– By the BFRB Special Interest Group
Check out part 1: More Than a “Bad Habit”: Living With a BFRB
Introduction
Living with a body-focused repetitive behavior (BFRB) often feels like an uphill battle, but recovery is not only possible, it’s entirely within reach when you have the right tools and support. To help illuminate the path forward, members of the BFRB Special Interest Group (SIG) shared their practical wisdom on what healing truly looks like in real life. From redefining success beyond a long-pick or pull-free streak to asking the right questions when interviewing potential therapists, these insights offer compassionate strategies to help you navigate recovery and build a support system that honors your unique needs.
Real Strategies To Support BFRB Recovery
If you live with a BFRB, chances are you’ve already experimented with dozens of strategies to manage or quit the behavior. But what does BFRB recovery actually look like and how is it best supported?
First, recovery is rarely a straightforward “stop the behavior.” The consensus among SIG members is that recovery is more about acceptance, reducing (rather than eliminating) the behavior, and living one’s life alongside their BFRB. So it may be helpful to think of recovery as freedom regained, rather than a number of pull- or pick-free days.
Achieving this requires a multi-faceted approach: increasing understanding of BFRBs, building awareness, finding alternate ways to redirect the energy, and changing one’s relationship with the BFRB. Finding community through BFRB support groups or other shared interest groups can also be incredibly helpful. One SIG member described the keys to recovery as “education and understanding, confidence with tools and flexibility, self-acceptance, honesty with myself, and vulnerability with my support system.” Recovery may also include investing in therapy or coaching, skin/hair/nail care, or sensory replacements.
Ultimately, BFRB recovery is an active, ongoing process rather than a checklist to complete once. And because needs change over time, staying in recovery means regularly checking in, assessing what’s working, and adjusting your approach along the way.
How to Find Help For BFRBs
It’s an unfortunate truth that finding effective help for BFRBs can be challenging. Many therapists and healthcare professionals don’t receive adequate training on BFRBs and may have some misconceptions about them. Therefore, individuals with BFRBs who are ready to seek professional help will likely benefit from interviewing therapists or other professionals before establishing care. In many cases this can be done via a brief consultation call or email before scheduling an initial appointment, and questions to consider asking include:
How do you view (or “conceptualize”) BFRBs?
A provider who sees BFRBs as simply a “bad habit” to quit is unlikely to be helpful in the long run, so look for someone who understands that these behaviors are complex, multi-faceted, and require individualized treatment. Be cautious of any therapist who views BFRBs as self-harm (an idea that’s widely rejected by BFRB specialists), insists they’re always rooted in past trauma, suggests parents are to blame, or claims medications are required for successful treatment.
What does the progression of treatment look like?
Recovery isn’t simply about doing the behavior less. It’s also about getting curious, understanding the behavior, and changing your relationship with it. Look for someone who acknowledges that progress isn’t linear and will likely involve ups and downs. Be cautious of anyone who promises to help you stop the urges or avoid the behavior completely, as this isn’t the most common outcome, even in successful treatment.
What specific type of therapy do you use to treat BFRBs?
Habit Reversal Training (HRT) and the Comprehensive Behavioral Model (ComB) are currently the two most evidence-based treatments for BFRBs. Cognitive Behavioral Therapy (CBT) can help with some aspects of treatment, but usually isn’t specific enough to serve as an effective treatment on its own. Exposure and Response Prevention (ERP, notably the gold standard for OCD) may be helpful for some types of BFRBs, particularly focused rather than automatic engagement, but like CBT, shouldn’t be the only modality used. Newer “third wave” modalities that focus on increasing awareness and changing one’s relationship with the BFRB are also being explored and studied. These may include Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), Mindfulness-Based Cognitive Therapy (MBCT), Compassion-Focused Therapy (CFT), and Internal Family Systems (IFS, which, while not technically a third-wave CBT modality, fits the same spirit).
How do you address when behavioral strategies don’t lead to improvement?
This is an important question, since many people with BFRBs don’t experience long-term relief from behavioral strategies alone (though some do). Make sure the provider you’re interviewing understands this and has an approach in mind.
How many people with BFRBs have you treated in the past and what were the results?
This doesn’t mean you should avoid clinicians with less experience. Even the experts had to start somewhere! But if they’ve treated fewer than 5 to 10 clients, ask whether they’re willing to learn more about BFRB treatment or have a resource for consultation with someone more experienced.
Do you know someone else with more experience treating BFRBs?
If a therapist doesn’t answer these questions in a way that makes you feel confident, there’s nothing wrong with asking for a referral. Even if they aren’t the right fit for you, they may know someone who is.
A Final Message
Above all, remember this: you do not have to navigate this path alone. The shame that thrives in secrecy softens the moment you connect with people who truly understand you, whether that’s a clinician, a support group, or a community of peers who see your value. Your experience is real, your struggles are valid, and there are people out there waiting to welcome you exactly as you are. Find your people and start creating a life so fulfilling that your BFRB is simply an interesting chapter in your incredible story.
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