Body-Focused Repetitive Behaviors Treatment

Specialized therapeutic methods and medications can provide much-needed symptom relief for individuals with body-focused repetitive behaviors (BFRBs).

Some people secretly struggle with body-focused repetitive behaviors (BFRBs). Treatment can provide much-needed symptom relief for these individuals. Not everyone who receives treatment finds it to be helpful, but researchers are beginning to understand how to stop body-focused repetitive behaviors.

Some currently available treatment options are promising and can provide emotional support. Many people get the most benefit by combining psychotherapy with medications. Support groups are also an essential part of ongoing recovery.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is an effective form of treatment option for BFRBs. CBT helps people make connections between their thoughts, behaviors and feelings. These three elements operate as a system to help a person make sense of the world. This therapy is based on the concept that disturbing behaviors and emotions come from irrational or distorted thoughts.

In therapy, the connections between these three elements are explored and defined, and the individual is taught how to alter one element to create change in all three. For example, a change in a specific BFRB behavior can affect the emotions and thoughts associated with it. Alternately, a person could constantly challenge a particular illogical thought connected with a BFRB. Over time, this change in thought can also affect the person’s emotions and behaviors connected with the thought. With this targeted approach, CBT can help a person improve BFRB symptoms.

Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) is a specific form of cognitive therapy often used to help improve BFRBs. DBT helps an individual hold two distinct and opposing beliefs at the same time. This approach can help decrease the extreme nature of black-and-white thinking and make it easier to cope with intense emotions.

The following DBT treatment modules can help people with BFRBs:

• Mindfulness: The person becomes more aware of triggers and body signals. Acceptance of the present moment is also encouraged, which can help reduce worry.
• Emotional Regulation: The person is taught how to manage their emotions more effectively. Some methods include identifying emotions, labeling emotions and experiencing emotions without taking action.
• Distress Tolerance: The person is taught ways to endure emotional distress without doing something that makes the situation worse. This method can help a person endure urges to pick or pull.

Acceptance and Commitment Therapy

Another type of therapy commonly used for BFRBs is called acceptance and commitment therapy (ACT). ACT works quite differently for people with BFRBs. Instead of actively trying to reduce disturbing thoughts, feelings or behaviors, this therapeutic approach helps the individual embrace them. The person is taught to accept and tolerate the urges to pick and pull without trying to reduce them.

During these moments, the person is encouraged to observe their emotions without judgment. This observation helps the person fully experience and better understand their feelings. The goal is to experience these feelings while knowing they do not always need to react to negative emotions by picking or pulling.

Habit Reversal Training

Habit reversal training (HRT) is a specialized form of therapy. HRT is helpful as a treatment for BFRBs. The primary purpose of HRT is to create a healthy replacement for the repetitive behavior. This replacement behavior is used at the moment the person feels the urge to engage in a BFRB.

Some examples of replacement behaviors include:

• Sitting on one’s hands
• Clenching fists
• Squeezing a spongy ball
• Handling Silly Putty or sticky tack

Therapy sessions also explore the situations and emotions that drive the urge to engage in BFRBs. As clients become more aware of triggering situations, they can better avoid them and recognize signs of impulsive urges early on. This recognition helps the individual interrupt BFRBs sooner.

Medications

Medications can provide relief for some individuals by reducing the physical sensations that lead to BFRBs. Not everyone finds improvement in their symptoms with medications, but medications often can be used in combination with therapy for added benefit, according to the TLC Foundation.

Body-focused repetitive behavior medication options include the following:

• Clomipramine (Anafranil): Clomipramine has provided relief for some people with trichotillomania. Trichotillomania is also known as hair pulling. Clomipramine may also be most useful for people who also have depressive or obsessive-compulsive symptoms.
• Selective Serotonin Reuptake Inhibitors (SSRIs): Some commonly known SSRI medications include Luvox, Celexa, Lexapro, Zoloft and Paxil. These medications have shown some symptom improvement for skin picking and trichotillomania. Prozac is the only SSRI to be extensively researched for the treatment of hair pulling and skin picking.
• N-acetylcysteine (NAC): N-acetylcysteine (NAC) is an amino acid with glutamate regulating properties. These properties can help calm some of the emotional stimulation linked with hair-pulling behavior. When glutamate levels are managed, hair pulling behavior is reduced.

Related Topic: Trichotillomania treatment

Alternative Treatments

Caution is required when considering alternative treatments for BFRBs. While many of these treatments promise quick solutions and easy fixes, enough research has not been conducted to test the safety and effectiveness of alternative treatments.

Acupuncture, herbal remedies and hypnosis are a few of the most common alternative therapies used to treat BFRBs. These methods may be useful along with standard treatment approaches. However, it’s important to speak with a licensed medical professional before partaking in any alternative treatment methods.  

BFRB Support Groups

Support groups can provide essential connections with others. Caring interactions are necessary for someone working to decrease BFRBs. Larger cities may have BFRB support groups that meet regularly. However, the internet also provides many opportunities for people with no physical access to a group. The established group includes International OCD Foundation. The TLC Foundation also has an informational page to help people locate support groups.

Self-Help

Self-help strategies typically involve using coping skills to manage symptoms. Online articles about self-help topics can provide helpful information quickly about how to manage BFRBs. Phone apps can also make it easier to track behavioral patterns.

Treating Body-Focused Repetitive Behaviors and Co-Occurring Conditions

The exact causes of BFRBs are not known. However, these behaviors do serve as a way to cope with emotional pain. For many people with BFRBs, treatment can provide relief and much-needed support. People in treatment learn how to stop body-focused repetitive behaviors using individualized coping strategies that work for them.

A person can feel overwhelmed when trying to manage a body-focused repetitive behavior. Treatment can become more complicated when these behaviors occur with other disorders, like depression and anxiety. In some cases, substance abuse can also develop alongside BFRBs.

Individuals with BFRBs and co-occurring mental health conditions tend to benefit most from treatment that addresses both conditions simultaneously. Treatment does not guarantee a cure for any disorder, however, it gives a person their best chance at recovery.

If you or a loved one is struggling to manage BFRBs and co-occurring addiction, you can find help today. Treatment is available. Learn more by contacting The Recovery Village today.

Editor – Megan Hull

Megan Hull is a content specialist who edits, writes and ideates content to help people find recovery. Read more

Medically Reviewed By – Erika Krull, LMHP

Erika Krull has a master’s degree in mental health counseling and has been a freelance writer since 2006. Read more