Hello all! For those of you who haven’t seem my Instagram feed (@lotustherapyatx) I wanted to share a talk I gave recently about why building self-compassion is a necessary part of treatment for body-focused repetitive behaviors (BFRBs):

Self-compassion is really important to counter shame. And, as those of you who pick your skin or pull out your hair know, there is a lot of shame that goes along with those behaviors. The shame can be crippling and it can form sort of a cycle, where you pick or pull and it feels good while you are doing it but at the end of it all you feel really ashamed. And then that shame itself can be a feeling that will draw you into pulling more hair or picking your skin again.

So we are really trying to interrupt that cycle and I tend to really work on that from the very first session when someone comes to see me. So, when we talk about self-compassion, I like to use a definition and some understanding about it brought to us by Dr. Kristen Neff, an author and professor at UT. She talks about how self-compassion has three different components: mindfulness, self-kindness, and common humanity.

First, mindfulness. We have to be aware of the feelings that are coming up that are driving us to be really self-critical, and to have an opportunity to counter those voices. Mindfulness also helps us to tolerate painful emotions. So, if any time I get mad, I pick my skin, if I bring some mindfulness in, as I am picking my skin I can think, “Oh, I wonder why I am picking my skin, and what feelings I am trying to avoid.” If I realize I am frustrated, I can maybe stop picking my skin and go talk to someone about how frustrated I am. So, once we are mindful of the feelings behind our behaviors, we have a better chance of maybe finding some other way to meet that need.

Second, self-kindness to counter self-judgment. And I like to tell people right off, you might think that your behavior of picking or pulling is your enemy or this thing you have to get rid of or this thing you hate, and that is understandable because it does cause problems in your life. But, on the other hand, we might think about it as a thing that has helped you cope. When we think about it as a coping mechanism, it’s a lot easier to feel self-kindness , to think “Oh, OK, I had a hard day, that’s why I was picking, and let me be nice to myself instead of just beat myself up for picking.

One thing I encourage people to think about is if you have a spot that you keep picking at or a bald spot after an episode of pulling, you might want to even think about naming that spot, what caused that, what led to that? So it could be, that spot is from that exam, when I worked really hard and I had to focus in, and that’s a trigger for me to pull my hair, so that’s an exam spot.

Or, that picking spot, that’s the pandemic spot, where any time I get really anxious, or frustrated from being cooped up indoors, or worried about getting sick, or grieving someone who I love who is sick, that can sort of be a name you give to that spot, to bring in self-kindness. Like, “I’m doing this because I am hurting, not because I am gross or weird.”

The third element is common humanity. This involves recognizing that none of us is perfect. So, of course, those of us who do pick or pull know that perfectionism is probably part of our personality. We like everything to be perfect and don’t want to show that we have any flaws, but once we can admit that we have some flaws we will often find out that others do also.

That’s where we begin to realize that we are just like everyone else. Everyone struggles, everyone has ways of coping, and it really helps to know other people who use picking or pulling as their primary way to cope. In this way, group therapy can be particularly helpful, or a support group, or just someone who you can look at and see, “Oh, I see, they are not weird or gross because they pick their skin or pull out their hair, they are just trying to cope with the same kind of stressors as I am. All of that together can lead us out of a cycle of shame and into a cycle of self-compassion. Like, “OK, I picked today, and I understand why, and today it might have been the best way to meet my needs but tomorrow I might find a different way.”

I just wanted to close by sharing with you a story from a recent client maintenance-treatment interview. And and I have been working together for several years. She picked her pseudonym and gave me permission to share some parts of her story.

Ever since pulling her first hair at the age of 10, Andi had labeled the part of herself that pulls and chews and eats her hair as not only bad but monstrous, and her hair itself as disgusting. She needed to shed that identity in order to allow self-compassion to build. She reflected on that shift: “From our initial contact, I felt very comfortable and cared for by Stacy. But it took a while to realize that there was no compassion for myself. It took even longer to build that compassion, to where now I can talk to myself, like, it’s going to be OK. And I can brush my hair with love now, I really started loving my hair, and recognizing that it is really beautiful, and I can take care of it and be nicer to myself.”

So I wanted to leave you all with that beautiful reflection by Andi, to remind you that you may start with not even knowing why in the world you would be nice to yourself or how you could ever think about doing that but with the help of someone, a good therapist, a good friend, someone who can really help reflect with you on the ways you’ve used picking or pulling to cope, you might be able to have a better relationship with ourself and some self-compassion.