Annual Conference on BFRBs: Hair Pulling & Skin Picking

For adults with a BFRB, this special add-on to the conference is a unique opportunity to develop a personalized plan for recovery with two of the top treatment providers for BFRBs. Utilizing the ComB model, participants will gain new perspectives on the role each individual's BFRB serves in their life, understanding why, where, and how a person engages in their BFRB so that individualized interventions can be selected to help the person achieve what they want to achieve without engaging in the behavior. The comprehensive behavioral (ComB) model, developed by Dr. Charles Mansueto and his colleagues, is based on the assumption that a person engages in their BFRB because it meets one or more needs in the individual (e.g., helping to relax, to fall asleep, or to feel like a goal was accomplished). This three-hour intensive is limited to 40 participants and is offered as an add-on to the conference itself.

Many people with BFRBs also have ADHD. This can interfere with BFRB treatment. Stimulant medications can exacerbate BFRBs. Some of the interventions that improve ADHD can also improve BFRBs. The common thread is the need to get off of autopilot. Methods doing this will be addressed.

How we see our body can directly affect how we treat our body. This experiential workshop will allow participants to identify how they perceive their bodies and experientially practice helpful behavioral and mindfulness treatment tools that can be used anywhere, anytime, in a compassionate and helpful way.

Although Habit Reversal Training (HRT) has been demonstrated as an empirically-based intervention for Body Focused Repetitive Behaviors (BFRBs), it may not prove effective for all individuals. Drs. Brauer and Rojas will present cases in which typical HRT was adapted to present the unique presentation of clients. Dr. Brauer will present a brief intervention for an emerging adult with Trichotillomania and Skin-picking which incorporated aspects of exposure and response prevention and mindfulness. Dr. Rojas will present an intervention used with a toddler with Trichotillomania, highlighting the use of parent training and generation of developmentally-appropriate language. Drs. Brauer and Rojas will also engage in a discussion of treatment recommendations for individuals with BFRBs, allowing time to answer questions from the audience bout their clinical or personal experience with these behaviors.

The presentation will focus on a novel 4 session intervention for mild trichotillomania and skin picking. Strategies discussed include: self-monitoring, competing responses, exposure and response prevention, and mindfulness. A case example will be used to demonstrate these techniques.

In this session, panelists and audience members will explore topics and challenges related to the experience and treatment of BFRBs. Patients, family members, and clinicians will have an opportunity to ask their own questions and introduce topics for discussion. Panelists are recognized experts in the field, with expertise spanning BFRB research, medication, cognitive behavioral therapy, and adult, child, and family therapy.

Acceptance Commitment Therapy (ACT) can be used to augment treatment of the Affective, Cognitive and Sensory modalities of the ComB model. You will learn an overview of ACT, how it complements ComB, and ACT-specific interventions. This presentation assumes that attendees will have a basic understanding of the ComB model.

The cognitive and emotional toll of living with a BFRB can present challenges to successful treatment. This session will introduce participants to Acceptance and Commitment Therapy (ACT), an evidence-based treatment augmentation for the enhancement of ComB/HRT. This didactic and experiential workshop will guide participants in the exploration of an individual's relationship to his or her own inner cognitive and emotional struggles in order to facilitate acceptance and behavior change.

Having a body focused repetitive behavior is more than just about skin, hair or nails. Many times struggling with BFRBs can affect your mood, your activities, your relationships and the way you feel about yourself. Hear about the different ways that BFRBs might be affecting your life. Then learn about what you may be doing that seems like a good idea, but might not so helpful. Then discover how to develop good coping skills, a better way to think about hair pulling or skin picking and improving your relationships with others…and yourself!

Body-focused repetitive behaviors and Sensory Dysregulation affect millions people world-wide. Some examples of Sensory Dysregulation (over-responsiveness or under-responsiveness to sensory stimuli) include the feeling of hair or skin on the fingertips, picking skin or cuticles, or biting or smelling hair Left untreated, children with BFRBs and Sensory Dysregulation can experience lifelong struggles with hair and/or skin in and a great deal of stress and family discord. This workshop will provide an overview of Sensory Dysregulation and identify how it affects BFRBs. Participants will learn how to identify Sensory Dysregulation as a potential co-morbid condition with BFRBs and how to effectively focus treatment in order to adequately address both conditions

Recovering from a BFRB is a process that takes time and the learning of skills. No one does it perfectly and lapses and setbacks are inevitable. Handling them well can make all the difference in reaching your goal. This workshop is intended to show you how to best do this.

Exposure and response prevention (ERP) entails intentionally activating anxiety, “leaning into” or staying with the anxiety while refraining from rituals or compulsive behaviors until distress naturally subsides. As a therapeutic intervention, ERP is widely used to treat anxiety disorders and obsessive-compulsive disorder, with solidly demonstrated efficacy and effectiveness for a variety of presentations and populations. We believe that ERP also has a role in the treatment of BFRBs. In this workshop, the theoretical underpinnings of ERP will be presented, and the rationale for applying to the treatment of BFRBs will be provided. We will discuss two major ways in which ERP can be used in the treatment of BFRBs. The first is to help target urges to pull or pick. ERP can be particularly effective for individuals who pull or pick due to perfectionism or sensory stimuli. ERP can also be beneficial for reducing fear and shame that often accompanies BFRBs, especially when interacting with others. For example, many individuals with BFRBs experience significant anxiety about others finding out or judging them or their appearance. These fears can be alleviated via exposure. Presenters will model this technique via live role-play. Attendees will be invited to ask questions or share their own cases to facilitate discussion of real-world applications. Finally, common pitfalls will be presented to help attendees avoid potential problems.

In this session, the importance and effectiveness of mindfulness in the treatment of BFRB’s will be discussed. Participants will engage in a mindfulness exercise in order to demonstrate how this technique is utilized. The efficacy of mindfulness as a method to increase cognitive flexibility and decrease shame will be demonstrated.

In this session, clinicians will learn how to assess and combine treatment methods addressing both OCD and BFRB’s. Exposure and response prevention, mindfulness and habit reversal training will be discussed. Real world examples and techniques of how to apply these treatment methods in sessions will be demonstrated.