What's Boredom Got to Do With It?

In the previous blog post, I covered four stressors that have been found to be triggers common both to humans and animals who engage in body-focused repetitive behaviors: frustration, boredom, the experience of being trapped in too small of a space or of feeling trapped, and isolation. I explored the role frustration has as a particular trigger for picking and pulling, and how psychodynamic therapy can help people develop ways to express and assert themselves, two elements of adaptive emotional regulation.

Another common trigger for picking and pulling is boredom. The term boredom encompasses both a physiological experience - feeling under-stimulated - and an emotional one - feeling uninterested, uninspired, perhaps a little depressed.

To look more closely at the ways boredom can lead to BFRBs, it is helpful to think first about boredom in the animal kingdom.

Animals in the wild don't develop BFRBs. It is only under the care of humans as pets or zoo or research animals that a bird will develop a problem with feather-plucking, a dog will lick off patches of her fur, or a horse will repetitively gulp in air, a behavior called cribbing.

When lions pace restlessly in their cages at the zoo, it is easy to see how a lack of stimulation can be damaging and difficult to cope with.

It was owners’ annoyance with behaviors like cribbing that attracted the attention of animal behaviorists. Looking for solutions to cribbing, for example, specialists found that if horses were given more space to graze, they can stop the cribbing behaviors altogether (Natterson-Horowitz & Bowers, 2012).

It makes sense that domestic animals would get bored. Their bodies and nervous systems are built to react to decades-old survival instincts to hunt down their food and protect their groups from danger. When the process of eating shifts from hunting, killing and consuming an animal to eating kibble from a bowl, boredom is an understandable result.

In the same way, our human bodies are often restless. Our lives tend to be covenience-based and focused around screens of some kind, whether at work or for entertainment. Exercise is a choice, sometimes a fraught one, rather than a part of daily living. All of these factors add to the boredom element of picking and pulling.

This dynamic is one element underlying the boredom that triggers picking and pulling episodes. Often, people pull while sitting on the couch, unwinding, and watching TV. It may be that the mind is engaged and the mood is good, but the body may still be feeling under-stimulated. Given that people with BFRBs tend to have sensitive nervous systems, restlessness often settles into their hands.

Luckily, as with restless animals, there are ways to change the environment to give the nervous system more of what it needs. These kinds of practical changes are encompassed within the range of behavioral therapy techniques. Another way to think about the goal when addressing boredom and restlessness is to develop the skill of identifying and meeting underlying needs.

In the case of restlessness while unwinding, having sensory objects to choose from at places where hands tend to get restless, like in a basket by the couch, can be a game-changer The idea of choosing to give the hands what they need at those times shifts away from the dictate to play with fiddle toys instead of picking or pulling. The psychodynamic therapy approach has set the stage for growth with self-kindness instead of by force of will.

Adding more home cooking into the mix can be one way to shift back to expending energy in a productive and creative way. Creative endeavors like beading and ceramics can be similarly helpful.

Other versions of boredom embody different needs and will lead to different solutions. Picking or pulling that happens while driving is often related to the anxiety of being trapped in a car with the stressors of the road. When I moved to a new house with a longer commute, I found that I had to time my drives away from rush hour, give myself plenty of time to get to work, and listen to books on tape in order to adjust to the new stressors without my hands getting restless.

Another way to think about animals’ struggles with BFRBs is as overgrooming behaviors. While licking and plucking and biting are elements of the healthy grooming process, when the these behaviors go beyond the grooming function t they become problematic.

Healthy grooming is another category of behavioral ways to address BFRBs. When biting the cuticles is the go-to behavior, nail care and manicures can provide a different kind of sensory input. Hair care can feel comforting and increase confidence. Choices around cuts and color can provide a different way to think about hair. These choices can lead from a shift in focus on criticism of the appearance to enjoyment of self-expression. While skin care can often have a negative repetitive element, bringing balance to a skin-care regime can be comforting.

Sensory stimulation, shifts to the environment, and healthy grooming behaviors. It can be fun and rewarding to figure out how to give the body more of what it needs when boredom rears its head!

References:

Natterson-Horowitz, B. & Bowers, K. (2012). Zoobiquity. NY, NY: Vintage Books.

Enhancing Emotional Expression and Assertiveness Skills

In the safety phase, we developed and strengthened the first level of adaptive emotional regulation skills: mindfulness and tolerance of difficult and painful feelings. With these skills in place, we are ready to move on to the next phases of the process.

Pickers and pullers tend to have specific deficits in emotional expression and assertiveness skills. Psychodynamic therapy is well-suited to developing these skills, beginning with the invitation to talk about the stressors that trigger current symptoms as well as the factors that contributed to the start of the behaviors.

One of the ways picking and pulling behaviors help people to cope is that they enable avoidance of difficult or painful emotions. In automatic pulling, this takes the form of dissociation, while in focused pulling, the focus on imperfections provides another outlet for negative feelings.

Once we can tolerate feeling our feelings, we can begin to develop ways to express them to others. This important skill can help both to process pent-up emotions from the past and to create healthier dynamics in current relationships.

My clients sometimes compare me to a massage therapist who presses on and releases trigger points of painful feelings. This comparison is apt, as I slow us down when a person’s body language doesn’t match what they are saying. Paying attention to incongruous laughter or a pasted-on smile can help us to discover anger, sadness and other painful feelings that may have felt unbearable in the past.

Referring back to the stress cup metaphor, I explain that if feelings are avoided they don’t go away. Instead they get tucked into the stress cup, adding to the cloud of yucky feelings that build up and get released through picking and pulling.

When we talk more about what initially triggered reliance each person’s reliance on picking and pulling behaviors, they have an opportunity to release feelings that may have been stored in the body for years. I ask them to tell the stories of early episodes of picking and pulling and together we try out expressing their feelings rather than suppressing them.

For example, when I find out that Paul lost his grandmother at the age of 15 and that pulling hairs from his developing beard comforted him through the loss, I have an opportunity to help him process those unresolved feelings.

Paul is able to talk about how much his grandmother meant to him and how he had tucked his sadness inside to focus on comforting his distraught mother. When he is able to cry with me, he is surprised that the feelings are bearable and the sadness comes in waves that dissipate.

Emotional expression can also help to relieve current triggers for body-focused repetitive behaviors. Four categories of stressors typically come into play: isolation or loss of a loved one, frustration, a sense of being trapped in an environment or situation, and boredom.

Discussion of the triggers in each of these categories helps us to discover the situations that overwhelm the coping mechanisms of each individual. Frustration is a common trigger for picking and pulling, and feelings of anger and dissatisfaction are often the main feelings a picker or puller is hesitant or unable to express.

One key intervention I use in my work is to encourage each person to express the frustrations that will inevitably arise in our relationship. The ability to express frustration is a key assertiveness skill, as it helps us to set boundaries that keep us safe.

For example, I engage Sara in a conversation about why she doesn’t want to talk about her feelings toward me after a scheduling snafu last month. I remark to her that she has been distant since that time and let her know that if she can express her angry feelings it could bring us closer.

When Sara tells me how my mistake hurt her, we are able to repair the rupture in our connection. She can then begin to bring this ability to manage conflict to her other relationships.

As Sara learns how to lean into the feeling cues her body gives her she can begin to assert herself more in the world.