BFRB Treatment: Habit Reversal Training (HRT)
Research and clinical experience has indicated Habit Reversal Training (HRT), a form of cognitive behavioral therapy (CBT), to be helpful for BFRBs. HRT is composed primarily of two components - awareness training and competing response training:
Awareness training involves learning to become aware of the urges, situations, and other warning signs to which pulling, picking, or biting is most likely to occur.
This allows for a window of opportunity to use a behavior that is physically incompatible with the BFRB, called a competing response. For example, a competing response may include crossing arms or making fists whenever an urge or warning sign arises to prevent pulling or picking. Competing responses are tailored per individual so they target specific BFRB behaviors.
In addition to these primary components, social supports may be identified to encourage or gently remind you to use your competing responses.
Additional skills to HRT have also been found to be helpful. Stimulus control involves creating barriers to make BFRB behaviors more difficult. This may include changing the environment (e.g., removing tweezers), modifying activities (e.g., limiting bathroom time), keeping nails short, or substituting BFRB behaviors with fidget toys in high-pulling or picking situations. Coping skills may also be included to manage distress and support treatment.