Can Habit Reversal Help Break the Cycle of Skin-Picking?

Can Habit Reversal Help Break the Cycle of Skin-Picking?

Skin-picking, also known as dermatillomania and excoriation, is a body-focused repetitive disorder (BFRD) in which the person has an irresistible urge to scratch, pick, or scrape their skin on a near-constant basis. Skin-picking can occur on any part of the body, but common areas include the scalp, face, arms, legs, and hands. When skin-picking isn’t addressed in time, it can cause scarring of the skin or co-occur with more serious mental health issues such as body dysmorphic disorder. 

What Is BFRB? 

BFRB stands for Body-focused Repetitive Behavior. BFRBs are defined as a cluster of behaviors in which an individual repeatedly engages in body focused acts (e.g., hair pulling, skin picking, nail biting) that result in damage to the body. The repetitive nature of these behaviors can make them hard to stop, and can lead to other mental health problems such as anxiety or depression.  

A person who compulsively bites their nails may start feeling anxious before they go into a meeting at work because they know they will have ruined nails afterwards, leading them back to nail biting again. 

What Is Habit Reversal Therapy? 

Habit reversal therapy is one type of cognitive behavior therapy for people with BFRBs. This therapy helps you to change your response to whatever triggers your urge to pick. The goal is to replace picking at your skin, hair, or nails with an activity that provides a similar sense of satisfaction but does not lead to damage. One example might be wearing gloves while you do dishes. Another example might be brushing your teeth instead of picking at any bumps on your face or fingers. There are many different possibilities and this method is often customized for each person’s needs. 

How Does Habit Reversal Work to Change Behavior? 

Habit reversal can be a powerful intervention for skin picking. It is a type of behavioral treatment that works by associating something with your picking that becomes incompatible with it. In other words, you reward yourself for not engaging in your compulsion by making sure you do something else instead. To make this happen, the person has to choose their replacement activity ahead of time and follow through on their commitment every time they stop themselves from performing their compulsive behavior. You can’t just tell yourself to stop picking and then continue to pick, or you may simply find that your compulsion grows worse. You have to replace your picking with something else. That something else is called a replacement behavior. 

Where Can I Learn More about Habit Reversal Therapy for Skin-Picking Disorder? 

Habit reversal therapy for skin-picking disorder is a technique that helps people learn how to stop unwanted behaviors, like picking their skin. Comb-B is a method that is used in this type of therapy, and it can help you learn what triggers your skin picking and what to do about it. Comb-B stands for behavioral, cognitive, emotional, and biological interventions. It’s designed to help patients identify triggers for their behavior and then create an action plan to prevent the behavior from occurring again. Comb-B has been shown to be effective in treating other body-focused repetitive disorders, such as nail biting, hair pulling, and compulsive hair plucking. If you are interested in referrals or treatment of skin-picking please contact us at Better Living Center for Behavioral Health. 

Habit Reversal: Treating Tics & Tourette’s

Habit Reversal: Treating Tics & Tourette’s

Tics are involuntary muscle movements or vocalizations that can affect the face, body, and even the limbs of someone with Tourette syndrome (TS). Tourette’s has recently gained more recognition as the famous singer, Billie Eilish, has been public with her experiences of Tourette’s and her symptoms can often be observed (by her report) in her performances. For many people with Tourette’s and involuntary tics, the involuntary movements or vocalizations experienced can be distressing and embarrassing. If you suffer from Tourette’s or tics, there is help. As with any repetitive muscle movement, it’s possible to train yourself to resist performing the tic that results from an urge. Treatment by habit reversal works by teaching you to recognize the urge to perform the tic, wait until it passes, and then perform an alternative response that doesn’t result in the tic.

What Are Tics?
We all have unwanted habits that crop up now and then. We might find ourselves biting our nails, twirling our hair, or tapping our feet when we get stressed. These are called tics. A tic is an involuntary movement or sound that people make repeatedly and cannot control. Common examples of tics include shoulder-shrugging, nose twitching, blinking eyes rapidly, tapping fingertips together, sniffing sounds, clearing throat and facial grimacing. Tics can be annoying for those around you, but they aren’t usually harmful. They may go away on their own within a few weeks or months. But if they don’t, it can help to talk with us about treatment options.

Where Do My Tics Come From?
Your tics can come from your body’s attempt to relieve stress. Many people who have Tourette syndrome also suffer from anxiety and stress. So, if you notice that a lot of your tics occur around certain stressful situations, it might be good for you to learn how to relax. Tics also may increase in frequency when we are more ‘unaware’ or bored or experiencing certain emotions. It is important to remember that everyone’s experience with tics is different.

Why Habits Work To Stop A Tic?
When it comes to a tic, your brain is doing exactly what it wants. Trying to force it not to do something can only make things worse. But, if you’re able to break down a tic into its individual components, you can reduce and even eliminate that tic by encouraging alternate behaviors and reinforcing them through repetition. This process is called habit reversal therapy or HRT.

How To Form A New Habit That Prevents Involuntary Movement
Here’s how to turn those involuntary movements into voluntary ones. It might sound counterintuitive, but it works—and has been used successfully for decades by psychologists and therapists. In fact, habit reversal is one of two behavioral therapies that have been shown to be effective in treating tics and other repetitive behaviors in children and adults (the other being habit-reversing drugs). It can also be used for a wide range of other conditions, such as nail-biting, hair pulling, skin picking, and even self-injurious behaviors like head banging or self-hitting.

Trichotillomania: What is problematic hair-pulling?

Trichotillomania: What is problematic hair-pulling?

Trichotillomania (TTM) is currently classified as an impulse-control disorder. TTM entails the phenomenon of repetitive hair pulling that results in hair loss. The diagnostic criteria for TTM include: an increased level of tension immediately before hair pulling or during attempts to avoid pulling and a feeling of relief, pleasure, or gratification in response to hair pulling. Trichotillomania must also cause the individual distress or impairment in occupational, social, or other areas of functioning. Hair is most often pulled, one hair at a time, either from the scalp, lashes, or eyebrows. Hair pulling from the pubic area is also common.

Pulling is generally executed by way of the fingers; however, tools such as tweezers, brushes, or combs may be used as well. TTM suffers will often partake in post-pulling actions that involve handling the pulled hair using the mouth, hands, or face. The hair can be chewed or ingested as well. Ingesting hair may also lead to a number of significant health issues. TTM is considered to be more common among females, although it is not certain whether this sex difference results from an actual variance in the occurrence of the disorder, represents a female treatment-seeking bias, or simply reflects higher acceptability in society of hair loss in men.  

At the Better Living Center for Behavioral Health we treat patients with trichotillomania with evidence-based treatments including Habit Reversal. Habit reversal helps the individual break down the series of actions that lead to hair pulling and engage in alternative behaviors to reduce hair pulling. If you would like to learn more about treatment of trichotillomania or other Body Focused Repetitive Behaviors (BFRBs) please contact us at 972-332-8733.



Woods, D. W., Flessner, C., Franklin, M. E., Wetterneck, C. T., Walther, M. R., Anderson, E. R., & Cardona, D. (2006). Understanding and treating trichotillomania: What we know and what we don’t know. Psychiatric Clinics of North America, 29(2), 487-501. doi:10.1016/j.psc.2006.02.009