Episodes
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In this episode of Your Anxiety Toolkit, Kimberley Quinlan guides listeners through practical strategies for managing the fear of medical procedures, such as needle and blood phobias. Drawing from both professional expertise and personal experience, she shares actionable tips to help listeners confront their fears with compassion and resilience. Learn how to turn anxiety into a manageable experience and feel empowered through the process.
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Finding Your Perfect Rest-to-Productivity Ratio The Burnout Dilemma
Ever felt like you’re constantly running on empty, juggling a never-ending to-do list, and battling that nagging voice that tells you you’re not doing enough?
You’re not alone.
In a world that glorifies hustle and productivity, finding the right balance between rest and work can feel impossible.
But what if I told you that striking this balance is not only achievable but essential for your well-being? Today, let's dive into the concept of the rest-to-productivity ratio—a game-changing approach to ensure you’re resting enough to fuel your productivity and thrive without burning out.
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In today’s discussion, we’re delving into the seven mistakes some OCD therapists are making in 2024. While the title might seem provocative, the goal is to highlight concerning trends in OCD treatment and provide insights that could enhance therapeutic approaches. Remember, this is my opinion based on what I've observed in various forums. I don't claim to have all the answers, but I hope to spark a constructive conversation.
Mistake #1: Insufficient Initial EducationImportance of Education at the Start of Treatment
Many clients report feeling thrown into exposure and response prevention (ERP) without adequate preparation. Therapists must take the time to educate clients about OCD, their obsessions, and compulsions, and what to expect from treatment. This foundational knowledge empowers clients, giving them a sense of control and a clearer understanding of their journey.
Mistake #2: Failing to Instill Hope and ConfidenceThe Power of Hope in Treatment
Therapists must remind clients that they have the potential to succeed. Treatment for OCD can be highly effective, and it's crucial to communicate this. While maintaining a realistic perspective, therapists should focus on the positive aspects of available treatments and instill a sense of hope and confidence in clients.
Mistake #3: Neglecting Evidence-Based ModalitiesTherapists should prioritize evidence-based treatments, particularly ERP. While it's important to integrate supplementary approaches like ACT, mindfulness, and self-compassion, the core of OCD treatment should be grounded in proven methodologies. Clinicians need to stay informed and ensure their clients understand the rationale behind chosen treatments.
Mistake #4: Misconceptions About ERP Being TraumaticERP: Not Abusive When Properly Delivered
Concerns about ERP being traumatic often stem from poor delivery rather than the method itself. Proper education and a strong therapist-client rapport can mitigate these fears. It’s vital to ensure clients understand why they’re facing their fears and to provide a supportive environment throughout the process.
Mistake #5: Rigid ERP PlansFlexibility in Treatment
While structured plans are important, rigid adherence can be detrimental. Treatment should be flexible and tailored to the client's evolving needs. Engaging clients in the planning process and adapting as necessary ensures that the therapy remains client-centered and effective.
Mistake #6: Overlooking Barriers to ProgressExploring Underlying Issues
When clients struggle with certain exposures, therapists should explore the underlying barriers. Understanding the client's fears, trust issues, or other relational dynamics can provide insights that help adjust the treatment plan accordingly. This approach prevents avoidance behaviors from taking hold.
Mistake #7: Not Assigning HomeworkThe Role of Homework in OCD Treatment
Homework is a critical component of OCD treatment. Without it, progress can be significantly hindered. Therapists should find creative ways to ensure clients complete their assignments, offering support and accountability measures. This empowers clients to practice skills outside sessions, enhancing overall treatment efficacy.
ConclusionThese seven mistakes highlight areas where OCD treatment can improve. It's essential for therapists to remain flexible, informed, and supportive, tailoring their approaches to each client's unique needs. Open communication and a collaborative mindset can help address these common pitfalls, ultimately leading to more effective and compassionate care.
Remember, this discussion aims to foster growth and improvement. If you're a client, don't hesitate to discuss these points with your therapist. Together, we can create a more effective and empathetic therapeutic environment.
