While often sought out, treatment options for body-focused repetitive behaviours (BFRBs) can seem elusive. Because of how little knowledge there currently is about BFRBs, many treatment providers don’t know about them, but suppose you do find someone that says they can help with your BFRB. That raises even more questions: what can I expect? How does this work? Can they actually help?
We always recommend doing research so that you can make informed decisions, whether that means looking more into the person offering treatment or the kinds of treatment they’re offering. In this blog, we’ve got an inside look at traditional treatment providers who treat BFRBs, which will be followed by a blog about BFRB coaches. These are intended to provide an overview to get you started in your searches.
From the treatment provider side, Joanna McBride of Archways Centre for CBT and Dr. Corrick Woodfin of Now In Colour Psychological Services volunteered some of their time to answer questions about being a treatment provider. You can find both of these individuals listed under our Canadian BFRB Treatment Providers page. The information in this blog will be broken down into different subsections:
- Defining Treatment Providers
- What to Look for in a Treatment Provider for BFRBs
- What to Expect When Starting Treatment for BFRBs
- Common Treatment Models: What Are They and Why These Models?
- The Challenges that Come with BFRB Treatment
- The Highlights: How Can Treatment for BFRBs Help?
- Taking It From Here…
I encourage you to read through each of these sections as they build on each other. By the end, you should have a sense of what to expect when it comes to BFRB treatment providers.
Let’s dive in.
Defining Treatment Providers
There are a number of terms that we might see thrown around when talking about treatment providers, such as therapists and psychologists. When asked about these terms, both McBride and Dr. Woodfin agree that “therapist” is a broad term, while psychologist if more precise and refers to someone who is registered with a psychological governing body. For McBride, that’s the College of Psychologists of Ontario. For Dr. Woodfin, it’s the College of Alberta Psychologists.
“A psychologist is a regulated professional,” Dr. Woodfin describes. “Only those who have completed a recognized training program, and who have met the requirements for practice, can refer to themselves as a psychologist.”
He adds, “Seeking treatment from a psychologist ensures the treatment provider is accountable to their governing body and has a duty to adhere to the standards of practice and operate ethically.”
While we might assume that only someone with the title “Dr.” would be a psychologist, McBride notes that she doesn’t have that doctorate designation although she is a registered psychologist.
What to Look for in a Treatment Provider for BFRBs
For treatment providers in general, Dr. Woodfin notes that finding someone registered with a psychologist governing body is important. McBride agrees that a psychologist or other regulated health care professional would be ideal.
On the BFRB side of things, there aren’t any specific qualifications to treat clients with these disorders, but McBride does have some suggestions of what attributes to consider on a treatment provider’s resume.
- Graduate of TLC Foundation for BFRB’s Professional Training Institute
- Someone who has experience with BFRBs
- Someone certified with the Canadian Association of Cognitive and Behavioural Therapies (CACBT) with some experience treating BFRBs or experience treating obsessive compulsive disorder (OCD).
“A BFRB treatment provider should have the knowledge and skills to thoroughly assess and effectively treat a BFRB,” McBride says. “Unfortunately, there is no standardized test for treatment providers to take to demonstrate their ability to work in this area. It is up to the person with the BFRB to ask how much experience and knowledge the treatment provider has.”
Both McBride and Dr. Woodfin have completed TLC’s training program.
What to Expect When Starting Treatment for BFRBs
If you’re feeling anxious or afraid when anticipating that first meeting or starting a session, that’s okay! Taking this step can be scary for a number of reasons, such as ingrained shame or conceptualizing what it’ll mean to face your BFRB head on. The good news is psychologists like McBride and Dr. Woodfin are there to work with you to find the best approach to addressing your BFRB and your situation. This is important because, as we tend to see in the BFRB community, these disorders don’t always affect two people in the same way.
Dr. Woodfin describes this process as developing a “baseline ‘model’ of the BFRB,” whereby he goes through a structured interview or assessment to get a sense of the way the BFRB impacts the client and also how it’s maintained. Part of the process is also in normalizing BFRBs.
“BFRBs are much more commonplace than many realize. They are also an extension of normative grooming behaviours—we all pick, pull, bite,” he explains.
Whether the psychologist or treatment provider approaches the first session like Dr. Woodfin does or not, establishing goals and readiness to take on the work involved in BFRB treatment are key pieces to establish in these beginning sessions.
Common Treatment Models: What Are They and Why These Models?
Whether you’re familiar with the existence of CBT, ACT, and even SCAMP or ComB or not, these are the main treatment methods or models that both McBride and Dr. Woodfin mention.
First, let’s define these terms.
- CBT is Cognitive Behavioural Therapy.
- ACT is Acceptance and Commitment Therapy.
- ComB stands for Comprehensive Behavioural Model, which employs the use of SCAMP (sensory, cognitive, affective, motoric, place).
According to Dr. Woodfin, SCAMP is used to explore “sensations, thoughts, feelings, movements, and environmental factors” related to the picking, pulling, or biting behaviours. This is useful for defining the BFRB’s role and impact in a person’s life.
“If the goal of treatment is to reduce the BFRB, then CBT is the treatment of choice I would use,” McBride says, noting that ComB is considered a form of CBT and the style she goes with specifically.
