Body-focused repetitive behaviors (BFRBs), such as nail-biting, skin-picking, hairpulling, and lip- and cheek-biting, can become a distressing issue for many individuals, leading to visual skin damage and affecting mental health. However, a new study published in JAMA Dermatology suggests a gentle self-help technique that might offer some relief for those struggling with these behaviors.
Understanding BFRBs: Coping Mechanisms for Stress and Emotions
BFRBs are common habits that many people experience to some degree over their lifetime, but they can become problematic when done excessively. For some, these behaviors lead to bald patches, scars, sores, and lesions, affecting their self-esteem and intimacy. In severe cases, BFRBs can become life-threatening, causing complications such as sepsis or severe stomach problems.
According to CNN, the study introduces a habit replacement technique that might be helpful for those unable to access immediate therapeutic help, even though cognitive behavioral therapy (CBT) under the supervision of a therapist is the gold standard treatment for problematic BFRBs.
The habit replacement technique involves softly stroking the skin in various ways, such as circling the index and middle fingers, tapping the fingers against the thumb, or crossing arms and stroking the forearms. This self-soothing method offers an alternative to the distressing behaviors while promoting emotional regulation under stress or boredom.
In a proof-of-concept trial involving 268 participants with BFRBs, half of the group received a manual describing the technique, while the other half was placed on a waitlist. After six weeks, 54% of those using the habit replacement techniques reported improvement, compared to 20% in the control group. Nail-biters showed greater benefit from the technique.
Despite the promising results, the study had limitations, including a short time frame and predominantly White female participants recruited via social media. The researchers acknowledge the need for further follow-up to determine the sustained effect of the technique.
Experts emphasize that the habit replacement technique is just one aspect of BFRB treatment. Addressing deeper emotional issues and seeking professional help remains crucial in treating the roots of these behaviors and achieving long-term relief.
Steffen Moritz, head of clinical neuropsychology in the Department of Psychiatry and Psychotherapy at the University Medical Center Hamburg-Eppendorf in Germany, explained that these behaviors are often shrouded in shame and secrecy. However, they should not be regarded as a form of self-mutilation, self-harm, or self-hate. Rather, they serve as coping mechanisms for calming and soothing the nervous system during times of stress or strong emotions, such as anger.
Moritz and his team aimed to develop a repetitive and self-soothing technique that is not dysfunctional or conspicuous. The habit replacement technique they devised involves various gentle touches on the skin, such as circling the index and middle fingers, tapping the fingers against the thumb, and crossing arms to stroke the forearms. By engaging in these activities, individuals can find an alternative means of calming themselves without causing harm or distress.
The study participants were between the ages of 18 and 80 and exhibited a range of BFRBs, including skin-picking, trichotillomania, nail-biting, and lip- and cheek-biting behaviors. While CBT is considered the gold standard for treatment for BFRBs, the habit replacement technique was offered as a potential self-help approach, especially for individuals who may not have immediate access to professional therapy.
After six weeks, more than half of the participants using the habit replacement technique reported improvement in their body-focused repetitive behaviors. In contrast, only 20% of the control group, which was on a waitlist, experienced similar improvement. The results suggested that this self-help technique could be effective, particularly for nail-biters, who appeared to benefit the most from its implementation.
However, the study had some limitations, including a short duration with no long-term follow-up, a predominantly female and White participant pool, and recruitment through social media. As such, the researchers acknowledged the need for further research to evaluate the sustained impact of the technique and to include more diverse participants.
Embracing a Holistic Approach: Combining Self-Help and Therapy
Despite these limitations, experts such as Stacy Nakell, a psychotherapist and clinical social worker specializing in treating BFRBs, appreciated the study's focus on acknowledging the self-soothing component of these behaviors. Nakell noted that many cognitive behavioral therapies tend to emphasize getting rid of BFRBs without fully addressing the underlying self-soothing function.
However, Nakell also stressed the importance of going beyond habit replacement techniques to address the deeper emotional issues associated with BFRBs. While the technique may provide temporary relief, it is vital to explore and understand the emotions driving these behaviors to achieve long-term resolution.
BFRBs, Nakell explained, can be likened to "a blanket with thorns." They offer momentary comfort, but the underlying emotional roots must be addressed to avoid adopting other problematic behaviors or experiencing disappointment when short-term symptom-focused treatments wear off.
As researchers and mental health professionals continue to explore innovative approaches to managing BFRBs, it is essential for individuals struggling with these behaviors to seek professional assistance and support. Treating the emotional aspects of BFRBs remains crucial for long-term recovery and well-being.
While the habit replacement technique shows promise, it is just one piece of the puzzle. Combining self-help techniques with professional therapeutic approaches can provide a comprehensive and effective strategy for addressing body-focused repetitive behaviors. Researchers hope to provide a glimmer of hope for those struggling with these difficult conditions by comprehending and assisting people in managing stress and emotions in healthy ways.
