What Are the Different Types of Therapy for BFRBs

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Specialized therapies can relieve a wide range of Body-focused repetitive behaviors (BFRBs), from trichophagia to lip and cheek biting. The severity of these conditions determines the intensity of the therapy one receives. These therapies are primarily focused on providing individuals with emotional support as well as a way to identify and control their triggers. While therapy may reverse some people's condition, others may need a combination of psychotherapy and medication. Individuals dealing with body-focused repetitive behaviors also join support groups as a form of therapy. Let's review some of the most common BFRB treatments that have proven successful.

Cognitive Behavioral Therapy

Cognitive behavioral therapy is a common option used in the management of various mental health conditions, including body-focused repetitive behaviors. The primary objective of CBT is to help individuals connect their thoughts, emotions, and actions. Through CBT, an individual is trained to become more aware of their thoughts and actions. Additionally, they are taught how to alter one element of the three, either their thoughts, emotions, or actions, to create a positive change. Furthermore, this type of therapy helps one identify the specific triggers that increase the severity of their BFRB episodes. After identifying their triggers, they learn how to reduce them. They find a distraction or healthy replacement that will give them the pleasure they get from the body-focused, repetitive behavior they are dealing with. For example, if one finds pleasure in biting their cheeks, they can chew gum or take crunchy snacks that can replace the pleasure they feel from biting their inner cheek.

Dialectical Behavior Therapy

Dialectical behavioral therapy sessions often involve mindfulness, regulation of emotions, tolerance, and distress management. This therapy model is often combined with cognitive behavioral therapy. Distress management helps individuals deal with the BFRB urges without indulging in the BFRB. Mindfulness helps individuals become more aware of their actions, making it easier to control external and internal triggers. As a result, they respond to their urges in a healthy way that does not involve inflicting injuries on themselves. The emotional regulation mode of therapy helps them become more aware of negative emotions, and how they can adopt more positive actions. Through the Emotional Regulation Module, one learns how to experience negative emotions without acting on them. For example, if one is anxious or agitated, they learn how to relax instead of engaging in body-focused repetitive behaviors that might be harmful. The emotional regulation model involves several elements, including: 

  • Understanding and labeling emotions
  • Observing if there are any obstacles in emotional management
  • Lowering emotional vulnerability
  • Focusing on positive emotions
  • Finding a counteraction to replace the BFRBs
  • Enhancing mindfulness
  • Going through negative emotions without acting on them

Acceptance and Commitment Therapy

Acceptance and Commitment Therapy (ACT) differs from most therapies because it involves helping one accept their behavior instead of trying to reverse it immediately. The approach taken for this therapy model is to help individuals love themselves as they are. They are also taught how to accept and manage their urges without necessarily reducing them. The main objective of this therapy model is to help an individual feel less guilty about their actions and observe their emotions without being harsh on themselves. Individuals dealing with BFRBs learn they can always experience their emotions without pulling their hair or biting their lips. Additionally, they commit to the management of their negative emotions. They also commit to tolerating unpleasant feelings and thoughts instead of avoiding them.

Acceptance and commitment therapy is a promising treatment model. It helps an individual understand themselves better since it involves exploring how they use these BFRBs to handle negative emotions. Moreover, the treatment process helps individuals learn and process their emotions. Once they get in touch with their emotions, they learn when to react and when not to. Often, people tend to block out negative emotions; however, through acceptance and commitment, one can learn how to handle various emotions, from anxiety to distress, in healthy ways that won’t harm their well-being. In ACT strategies, one learns how to accept any internal or external issues they are experiencing without eliminating or reducing them. Getting in touch with the unpleasant emotions and facing them is one thing that makes this type of therapy successful.

Habit Reversal Training

Habit reversal training consists of three primary modules: training, social support, competing response, and awareness training. Through awareness training, one learns how to focus on one's triggers and where pulling or biting begins. Once they know the triggers, it becomes easier to contain the situation. Competing response training helps one find a healthy replacement for body-focused repetitive behavior. The replacement is often used whenever one feels the need to address a negative emotion with hair pulling or lip biting. Some of the behaviors one may adopt include:

  • Sitting on their hands 
  • Fist tightening  
  • Squeezing a stress ball 
  • Playing with a silly putty

Habit reversal training also looks into the emotions that lead one to engage in BFRB urges so that they can contain the impulsive urges early. The social support aspect in habit reversal training involves including family and friends in an individual's recovery journey. Psychosocial support plays a key role in one's healing process. Family members and friends can help motivate an individual struggling with BFRBs, especially through their feedback when one is making improvements. Furthermore, they may help keep one in check when implementing healing strategies. Having accountability makes the healing journey more effective.

Comprehensive Behavioral Treatment

Comprehensive Behavioral Treatment aims to identify the factors that trigger BFRBs and then change the individual’s relationship with them. This treatment method tries to identify why and where the person engages in these behaviors. The comprehensive behavioral treatment method includes modules such as: 

  • Assessment whereby the therapist takes time to monitor an individual's behavior in between their sessions to determine their triggers, whether it is emotion, physical places, or activities.
  • Developing customized strategies that are set to address their specific triggers and sensations. 
  • Developing interventions that are meant to counter the BFRB urges.

The comprehensive behavior treatment method gives individuals struggling with BFRB a comprehensive framework for managing their condition. The treatment methods also develop various intervention methods to help in the early prevention of BFRB conditions.

 Wrapping Up

The primary causes of the different BFRBs are not well known, but several treatment methods have been developed to help manage these conditions. BFRBs are often related to various mental health conditions, such as anxiety and stress. Therefore, managing these BFRBs takes the approach of managing mental health conditions first. For example, anxiety management will lower the urge for lip-biting or hair-pulling. Dealing with BFRBs and mental health conditions simultaneously is a more effective treatment approach since the condition is addressed comprehensively. Dealing with body-focused repetitive behavior can be overwhelming both emotionally and physically, thus the need to seek professional help. Therapies may not guarantee that one will get better; but they give one the best shot at recovery.

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