Habit Reversal Therapy for BFRBs 

Body-Focused Repetitive Behaviours, often known as BFRBs, are repetitive behaviours involving the body that can become difficult to control and may cause distress, physical damage or embarrassment.

 

Common examples include hair pulling, skin picking and nail biting.

 

I offer Habit Reversal Therapy for BFRBs in Harrow and online across the UK, using structured approaches such as Habit Reversal Training (HRT) and the Comprehensive Behavioural Model (ComB) to help clients understand what triggers the behaviour and develop practical ways of responding differently.

 

What are BFRBs?

 

BFRBs are repetitive behaviours directed towards the body.

 

They may include

• hair pulling

• skin picking

• nail biting

• biting the inside of the mouth

• repetitive touching or picking

• other habitual grooming behaviours

 

These behaviours can happen consciously or automatically.

 

Some people notice a strong urge before the behaviour, while others may only become aware after they have been pulling, picking or biting for some time.

 

BFRBs are not simply “bad habits”. They can be influenced by emotional, sensory, behavioural and situational factors.

 

What is Habit Reversal Training?

Habit Reversal Training, or HRT, is a structured behavioural approach often used to help reduce repetitive behaviours such as hair pulling, skin picking and nail biting.

 

HRT typically includes

 

• increasing awareness of the behaviour

• identifying early warning signs or urges

• recognising situations that trigger the behaviour

• learning a competing response

• building motivation for change

• practising new responses across different situation

 

A competing response is an action that makes the BFRB difficult or impossible to carry out for a short period of time. The aim is not simply to rely on willpower, but to make the behaviour easier to notice and easier to interrupt.

 

What is the ComB Model?

 

The Comprehensive Behavioural Model, known as ComB, is another approach used for BFRBs.

 

ComB looks at the different factors that may be contributing to the behaviour.

 

These can include

 

• sensory factors- for example, the feel of a hair, nail or skin irregularity

• cognitive factors - thoughts such as “I need to get rid of this rough bit”

• emotional factors - stress, boredom, frustration or anxiety

• motor habits - automatic hand movements or familiar routines

• environmental factors - particular places, times or activities associated with the behaviour

 

By understanding your individual pattern, therapy can be tailored more precisely.

 

Trichotillomania and Hair Pulling

Trichotillomania involves repeated hair pulling that can lead to hair loss or noticeable thinning. Hair pulling may involve the scalp, eyebrows, eyelashes or other areas.

 

For some people, pulling is focused and intentional. For others, it happens automatically while:

 

• watching television

• reading

• working at a computer

• lying in bed

• studying

• feeling bored

• feeling stressed

 

Therapy can help you identify the situations, sensations and urges linked to pulling and practise alternative responses.

 

Habit Reversal Training and ComB can be particularly useful because they focus on the specific patterns maintaining the behaviour rather than simply telling you to stop.

 

Skin Picking

Skin picking, sometimes referred to as excoriation disorder, involves repeated picking, scratching or touching of the skin.

 

You may find yourself picking

 

• spots

• scabs

• dry skin

• uneven areas

• blemishes

• perceived imperfections

 

Some people describe feeling an urge to make the skin feel “smooth” or “right”. Picking may be triggered by stress, boredom, visual inspection of the skin or particular textures. Therapy can help you understand these triggers and develop practical strategies to interrupt the cycle.

 

Nail Biting

 

Nail biting can range from a mild habit to a repetitive behaviour that causes pain, bleeding or damage to the nails and surrounding skin. It may happen automatically during:

 

• concentration

• boredom

• anxiety

• driving

• television watching

• work

• studying

 

Habit Reversal Training can help you become more aware of when biting begins and develop alternative responses.

 

Why are BFRBs difficult to stop?

 

Many people with BFRBs have tried repeatedly to stop.

 

You may have used

• willpower

• reminders

• bitter nail products

• gloves

• covering mirrors

• asking other people to point it out

 

These strategies may help temporarily, but they do not always address the factors driving the behaviour.

 

A BFRB may provide

• sensory stimulation

• relief from tension

• relief from boredom

• emotional regulation

• a sense of satisfaction

• automatic comfort

 

Understanding what the behaviour is doing for you is often an important part of changing it.

 

Automatic and Focused BFRBs

 

BFRBs can occur in different ways. Automatic behaviours may happen with very little awareness. For example, you may realise you have been pulling your hair while reading only after several minutes.

 

Focused behaviours involve greater awareness and may be linked to a particular urge, emotion or sensory experience. For example, you may notice a rough hair and feel compelled to remove it.

 

Many people experience a mixture of both. Therapy helps identify which pattern is happening and adapt strategies accordingly.

 

What happens in BFRB therapy?

 

At the beginning of therapy, we will explore your individual behaviour pattern. This may include looking at

 

• when the behaviour occurs

• where it happens

• what you are doing at the time

• thoughts and emotions

• physical sensations

• urges

• sensory triggers

• environmental triggers

• what happens immediately before and after the behaviour

 

Keeping a brief diary or tracking sheet may help identify patterns. From there, we can develop a personalised treatment plan.

 

Strategies used in Habit Reversal Therapy

 

Depending on your individual needs, therapy may include

 

• awareness training

• competing responses

• stimulus control

• environmental changes

• sensory substitutions

• urge management

• behavioural experiments

• emotional regulation strategies

• relaxation

• cognitive work

• imagery rehearsal

• relapse-prevention planning

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The aim is to build practical skills that can be used in real-life situations.

 

Do I need to stop completely straight away?

 

No, For many people, aiming for immediate complete stopping can create additional pressure.

 

Therapy may begin by

• increasing awareness

• delaying the behaviour

• reducing frequency

• changing the environment

• practising competing responses

• targeting one situation at a time

 

​

Progress can be gradual.

 

The goal is to develop greater choice and control over the behaviour.

 

What if I have had the BFRB for years?

 

Long-standing BFRBs can still be worked with. The fact that a behaviour has been present for many years does not mean that change is impossible.

 

Therapy focuses on understanding how the behaviour operates now and identifying the most useful strategies for your current patterns.

 

Can anxiety and stress affect BFRBs?

 

Yes, For some people, BFRBs increase during periods of anxiety, stress, boredom or emotional overwhelm. This does not mean that anxiety is always the cause, but emotional states can influence the frequency or intensity of the behaviour.

 

Where relevant, therapy may therefore include work on anxiety management, stress, self-criticism or emotional regulation alongside Habit Reversal Training.

 

Can hypnotherapy be used for BFRBs?

 

Cognitive Behavioural Hypnotherapy may sometimes be used alongside behavioural approaches such as HRT and ComB.

 

It may support

• awareness

• imagery rehearsal

• competing responses

• attention control

• relaxation

• confidence in using new strategies

 

Hypnotherapy should support rather than replace the behavioural work at the centre of BFRB treatment.

 

Habit Reversal Therapy in Harrow and Online

 

I offer Habit Reversal Therapy for BFRBs from my practice in Harrow, North West London, as well as online across the UK.

 

If hair pulling, skin picking, nail biting or another repetitive behaviour is affecting your confidence, wellbeing or everyday life, therapy can help you understand the pattern and develop practical strategies for change.

 

Please get in touch if you would like to discuss whether Habit Reversal Training or ComB may be suitable for you.