This week is body-focused repetitive behavior (BFRB) awareness week. BFRBs are compulsive behaviors involving the body and are often related to excessive grooming. For instance, people may compulsively bite nails, pick their skin or pull hair in a way that is physically harming and can lead to health complications.
There are many times where it feels impossible for us to just sit still. Pent up energy can be incredibly hard to ignore. For people with BFRBs, these urges become uncontrollable.
One strategy that I have found incredibly helpful in treating people with BFRBs is habit replacement. This is the act of replacing the physically damaging habit, such as skin picking, with something more benign.
There are so many options available, but I have some favorites that I recommend to patients. Symptoms, urges, and experiences vary so much that I can only call these recommendations–individualized treatment is usually the best way to ensure that what is being used works as part of a treatment regimen.
Koosh balls (for trichotillomania)
These balls are great for occupying wandering hands, and can easily satisfy the physical sensation of pulling something with a bit of a snap
Tangles can provide a wonderfully smooth, bumpy, or fuzzy tactile experience in addition to being a great option for keeping hands busy. Many people enjoy the option for snapping them apart and creating a length that best fits their needs. Keep in mind that these come in metallic colors, and therefore are not necessarily as conspicuous for adults
Meditation (spinner) rings
My number one recommendation for the working adult is to get a ring that spins or moves. These are easily made a part of a daily outfit for men and women and can be used mindfully or as a distraction during the work day. The plethora of options for style, metal, etc. makes this a personal favorite.
Putty (for excoriation)
Be it silly, magnetic, color-changing, or the blue stuff that holds up posters, this is a good choice for digging in your nails when the desire kicks in. It is fairly portable and often not expensive to replace regularly if it becomes dirtied or loses its texture.
This is a pretty traditional option, but who doesn’t have a stress ball lying around somewhere that they got at some presentation or event? Stress balls can provide a focal point and keep hands busy. Winner number five is an oldie but a goodie.
But why do these work?
According to competing response theories, an unwanted action or response can be replaced with a more acceptable action and the desire for the unwanted action should decrease. For example, someone who has the habit of picking their skin can instead play with a toy every time they feel the urge to pick. Competing responses are part of a broader theory called habit reversal that is supported by several studies. Finding a replacement habit can be a first step towards long-term dissolution of the undesired behaviors.