Cristian Chereches. MSW, RSW, Psychotherapist

 

What are BFRBs ?

BFRBs, or “Body-focused, repetitive behaviours”, are repetitive behaviors directed toward the
body (hair pulling, skin picking, nail biting, cheek biting, etc.) that cause damage or distress, and
that the person has usually tried to stop doing many times over many years. (ADAA)

BFRB’s often have internal triggers (urges, sensations, anxiety, boredom) and external triggers
(situations, environmental cues), and maintaining factors like reinforcement (e.g. relief,
distraction) are important. (The TLC Foundation)

The Canadian BFRB Support Network suggests that between 2‑4% of the population suffer in
silence with BFRB’s such as trichotillomania. (canadianbfrb.org)

Our clients often tell us that they feel significant shame about their condition, and this has
stopped them from seeking help. In addition, many health care practitioners are unaware of the
condition itself, or of the best, evidence-based treatments, making it difficult for patients to
access appropriate care.

Evidence based treatments for BFRB’s

The most effective treatment for BFRBs is Cognitive-Behavioral Therapy (CBT), especially a technique called Habit Reversal Training (HRT). Working with a therapist who has experience in BFRBs is usually best.

Other tools that can help:

• Acceptance & Commitment Therapy (ACT)
• Mindfulness practices
• Emotion regulation strategies (useful when urges feel overwhelming)

Lasting progress often comes from:

• Regular practice
• Tracking behaviors (self-monitoring)
• Occasional “booster” sessions

In some cases, medications, supplements, self-help resources, or peer support groups can provide extra support, especially if other mental health challenges are present.

What to Expect When You See a Therapist for a BFRB ?

📝 Initial Assessment

• The first few sessions will involve a comprehensive assessment.
• The therapist will ask about the nature of the behavior (what, when, how often, triggers), its impact on daily life, and any co-occurring conditions (like anxiety or depression).
• The goal is to understand the function of the BFRB—why it happens, what maintains it, and how it fits into the person’s life.

📋 Psychoeducation

• The therapist will explain what BFRBs are (not just “bad habits”) and how they are maintained through habit loops and reinforcement.
• You’ll learn about the neurology and psychology behind the behavior, which can reduce shame and increase motivation.

🛠️ Core Treatment (Typically CBT-based)

Most therapists use a structured, evidence-based approach. The most common components include:

1. Habit Reversal Training (HRT)

• Awareness training: Learning to detect early signs of the behavior (urges, movements, emotions).
• Competing response training: Developing alternative behaviors to replace the BFRB (e.g. clenching fists, using fidget tools).
• Stimulus control: Modifying the environment to reduce triggers (e.g. mirrors, tweezers, lighting, idle time).

2. Comprehensive Behavioral Model (ComB)

• The therapist helps identify specific triggers across five areas (sensory, cognitive, affective, motor, place).
• Interventions are tailored to the person’s unique patterns (e.g. managing anxiety, reducing boredom, improving focus).

3. Mindfulness / ACT / Emotion Regulation (if needed)

• If the BFRB is linked to emotional distress, mindfulness or Acceptance and Commitment Therapy (ACT) may be added.
• Skills for tolerating urges, staying present, and managing emotions can be introduced.

🔁 Ongoing Practice & Monitoring

• You’ll be asked to track behaviors between sessions using logs or apps.
• Expect to practice new skills daily and bring insights back to therapy.
• Sessions may include reviewing progress, troubleshooting, and adjusting strategies.

🧩 Adjunct Supports (if helpful)

• The therapist might suggest supplements (like NAC), medications (if anxiety or depression is severe), or self-help tools (apps, fidget tools).
• Peer support groups or online communities may also be recommended for additional accountability.

⏳ Duration and Timeline

• Many people see meaningful improvement in 8–20 sessions, though this varies.
• Relapse prevention is built into later sessions: learning how to maintain progress and what to do if urges return.

What You Can Expect to Gain

• Increased control over urges
• Reduced damage to skin/hair/nails
• Improved self-esteem and reduced shame
• Better emotional regulation
• A sense of empowerment through evidence-based strategies

 

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