting & hair pulling:

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.

Septian Simon, Unsplash
Septian Simon, Unsplash


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.

“…stimulus control and competing responses work together in opposition to the body-focused repetitive behavior…

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.

Photo by Grant Richie, Unsplash

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.


About TrichStop
TrichStop is an online resource for people affected by trichotillomania. Their goal is to make treatment available and approachable for people worldwide, via the internet. They are a team of professionals experienced with BFRB treatment, and passionate about providing behavioral health services online. 
About Keen by HabitAware
HabitAware makes Keen, a smart bracelet that helps manage nail biting, hair pulling, thumb sucking, and other subconscious behaviors. Customized gesture detection brings you into awareness and helps you develop healthier habits.
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