As a BFRB expert via lived experience, my copy of Stacy Nakell’s book “Treatment for Body-Focused Repetitive Behaviors: An Integrative Psychodynamic Approach,” has so many highlights, stars, exclamation points, and “YES”es in the margins.
As I wrote in my amazon review for the book, “Stacy is an expert in BFRB treatment. Her book focuses on a psychodynamic approach to BFRB recovery that is a marked shift from purely focusing on the physical behaviors of hair pulling, skin picking and nail biting. If you have a BFRB, Stacy's insightful case studies will take you on a journey to reviewing your own BFRB relationship. As innovators and leaders in the BFRB recovery, we (at HabitAware) believe Stacy's approach is compelling and very needed to break the BFRB cycle, as well as the cycle of shame that comes with it.”
The current “gold standard” treatment modalities for Body-Focused Repetititive Behaviors are rooted in curbing the in-the-moment physical behaviors of hair pulling, skin picking, nail biting, nose picking and other Body-Focused Repetitive Behaviors (BFRBs). These treatments include Habit Reversal Training (HRT) and Comprehensive Behavioral Therapy (ComB / SCAMP).
HRT is a behavioral intervention from the 1970s that encourages the use of awareness to choose a competing response to the unwanted BFRB. In clinical settings, this response is typically making a fist with your hands so that they cannot engage in (compete with the) hair pulling, skin picking, or nail biting. The limitation to this approach is that it doesn’t allow the person to replace the behavior with something healthier that meets the true self-soothing need. Additionally, as I associate fist-making with getting angry, I prefer not to use it as I don’t want to psych my brain into feeling that way.
The recommended strategies from ComB of wearing hats, or gloves as blockers, or keeping hair or nails short, or using fidgets to keep the hands busy are surface-level strategies focused on taming the symptoms that indicate an issue: baldness, skin infection, rather than subduing the origin of the urge itself.
As we’ve seen through our work at HabitAware, BFRBs are not “easily solvable through behavioral change” alone (Nakell, pg. 1). It takes more than physical behavior change; it takes mindset change too!
The current definition of BFRBs are also very focused on the “what” of the hair pulling, skin picking or nail biting, but not so much on the “why.” Specifically for Trichotillomania (Compulsive Hair Pulling Disorder), Mayo Clinic cites the following to be true:
- Frequent, repeated and irresistible urges
- Inability to stop, despite repeated attempts
- Causing debilitation / impairment in regular life
The integrative approach recommended in Stacy’s book takes a holistic view of the BFRB as a coping strategy to regulate discomfort in a person’s life and encourages us “to go below the surface to see what is motivating the restless hands” (Nakell, pg. 3).
“Restless hands” is what we at HabitAware have been calling them too! The discomfort is restlessness of the mind or body (think physical discomfort like hunger, thirst, tiredness or even, a full bladder) that then becomes restless hands - if we don’t take care of ourselves.
Stacy’s bravery in sharing her own lived experience with skin picking disorder is another reason I recommend this book. The secret of our BFRB - the constant hiding and worrying about being found out - makes us sick. When we can share our story, we release the hold the secret has over us and this opens the door to shattering shame and taking control.
Stacy’s work is based on 20 years of research and focuses on how by pushing down our emotions, they get bottled up and the pressure releases through BFRBs. Ultimately, Stacy’s approach, as detailed in Part 2 of the book, encourages treatment professionals to go beyond the surface to understand WHY BFRBs occur. In doing so, professionals can help their clients create lasting change.
To learn more about this Integrative Psychodynamic Approach to Treating BFRBs, join Stacy’s upcoming CE training on August 16, 2024 through BFRB Changemakers Non-Profit Training Academy.
BFRB Changemakers non-profit (FIN #93-1544492) supports BFRB healing through community. Through the BFRB Changemakers Training Academy we strive to increase access to care by offering Continuing Education training to new and seasoned treatment professionals.
