Body-focused repetitive behaviors or BFRBs are a group of disorders characterized by an intense and irresistible urge to engage in a body focused behavior such as picking the skin (excoriation disorder) or pulling out bodily hairs (trichotillomania). It is estimated that between 1-4% of the global population suffers from a BFRB, and with an increase in awareness about the disorder the numbers are seeing an increase. Compulsive skin picking and hair pulling can often lead to skin damage, hair loss, and scarring. But it also leads to feelings of shame and guilt, often resulting in social isolation and loneliness. There is known definitive cause for BFRBs, and while there is evidence that in some cases there is a genetic component, onset has also been linked to a co-occurrence depression, anxiety, and even stress.
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Mindfulness-based therapy for BFRBs
Mindfulness-Based Cognitive Therapy (MBCT) combines the ideas of cognitive therapy with meditative practices and attitudes. Central to mindfulness is that the individual becomes deliberately aware of the thoughts that characterize his/her emotions while simultaneously learning to develop a new relationship to these thoughts. The primary goal is to learn to non-judgmentally accept uncomfortable psychological experiences. From a mindfulness perspective, much of our psychological distress is the result of trying to control and eliminate the discomfort of unwanted thoughts, feelings, sensations and urges. In other words, our discomfort is not the problem – our attempt to control and eliminate our discomfort is the problem.
One of the benefits of meditation for people with BFRBs is that it lowers stress, anxiety, and anger while maintaining emotional balance. These techniques benefit mental health in general. The belief is that by watching the physical sensations that come with intense emotions like passion, greed, and anger you realize that these emotions are impermanent and therefore can begin to change blind reactions to these emotions. Human nature is that we try to protect ourselves from that which is unpleasant. We tend to do this by either expression or suppression of that emotion. Through mindfulness and practicing being present you practice a third option, which is pure observation. Distancing yourself from your emotions allows you to objectively understand where it is coming from and how your thoughts and experiences influence your emotions. This is the cornerstone of work you do in cognitive behavioral therapy.
It’s not about control, it’s about acceptance
Compulsive skin picking and hair pulling are not simply bad habits that can just be broken with sheer will power. When you have a BFRB it seems like the more you try to control the behavior, the stronger the urge to engage in the behavior becomes. Acceptance and Commitment Therapy (ACT) is based on the premise that the struggle is not about lacking control, but rather lacking acceptance. ACT does not attempt to directly change or stop unwanted thoughts or feelings, but instead encourages people to develop a new and compassionate relationship with those experiences. This shift can free people from difficulties attempting to control their experiences and help them become more open to actions consistent with their values, values clarification and the definition of values-based goals also being key components of ACT.
Meditation for BFRBs
Meditation exercises are closely linked to mindfulness and are recommended to help cope with stress related to skin picking. These exercises keep the mind and body healthy. They enable patients to keep busy and replace skin picking with something more positive. Exercise can reduce anxiety and depression also. It minimizes skeletal muscle tension and increases metabolism of excess adrenaline and thyroxin in the blood. From abdominal breathing to guided visualization meditation, different methods are used to treat patients. Once you are relaxed, tiredness is minimized, energy level is improved, self-confidence is enhanced and coping with stress becomes easier.