Skin Picking & Hair Pulling Therapy
Are You Ashamed of Your Repetitive Body-Focused Behaviors?
You’ve been picking, pulling, or biting your skin, hair, nails, or mouth, and you desperately want to stop, but you can’t.
You feel so ashamed of your behavior, and it may limit you in social situations, impact relationships, prevent you from engaging in once-loved activities, or diminish your confidence and self-esteem.
You may have promised yourself countless times that you will finally stop causing damage to your body, only to repeat the cycle, which leaves you feeling discouraged and helpless.
You might have been to doctors and talk therapists, or you may have been too embarrassed to talk about the issue with anyone. I want you to know that I not only deeply understand the emotional and physical pain that comes from skin picking, hair pulling, nail biting, and other body-focused behaviors, but I have extensive knowledge and experience in treating this problem.
I treat Body-Focused Repetitive Behaviors (BFRB’s), which include hair pulling, which is known medically as trichotillomania, and skin picking, known as excoriation or dermatillomania. Nail biting, cuticle picking, lip picking, cheek biting, or nose picking are also common BFRB’s that clients come to me for. As you may already know, these issues can significantly affect an individual’s quality of life, but you may not have known that they are considered disorders. This is because, as you may have experienced, these compulsive behaviors often lead to physical damage and emotional distress. This is why effective treatment is essential, which means being treated by someone who is an expert in the area. You deserve to understand why you do this behavior (hint: it is not because you don’t have enough willpower or discipline!) and how to gain freedom from it.
In my work with clients, I use two evidence-based approaches that have been shown to effectively treat BFRBs: the Comprehensive Behavioral Model (ComB) and Habit Reversal Training (HRT). These specialized treatments for hair pulling, skin picking, and other BFRBs help individuals understand and manage this disorder effectively.
Do I have a BFRB?
If you experience recurrent, compulsive actions directed at your body, and this action results in physical harm and emotional turmoil, you likely have a BFRB, such as trichotillomania or excoriation. Some folks may experience a sensation, such as tension, itching, or tingling, before engaging in the behavior, while others may simply feel drawn towards picking, pulling, or biting. People also often report feeling some form of relief after they pick, pull, or bite, which creates a challenging cycle: the very thing that causes them distress also feels rewarding, which can be incredibly frustrating. Understanding this cycle through BFRB treatment with a BFRB therapist is critical to addressing the underlying issues and developing effective strategies for change.
Why Use ComB and HRT for BFRB treatment?
When a trained therapist works with a client using the ComB model, they typically follow these steps:
In our work together, I’ll teach you how to properly track when and where your BFRBs occur, along with associated thoughts and feelings, so we can pinpoint specific situations or emotional states that lead to the behavior. This allows us to uncover important insights around the unique reasons you pick your skin, pull your hair, or engage in another BFRB.
Then, through BFRB counseling, I help my clients improve their ability to manage urges by introducing coping strategies. This can involve stress management techniques, such as cognitive behavioral therapy, mindfulness, or emotional regulation interventions. We will also focus on environmental modifications to reduce triggers and create a more supportive atmosphere for change.
Both the Comprehensive Behavioral Model and Habit Reversal Training provide structured frameworks for understanding and modifying BFRBs. ComB focuses on the interplay of motivation, ability, and prompts, while HRT offers practical strategies for replacing unwanted behaviors with healthier alternatives. Together, they create a comprehensive treatment approach that can empower individuals to take control of their hair pulling, skin picking, or other BFRB.
The Comprehensive Behavioral Model (ComB):
1. Motivation: Together, we’ll examine why you engage in your BFRB, whether it’s to gain emotional relief, sensory stimulation, or something else. Understanding these motivations is essential for creating effective interventions that are tailored uniquely to you!
2. Ability: Ability refers to your capacity to engage in hair pulling, skin picking, nail biting, etc. This includes how things like your emotional state and your environment influence your ability to resist urges.
3. Prompts: Prompts are the internal or external cues that trigger the BFRB. Investigating and understanding these prompts is a crucial aspect of therapy; it allows us to develop strategies to avoid or manage the picking, pulling, or biting.
Habit Reversal Training (HRT)
HRT is a cognitive-behavioral technique specifically designed to help individuals modify the habitual behaviors of BFRBs. It complements the ComB model by providing structured methods for replacing unwanted behaviors.
Key Components of HRT
1. Awareness Training: My work involves teaching you to recognize when you are about to engage in their BFRB. After all, we can’t treat what we’re not aware of, so this is a super important first step.
2. Competing Response Training: Together, we develop alternative responses to usewhen the urge to engage in your BFRB arises. This is a trial-and-error approach which often frustrates clients when they attempt to go at it alone, which is why it is so important to partner with a trained BFRB therapist.
3. Social Support: We may decide to involve specific family or friends to enhance accountability and provide encouragement as you work toward reducing your BFRBs. However, this is not a necessary part of the model, and BFRB treatment can absolutely be successful without adding anyone other than a BFRB therapist.
4. Generalization: Once you have gained success in applying the competing responses we develop in treatment, the next step is to apply these strategies in various contexts to reinforce their effectiveness.
The Therapeutic Process
I’m so glad you’re prioritizing your mental health by seeking BFRB treatment. Not only do I have years of experience in treating this disorder, I also have a personal history of excoriation, so I understand just how painful it is to live with a BFRB. I, as well as my clients, are testaments to the fact that using evidence-based models, like ComB and HRT, with a skilled BFRB therapist works!
What to expect
1. In the initial sessions, you and I will establish a positive therapeutic relationship and I’ll gather information to understand your unique experiences with your BFRB. We’ll also go over general history and discuss any issues that co-occur, such as anxiety, depression, or OCD.
2. Then, we’ll collaboratively create a personalized treatment plan that incorporates both ComB and HRT strategies. We’ll set realistic, achievable goals to help you stay motivated (i.e. reducing the frequency of your BFRB by a certain percentage over a set period. In session, we will practice coping strategies and competing responses so that you feel confident in applying these skills in real-world situations.
3. I’ll provide ongoing support and guidance as we navigate your journey so we maintain motivation and reinforce positive changes. I’ll be by your side to offer encouragement and adjustments to strategies as needed.
Reach out!
I’d love to come alongside you in your BFRB recovery journey. It is so possible to achieve a life that is not dominated by skin picking, hair pulling, or any other BFRB you might struggle with. Getting the right treatment from an expert in trichotillomania and excoriation can get you there! Call, text, or email for a free consultation to see how we can work together!
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