Transcript
Today we’re talking about the seven mistakes some OCD therapists are making in 2024. Now, I know the title sounds spicy, but in no way am I trying to be spicy. What my goal is today is to talk to you about some of the things I’ve heard, whether that be on social media, on podcasts, on blogs, or at conferences, when people are talking about the treatment of OCD that deeply concern me.
Now, let me first say, in no way do I consider myself the moral police on OCD treatment. In no way do I believe that I am the knower of all things. In no way do I think that I know more than other people, my way or the highway. That is absolutely not what I’m saying here today.
However, I am going to give you my opinion on some of the things that I hear that deeply concern me. I’m just here to share what I think is helpful. I hope, if anything, it’s here to really reassure clinicians that they’re on the right track because there are some amazing, amazing OCD specialists out there. If not, if this is something that you may find is calling you out a little, please, I’m here to hopefully bring some goodness into the world. Let’s talk about the seven mistakes some OCD therapists are making in 2024.
As I said, this is all about my opinion. Again, in no way am I the moral police, but let’s talk about it. My guess is you’re probably going to agree with everything I say. If not, I’m totally okay with being disagreed with.
Mistake #1: Not spending enough time at the beginning of treatment educating their client about the research and the science-backed treatment approaches that are here ready for us to use for OCD
So often, I hear clients saying in my office that they had this experience of ERP exposure and response prevention where they were just thrown into it, and they were like, “Let’s just go.” I get that. I love an eager therapist. I love a therapist that’s not going to waste people’s time, but we have to spend a lot of time in the beginning educating them about the condition of OCD, helping them to understand their obsessions and their compulsions and how we get stuck in them and how they can be so seductive and how they can trick us, and also talking about what’s coming, what treatment’s going to look like, and what you can expect.
We have to spend a lot of time talking about that as well so that the person who’s engaging in this treatment feels a sense of mastery over what’s about to happen. They feel like they can make decisions as they go because they’ve got a plan. They can see them crossing the finish line. They can keep that. They know what that’s going to look like, and they can use that to inform their decisions and how they connect and communicate with the clinician.
Mistake #2: Not instilling hope and confidence in the client
We have to remind our clients that they have everything that they need, that the treatment can be very, very successful, and that it’s an experiment. We don’t have to get it perfect the first time. This is a collaborative experience. There’s a lot of hope here that by us collaborating and by us talking through what’s working and what’s not working and having them understand that this is actually a really good thing to have in terms of there are many conditions that the treatment sucks, the treatment isn’t that effective. The treatment doesn’t help as much as it does with OCD.
I never want to do the toxic positive thing with clients, but I also want them to acknowledge the conditions. This is one that we actually have some good research on. We have some good treatment options. We have these great supplement modalities that can help us along the way. We want to infuse them with hope. We want to infuse them with confidence in this process.
I do often see particularly younger therapists not spending enough time really bringing a sense of hope to treatment because it’s so scary. They’re already in so much pain. They’ve probably been through treatment that sucked in the past. What we want to do is really focus on that hope, because hope is often what motivates us to take those first baby steps.
Mistake #3: Not engaging in evidence-based modalities
This is a huge one. I could spend a whole podcast episode or a week on this topic. There is so much misinformation about treatment and what is considered evidence-based.
Now again, I’m not here to tell anybody what their treatment should look like. That’s a personal decision, and every client gets to make that decision. Who am I to judge? People need to come and know that they have agency over their lives and the decisions they make. But clinicians should be educated, and they should educate their clients on the options for evidence-based treatment modalities.
Now, I am a huge supporter of exposure and response prevention. I have been trained in it. I have been doing it for 14 years. I have seen it succeed over and over and over and over again. As I’ve been public in saying, I see no reason to abandon that.
Now, that’s not to say that I haven’t introduced modalities that supplement ERP. I love the use of ACT. I love the use of mindfulness-based cognitive therapies. I love the application of self-compassion. In many cases, I have applied dialectical behavioral health therapy to clients who are struggling with emotional regulation. Maybe they’re having self-harm or suicidal ideation. Absolutely. As time continues, we’re seeing newer approaches and modalities come up. But I see it in my job as a clinician to educate my clients on the treatment, what has worked, and what I’m skilled at doing too.