Even with that in mind, she sometimes incorporates aspects of ACT to examine values and encourage movement that aligns with those values. ACT is something that Dr. Woodfin says he sees as being an important piece of transforming a client’s perception of their BFRB.
“ACT differs from classic CBT in that it doesn’t ask an individual to put energy into changing thoughts, but simply to work on distancing themselves from negative thoughts and experiences, to work on acceptance, and to pivot toward more flexible and meaningful behaviours,” he explains.
“A client once told me that ACT is basically learning to be much kinder toward ourselves,” he adds.
But what about counselling or talk therapy? These are popular choices for many with mental health struggles, but McBride feels they’re not as effective for complex issues like BFRBs and recommends sticking with treatment options that have more scientific and evidence-based backing for the best results. While there is still a wealth of research that can be done about BFRBs, she works with the information that is available and keeps up to date with new studies and practices.
The Challenges that Come with BFRB Treatment
This is not an attempt to squash any optimism or hope that anyone has about starting treatment. However, it is good to keep in mind that this is a challenging task to undertake. Fear, shame, stigma, and the fact that BFRBs are reinforced behaviours that have often been occurring for a length of time (and therefore can be difficult to change) can all factor into this. Dr. Woodfin notes as well that sometimes clients are hesitant to really dive into the impacts of the BFRB and the meaning this has.
McBride says the shame can be one of the most challenging things to overcome.
“Often the BFRB has been going on for a long time, so the person can build up a very negative view of themselves which can be hard to break down,” she says. “It can be difficult to see individuals struggle with such a high degree of shame.”
Dr. Woodfin notes that it can often feel like he’s working with multiple people in one session: himself, the person who wants to be free from the behaviour, and the person who enjoys the behaviour. Usually, people schedule an appointment because they want to stop, to avoid consequences like scarring, bald spots, lost time, and emotional impacts. However, there is another aspect involved too.
“I would argue a part of them doesn’t want to stop and they want to actively maintain the good stuff,” he explains. The “good stuff” can be things like the perfect pull, stress relief, and the “productive spot.”
The Highlights: How Can Treatment for BFRBs Help?
Now that we’ve got the challenges out of the way, let’s highlight some of the good things. Despite the initial struggles, treatment can be beneficial, even right from that first meeting.
“The most rewarding aspect of being a treatment provider of BFRBs is seeing a change in the individual in the first hour,” McBride says. To clarify, she says that she doesn’t mean in terms of behaviour reduction (although that would be amazing), but rather the sense of relief that someone can feel in realizing they’re not alone. “Often, this is the first time the person has told anyone about the BFRB, and seeing the change from nervousness to relief is amazing.”
The progress that comes throughout the process is also something she loves to see and becomes shining moments in treatment. She says that people are often surprised by early changes and gains when working with the strategies.
“The optimism they emit is very rewarding because I know how much they have struggled to this point.”
Dr. Woodfin notes that there is a moment in therapy when things just click into place and the client’s management becomes more effective. He also enjoys working with the BFRB community in general and helping people recognize their normalcy.
“They have normal lives—families, jobs, school, work—and they are just ticking on with life, but they happen to pull, pick, or bite more than they would like. It’s great to acknowledge this with a client and have a joint understanding that we are not trying to change them necessarily, but help them to manage a behaviour more effectively.”
He also likes to help people reconceptualise their identity with their BFRB. We might be quick to think that we are a picker, puller, or biter, but there are many windows of time where we don’t engage in these behaviours and we can think of ourselves as non-pickers, non-pullers, and non-biters.
“Think about the time you don’t engage in your BFRB—how much of the day is this? How many of 24 hours do you not engage in a BFRB? Then think yourself, ‘I am a non-BFRB person for X hours, and therefore, there are X hours in the day that I would like to manage/change. That is much better than thinking you are defined by your BFRB and that this is a 24-hour problem.”
Essentially, you gain the tools to manage and work through your BFRB and the struggles that accompany it. Through the work you do and the help of the treatment provider, you empower yourself in addressing your BFRB and its impacts on your life.
Taking It From Here…
The goal with this blog has been to provide a comprehensive glimpse into what a traditional treatment provider like a psychologist can offer people struggling with their BFRBs. Of course, much of this just skims the surface in terms of what treatment can look like and what other professionals or models might be considered. Another thing McBride brings up as noteworthy is how there are challenges such as accessibility when it comes to BFRB treatment options, and not necessarily in the way we might initially think of there not being enough treatment providers.
“I think a big piece missing from this conversation is about how specialized services (such as ComB for BFRBs) is not always accessible,” she says.
These kinds of services come at a cost, which either means the person pays out of pocket or they have the privilege of having extended insurance coverage through their employer. To fill in the gaps, she hopes to be able to start a psychologist-led treatment group, which would help bring down costs for individuals while also giving them the opportunity to meet others, which is a big component in reducing shame.
So yes, there’s more to this discussion to be had, and we hope to be able to explore it in the future. But there is a lot of available knowledge and positive takeaways that can be had already. I hope that this inside look into BFRB treatment providers has brought that to light.
Next: An Inside Look at BFRB Coaches
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