Why Resistance Is a Normal Part of BFRB Treatment

You know the story. You hate your body-focused repetitive behavior, and all you want in the world is to get rid of it. You tell yourself to stop picking or pulling, and you are frustrated that at the same time, your hand is reaching up to your hair or skin.

Maybe you’ve delayed seeking therapy, with a nagging part of you saying you'll start next week, or next month. You might have recently started treatment, but you’re frustrated the therapist doesn't have a magic wand to keep your hands from doing damage to your hair or skin.

Therapy might even make this inner conflict more difficult—you're more aware of the triggers for your behaviors, you've committed to learning new ways of coping with stress, and you can no longer push away the pain the behavior brings to your life. And yet here you are, still picking or pulling!

This inner conflict is okay. It means you have bumped into your own resistance to change. You are not alone in this—everyone struggles to let go of behaviors they know are harmful to them! Think of all of the times people try to quit smoking or resolve on January 1st to hit the gym, then find themselves buying a pack of cigarettes or wasting money on that unused fitness membership.

Because resistance to change is universal, it can be helpful to understand why we cling to the very behaviors that harm us the most. To begin with, it’s important to understand that problematic behaviors have an important role in our lives, so much so that the idea of letting go of them brings up feelings of anxiety that can’t be ignored.

Picking and pulling serve many different functions. The behaviors can help us wind down after a hard day, relieve stress and tension, enable us to escape emotional discomfort, help us cope with feelings that are hard to sit with, boost our focus and concentration on a difficult problem, or keep our hands busy when we’re bored at work, school, or in the car. It may sound strange, but BFRBs can also serve as friends—always available to occupy our time and relieve stress.

And, of course, your hair and skin are right there, you don’t even need to head out the door to find your old trusty way to comfort your central nervous system when life gets stressful! If we think about getting rid of one of our friends who comforts us, we can see why letting go is easier said than done!

One way I address this resistance is to shift the focus away from getting rid of a behavior. That way, we can sidestep the tug-of-war between the parts of ourselves that want to let go and the parts that want to cling to the way things are. Instead, I focus on what needs the behavior meets.

For example, a pre-teen client of mine, who hated using the fiddle toys her parents often encouraged her to pick up, recently found a different strategy. During a test, she found herself pulling out a hair. Instead of thinking, “Stop it!” she took my suggestion to instead ask herself, “What does my body need right now?” She realized that she was feeling frustrated and trapped in her seat, and asked the teacher if she could take a stretch break. She came back to her desk and finished her test, and her hand didn’t go back up to her hair!

In this way, if we think about bringing in new behaviors to meet our needs—whether for physical or emotional comfort, relief of tension, or help focusing—we may be able to add to our emotional regulation toolbox without kicking out body-focused behaviors. Without the pressure to get rid of our trusty old behaviors, we may have more capacity to reach for other tools.

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