Body Focused Repetitive Behaviors (BFRB)

BODY FOCUSED REPETITIVE BEHAVIORS

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I would like to discuss "Body Focused Repetitive Behaviors "(BFRB). These are habits, both conscious and unconscious, that result in damage to the body, including hair pulling (trichotillomania), skin picking (excoriation), nail biting, cheek or tongue biting, lip biting or picking, and compulsive nose-picking.

Since I am always seeking to expand my toolbox and better serve the needs of my clients, I have received a certification in the treatment of Body Focused Repetitive Behaviors. While there is no one-size-fits-all approach to any issue, hypnosis can help with certain aspects of these conditions, and we can use hypnosis to help establish pieces of other evidence-based Cognitive Behavioral therapies such as Habit Reversal Training (HRT) and the Comprehensive Behavioral Model (ComB).

Hypnosis alone can often provide relief from repetitive body-focused behaviors using habit breaking techniques, but many clients may find that they need refreshers from time to time. (But wait- there's more!)

I really understand this issue. I have been a nail-biter and destroyer of cuticles since I was 12 years old. That is about the age that most BFRB's tend to emerge. I can tell you exactly where I was, what I was doing, and what I was thinking the first time I bit into my nail. Right now, I have 10 long nails and 10 cuticles that range from perfectly healthy to somewhat damaged. I have personally used hypnosis from a colleague that ended my nail biting habit for almost a year. But I found that with added stress, the habit returned. I have learned so much more about these habits since then!

These body-focused behaviors are best treated by taking a multi-prong approach.

We can use hypnosis and other cognitive therapies to increase our awareness of the unwanted habit (there is some really cool tech out there that can be programmed to alert a person to unconscious movements).

We can learn triggers that engage in competing responses to the behavior (for example, playing with putty or string when you feel the urge to pull hair.)

Hypnosis can help with alleviating the feelings of shame that often follow BFRB's.

Hypnosis can help with relaxation training and generalization skills,

and can help with "negative cognitions" that support the behavior (for example, a person who repeatedly injures themselves by picking scabs may have the thought that "I must ALWAYS have smooth skin.")

In addition to hypnosis, a solid treatment plan will involve so much more... social support and family education (See my next post), habit blockers, stimulus control, and an evaluation and response to the sensory, cognitive, emotional, motor, and environmental conditions that contribute to the behavior.

For example- for my OWN treatment, I am now keeping a bowl of sunflower seeds beside my living room chair. When I feel the urge to bite my nails or become aware of unconscious movements, I can reach for my sunflower seeds as a healthy and non-damaging alternative. There are so many fun things that we can do both in the office and at home to reduce and change these body-focused repetitive behaviors.

Success is NOT measured by NEVER engaging in the behavior again. Success is measured by reducing the behavior, by increasing awareness, and by use of alternates.

BODY FOCUSED REPETITIVE BEHAVIORS

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Important information for loved ones of a person who has a Body-Focused Repetitive Behavior (See my previous post)

It can be distressing when you see your loved one damaging their body. It is natural to want to DO SOMETHING to make them stop. But shaming them, punishing them, and harassing them does not work. It can actually increase the feelings of anxiety that contribute to the behavior. While this is not necessarily an anxiety-caused behavior, and even if we could "cure anxiety" the behavior would not necessarily end, we DO know that anxiety is often a contributing factor.

Of course you want to say something when you see your loved one damaging themselves! That is understandable!

A better option would be to agree on a code-word that you can create together so that you can mention it in an empathic way that is free from judgment, disapproval, and simply brings awareness. But know that you are not responsible for how they respond.

We can use hypnosis to strengthen your code-word, as well as in the ways mentioned in my previous post. Comprehensive treatment will usually include more than hypnosis alone.

And finally, don't be surprised if your code-word needs to change from time to time. People can become desensitized to the effectiveness of a particular word.