September 20, 2021

Habit Reversal Therapy for Body Focused Repetitive Behaviors

Our group facilitator gives insights into this therapy 

By Abigail Callard, LLMSW, Social Work Post Grad Fellow

According to the TLC Foundation for Body-Focused Repetitive Behaviors, "body-focused repetitive behavior (BFRB) is a general term for a group of related disorders that includes hair pulling, skin picking, and nail-biting, affecting at least 5% of the population. These behaviors are not habits or tics; rather, they are complex disorders that cause people to repeatedly touch their hair and body in ways that result in physical damage."

Body-Focused Repetitive Behaviors (BFRB) are a subset of diagnoses that I understand on both a professional and personal level. They are something that I have struggled with myself since the age of nine, typical onset for BFRBers. I was unaware of the name or that it was a clinical diagnosis until much later in my life. Since that time, I have educated myself about this diagnosis with the help of some awesome resources and groups moving towards the point where I can now work on treating them as well, in my clinical practice.

I have found though, being the only adult clinician in the Department of Psychiatry outpatient clinic with a special interest in this area, that there is not enough time on my schedule to see all the many patients dealing with diagnosis. It also tends to be more secondary for patients -- so they’re coming into our clinic for anxiety, not hair pulling or nail biting. 

Dr. Jim Abelson, the head of our anxiety team, and I wanted to catch others that might not partake in individual treatment for it. Hence, the department started an 'Introduction to Habit Reversal Therapy for Body Focused Repetitive Behaviors' group that I lead. The group is helping our patients to understand basic psychoeducation surrounding BFRBs and to be able to use the skills of Habit Reversal Therapy (stimulus control/competing response) with some inclusion of acceptance and commitment therapy like cognitive diffusion. 

Habit Reversal Therapy is a hard treatment, but fairly simple which makes it ideal for a group setting. The normalization that comes from this setting as well will be so helpful to patients, as typically people suffer in silence and are often unaware that there are others partaking in the exact same behavior.

Habit Reversal Therapy for Body-Focused Repetitive Behaviors Group Information:

What is it? 
A skills-based group where you can learn effective management strategies for your body-focused repetitive behavior. You will also likely find that the group offers a supportive environment while working on these skills at a pace appropriate for you.

Who is it for? 
Patients in our department who are dealing with body-focused repetitive behavior problems that have started to feel unmanageable. This could be interfering with your daily life or making you feel isolated and alone. If you want to start working on skills to break up that unmanageable or isolated feeling, this group is for you.

How often does it meet?
The group meets the first four Tuesdays of every month from 3:00-4:30 PM.

How long can I participate? 
Most people will cycle through all four sessions in a month and then decide if they would like to continue working on these skills by repeating the group. You are welcome to continue as long as appropriate for you.

How do I sign up? 
First, you must complete a New Patient Psychiatric Evaluation here in Michigan Medicine's Department of Psychiatry. Once you have done that, tell the clinician you are working with that you would like to be enrolled in the HRT Group for Body Focused Repetitive Behaviors.


For more information on this topic, I recommend the TLC Foundation for BFRBs. They are the primary foundation that focuses on education, research, and most importantly, support for those suffering.

Here are some other helpful websites:  

Information on Trichotillomania (Hair Pulling Disorder)

Information on Excoriation (Skin Picking Disorder)

Information on Other BFRBs

Treatment Information