Hi, I'm Dr. Tracey Marks, a psychiatrist,
and I make mental health education videos.
In a previous video, I talked in detail
about the body-focused repetitive behaviors,
such as hair pulling, skin picking, and nail biting.
These are compulsive behaviors
that can cause a lot of problems and are much more
than just having a nervous habit.
These compulsions don't respond well to medication,
but can respond well
to a therapy called habit reversal training.
This therapy can also work with ticks and nervous habits,
like touching your face.
Important precautions for COVID
are that you disinfect your hands
and refrain from touching your face,
but we touch our face a lot more than we realize.
Some studies have shown that people touch their face
on average of 10 to 20 times an hour
without even being aware of it.
In this case,
touching your face isn't necessarily a compulsion
but a habit.
So habit reversal training can also help
with touching as well.
The most effective way to use this technique
is with a trained therapist,
who can create a customized plan for you,
but you can apply the concepts on your own.
Habit reversal training
can be broken down into three phases:
awareness training, competing response training,
and establishing motivation and support.
And then there's an add-on technique called stimulus control
that pairs well with habit reversal training
to make it even more effective.
Let's take us or look at each phase.
First, there's awareness training,
which we can further break down into three steps.
The first step is to identify the habit
or the problem behavior that you want to break.
This could be hair pulling, skin picking, nail biting,
or even touching your face.
The next step is to recognize
when you engage in the behavior and what triggers it.
Even though you may have an idea of when you do it,
you should get someone to spend time around you
to point out when you do it,
because there may be times
that you mindlessly engage in the behavior
like when reading or watching television.
Stress is a common trigger,
but so is boredom.
Once you start paying attention to the behavior,
you'll get good at recognizing when you do it.
Then, the third step in this phase of awareness training
is to identify the earliest signs of the behavior
when you first feel the urge to do it.
This is called early warning training.
With the compulsive behaviors,
you may have physical sensations.
For example, you may feel tingling in your hands
when you want to chew them
or tightness around your mouth
that makes you want to chew your lip.
Also, think about if there's any situations
that makes this most likely to occur.
By the time you complete these steps,
you should be fully aware of the problematic behaviors,
when and where they happen,
and under what circumstances they're most likely to happen.
So write down the places, situations, and early signs down
in a journal so that you can refer back to them.
The next phase is training yourself to engage
in competing behaviors.
Here, you substitute a new behavior for the old one
that you want to extinguish.
And here are some examples.
For things that involve your hands,
like nail biting, skin picking, or hair pulling;
you could squeeze a ball, snap a rubber band on your wrist,
or you could play with yarn
to substitute for playing with a pulled hair.
You want to pick something that occupies the body part
that's involved in the behavior,
so it can't do the old behavior.
It's even better if the activity
somewhat resembles the old behavior.
For example, with hair pulling and skin picking,
you not only pick,
but part of the ritual usually involves playing
with the object and feeling the texture of it.
So wrapping a piece of yarn around your finger
or fiddling with the yarn can be a good substitute
because it keeps your hands busy
and you can play with the texture of the string.
Now, you may wonder,
"How is this helpful?
"I'm still fidgeting with something,
"and I'm just trading one thing for another."
And that's true.
The goal is not to keep your hands still,
but to keep them busy with something
that doesn't produce a negative consequence
like bald spots, chewed fingers with sores,
viruses in your eyes.
You get the a picture.
That said, it's still important
that the competing behavior be something
that's not noticeable to others.
Some people will clench their hands into fists
or fold their hands across their chest
as their competing behavior.
And it doesn't have to only be one thing,
you can have a few options.
To practice the behavior,
you pretend to do the old behavior,
but before you do it,
you switch to the new behavior and do it for one minute.
This breaks the pattern and weakens the urge.
Because remember, with the compulsive behaviors,
you have strong urges to do them.
And this technique works to interrupt the urge.
That one minute interruption
takes some of the wind out of the sails
and lessens the urge.
The next phase is cultivating motivation and support.
For the motivation,
you write down all of the negative consequences
of the behavior.
How did it, or how can it cause problems for you?
It doesn't always have to be serious,
as far as the outcome.
What's the inconvenience cost to the behavior?
Writing these things down is also a good journal exercise.
You want to use this list as a reminder
for why you need to stick to the plan.
Support is what you get from someone you choose
to make part of your plan.
This person will know
what your problem behaviors or habits are
and know what your new competing behaviors are.
Then, that person will be on the lookout
for the compulsive behavior and its warning signs,
and reminds you to use your competing behavior.
They can also cheer you on, so to speak,
if they noticed that you haven't engaged
in the compulsive behavior.
So the support person provides positive reinforcement
and helps you detect warning signs
or detect the behaviors when you don't notice them.
The last part of the strategy
is what's called stimulus control.
It's a separate process,
but it combines well with habit reversal training.
It's designed to reduce the things in your environment
that can trigger your behavior.
With stimulus control,
you take a list of the triggers and situations
that you made in the awareness training phase,
and then put blocks in place to make it harder
for you to be triggered.
With competing behaviors,
you're blocking the compulsive behavior or the habit.
But with stimulus control, you're blocking the trigger.
So it's like you're trying to catch things early.
Examples of stimulus control
are covering your bathroom mirror
to discourage face picking,
or limit the time that you spend in the bathroom,
putting self or petroleum jelly on your fingers or skin.
Keeping your skin slick with heavy creams
makes it harder to pick.
If you use instruments like tweezers to pick,
then discard them so that you're not tempted to use them.
If you lie in bed at night and pick, wear gloves to bed.
And these are just a few examples of ways
to control your triggers or things in your environment
that make it easier for you to engage in your behavior.
You may realize that over time, as things change,
you recognize new warning signs
for which you can create another control.
Keeping up with all of this
is where journaling comes in handy
so that you're not having to keep it all in your head.
To help you organize this process,
I created a handout that summarizes the steps.
You can download it from my website,
and you don't even need to put in your email address
to get it.
But if you are a part of my email community,
you already got the handout in your inbox
when this video publish,
so you don't have to go searching on my website.
Watch this video for more on the nuances
of body-focused repetitive behaviors.
Thanks for watching!
See you next time.