TICS, TRICH, SKIN-PICKING, BFRBs
BFRBs & HABIT REVERSAL
Recent advances in a behavioral technique called Habit Reversal have been very effective in several Body Focused Repetitive Behaviors (BFRB), conditions which involve a strong urge to perform a bodily movement. These include Tics and Tourettes, Trichotillomania (hair pulling), and Dermatillomania (skin picking). Habit reversal means doing an opposite or competing behavior which prevents BFRBs from being performed and allows the associated urges to weaken. It is not uncommon for BFRBs to coexist with OCD and it's important that the treatment provider knows the difference and treats them with the right kind of therapy.
TICS, TOURETTES, & CBIT
Tics and Tourettes involve an irresistible urge to perform repetitive motor movements of the limbs and head, facial gestures, or vocal sounds (verbal, throat clearing, or nose blowing). It's almost like an extreme itch that you have to scratch, but becomes harder to stop once you start. They are largely genetic and are not the person's fault. Fortunately, these can be greatly reduced with a new treatment called Comprehensive Behavioral Intervention for Tics (CBIT). CBIT is a non-medicated treatment that
trains the patient to be more aware of what triggers the urge to tic, trains a competing behavior to inhibit the tic until the urge weakens, and makes other changes that can keep tics to a minimum.
The details of competing behaviors are very systematic and different for each person; what is helpful to one person might make another person's symptoms worse. One example of a competing behavior to a vocal tic might be to breath slowly with mouth closed for a few minutes, or to hum or whistle, until the urge reduces. For a blinking tic a competing response might be to close one's eyes for a minute and then open them making one slow motion normal blink. For arm or hand movements, a competing response might be holding one's harms down against the sides of one's body, breathing slowly to calm down, until the urge usually weakens in a few minutes. These are just for illustration and not treatment recommendations; an experienced CBIT therapist is necessary to design the most effective treatment for each individual. The accumulation of practicing these strategies--catching the tic before it gets out of hand--begins to reduce the urges for an extended period of time beyond just the individual incident.
DERMATILLOMANIA (SKIN PICKING)
Dermatillomania, or skin picking, involves an urge to pick at skin, often creating wounds to the skin. This also has a genetic component and the person shouldn't be blamed or be expected to "just stop." Often people think the picking happens "all the time," but in reality it happens more in certain situations than others. Some people pick more when stressed, and others do so when totally relaxed and are almost unaware of it happening.
Habit reversal also has been helpful in reducing this behavior by becoming more aware of a person's trigger situations that lead to skin picking and practicing a competing behavior in the moment to allow the urge to subside. Just one of many competing responses to an urge to pick would be holding something with the hand, wearing a glove the prevents picking, or picking at an tactile object (for example, bubble wrap) that mimics the feeling of picking.
TRICHOTILLOMANIA (HAIR PULLING)
Trichotillomania, or hair pulling, involves an irresistable urge to pull and sometimes pull out hair. It has a significant genetic component. This also can be effectively reduced with habit reversal techniques including creating competing responses that make the hair pulling impossible to perform until the urge subsides. This can include finding an object that gives the sensual satisfaction of pulling, twirling, or stroking. With continued practice even the urge itself begins to weaken over time. There are tons of pulling "toys" and gadgets on the internet, but often a simple household item will do.
Email a question to Dr. Brodsky or arrange a free same-day consultation. If you feel ready, make an appointment online instantly or call 212-726-2390. In-person sessions are available in New York and New Jersey. Virtual teletherapy is available nationwide in 43 states for tics, BFRB's, and OCD from Billings, Montana to Palm Beach, Florida.