There’s still a lot of research to be done when it comes to body-focused repetitive behaviours (BFRBs), and that includes research into what treatment options are the best for people with BFRBs. That being said, there are treatments that are currently being used to help people with BFRBs reduce their behaviours and alleviate symptoms and emotional impact.
This page is a compilation of the most common treatment models, however, this should not replace guidance from a professional. Each individual is different, and it’s best to have a treatment plan that’s tailored to you. It’s best to speak with someone who can work with you to find that or before starting or changing any treatments you’re currently using.
Traditional Treatment Options for BFRBs
Cognitive Behavioural Therapy (CBT)
Cognitive behavioural therapy has been developed over many decades and is an evidence-based model of treatment used for many mental disorders, including depression, anxiety, addiction, and BFRBs. This method of treatment focuses on learning to identify, question, and change beliefs and attitudes associated with unwanted behaviours and emotions. It demonstrates the connection between thoughts (or “cognitions”) and behaviours in an effort to find new ways to overcome or manage the behaviour.
Learn more:
- Cognitive Behavioural Therapy (Sunnybrook Health Sciences Centre)
- What is Cognitive Behavioural Therapy? (Centre for Addictions and Mental Health)
- Cognitive Behaviour Therapy (Anxiety Canada)
Acceptance and Commitment Therapy (ACT)
Acceptance and commitment therapy is empirically-based and a derivative of CBT that also touches on mindfulness. ACT teaches an individual to stop avoiding or denying their emotions and accept that they are appropriate reactions that one can move forward from. In doing this, the individual can accept their struggles and commit to make changes to their behaviours. It focuses on being flexible with reactions and on values to encourage the behavioural changes.
Learn more:
- Acceptance & Commitment Therapy (ACT) (Association for Contextual Behavior Science)
- Acceptance and Commitment Therapy (Psychology Today)
Comprehensive Model for Behaviour Treatment (ComB)
The Comprehensive Model for Behaviour Treatment is a highly recommended treatment option for people with BFRBs. This model involves the professional and the individual seeking treatment working together to identify triggers and their relationship to the BFRBs. The sessions begin with structured assessments to identify patterns linked to hair-pulling, skin-picking, nail-biting and other behaviours in order to effectively address them.
Learn more:
- A Comprehensive Model for Behavioral Treatment (ComB) (TLC Foundation for BFRBs)
- Comprehensive Behavioral (ComB) Treatment for Skin Picking and Hair Pulling Disorders (International OCD Foundation)
Habit Reversal Training (HRT)
Habit Reversal Training is geared toward intervening on unwanted behaviours by building awareness of the behaviour, noting the situations in which it occurs, enduring urges, minimizing triggers, and developing competing responses to use instead of the picking, pulling, or biting behaviours.
Learn more:
- Break Bad Habits with Habit Reversal Training (Anxiety.org)
- Using Habit Reversal Training to Reduce Physical and Verbal Tics (VeryWellMind)
Alternative Treatment Options for BFRBs
Mindfulness
Mindfulness asks you to be in the moment, focusing on what’s happening, what you’re doing, and the space you’re in. It encourages people to be in touch with the present and your body to avoid being overcome by obsessive thoughts and behaviours. One of the keys of mindfulness is being present in the moment without judgement of the thoughts you’re experiencing and using breathing techniques and other practices to reduce stress.
Learn more:
- What is Mindfulness? (Mindful.org)
- Mindfulness exercises (Mayo Clinic)
Emotional Freedom Technique (EFT Tapping)
Often referred to as “tapping,” EFT is used to address physical pain and emotional distress. Based in Chinese medicine, this alternative treatment method focuses on meridian points in the body to balance energies as imbalances are seen as contributing to disease and illness. It’s used for many anxiety disorders as well as post-traumatic stress disorder and other conditions.
Learn more:
- EFT Tapping (Healthline)
- A Guide to EFT Tapping (MedicalNewsToday)
N-acetylcysteine (NAC)
N-acetylcysteine is an amino acid that is showing some success for people with BFRBs. There is more research to be done on NAC and its effectiveness with BFRBs, but initial research is promising. It helps people with BFRBs and other unwanted behaviours because it can regulate levels of glutamate in the brain. Glutamate is related to triggering excitement, which is often linked to obsessive-compulsive disorders. This is an over-the-counter option that can be found in many health-food stores.
Learn more:
- N-acetylcysteine for Trichotillomania, Skin Picking, and Nail Biting (TLC Foundation for BFRBs)
- Top 9 Benefits of NAC (N-Acetyl Cysteine) (Healthline)
Additional Resources
Canadian BFRB Treatment Providers
Find a Therapist (TLC Foundation for BFRBs International database)