The other thing is there is some research on other treatment modalities besides ERP. I think that’s wonderful. I mean, my hope is that one day we have something that is a sure thing, 100%, and we can absolutely promise that we’ve got guaranteed results. This is going to be something that I continue to learn and educate myself on, but my opinion is that I’m sticking with ERP. I love it. I find it so helpful and empowering. It lines up with everything and my treatment that has helped me. For those who are wondering, I am a committed ERP therapist.
Mistake #4: Saying that ERP is traumatic or abusive
Now, in fact, this concerns me so much that I did an entire episode with Amy Mariaskin. It’s Episode 365. We talk specifically about this very sensitive and important topic, “Is ERP abusive?” What came from that episode, which is very similar to this one, is I don’t actually feel like ERP is an abusive treatment modality. I think that sometimes how it’s delivered can be concerning, but that’s the truth for any treatment modality. You could say the same about cognitive behavioral therapy. We could say the same about any medical treatment in terms of how the delivery can determine whether it harms people who are vulnerable.
One thing that I will be very clear, and I believe this in my heart, is the narrative that exposures, that facing your fears is mean, is a traumatic experience. I agree that if you’re having someone face their fear without giving them the education that they need and not explaining to them why they’re doing it -- believe me, guys, let me also disclose here. I’ve made a lot of these mistakes myself as a clinician. Let’s just be open. I have been in this particular situation. Actually, if I’m going to be really honest with you, number one, that mistake of not educating your clients, I learned that by a client telling me, “Kimberly, I do not understand why you’re having me do what you’re doing. I’m someone who needs to know what I’m doing, or I’m not going to trust you. Slow down and tell me what this looks like.” Again, no judgment over here. I’ve made a lot of these mistakes myself. But I think that throwing people too fast and too hard can feel very overwhelming, very activating.
Again, these are things we learn as we get better. Every clinician makes mistakes. That’s what makes them good clinicians. In no way do I want clinicians to feel blamed or judged here. We’re human beings. We’re doing the best we can, and every client is different. Sometimes we also need to build a rapport with clients so that they can share with us. We talked about that in the episode with Amy.
The most important piece here is having a rapport and a connection of trust and respect so that the client knows that they can tell us that this doesn’t feel right, that this crosses my values, my limits, and my boundaries. This doesn’t feel like it’s something that lines up with my values. We can have a conversation about that and be respectful about, “This is what works for me in this relationship, and this is what’s not,” or “Here are my concerns about ERP. Could you help me to work through this, or could we consider having a conversation before we move forward?” I think that’s what also helps this from being experienced as a trauma as well.
But if this is something that is a hot topic for you, go and listen to that because it’s such an important, compassionate, respectful episode. Amy did a beautiful job of going deeper into this specific topic.
Mistake #5: Following an ERP plan that has zero flexibility
I get it. When I first started as an OCD therapist, I was trained to use a very structured exposure and response prevention plan. There were modules and systems, and you had to follow the manual. I loved my training. My training literally set me up. It was some of the best OCD training I think anyone could ask for. But there were times when I stuck to the plan so diligently that I missed the client. I missed their needs. I missed hearing from the client on what they think the next step is.
Now, what I have found to be so beneficial is to talk to the client. What would you like to do next? This is our plan that we originally made together because we talked about it at the beginning of treatment. Do you feel like you’re ready to take this next step? What’s getting in the way of you taking this next step? Let’s discuss. Is this the right step based on what we thought we knew, or are we going to shift it up now?
I think that the flexibility in treatment helps teach clients how to be flexible in their daily lives as well. We don’t want to follow a rigid plan unless there’s some clinical reason to do so. I think we also have to understand here that some intensive treatment programs require really rigid plans because of the severity of the disorder. Absolutely, I completely get that. But I think where we’re really going with that is it has to be individualized. We have to understand the client’s needs in order to make a plan. And then from there, we can decide what’s best. But we have to stay away from rigidity.
I also don’t love any treatment modality that has modules that make the clients go through modules because, again, I think it misses the client, where they’re at, what their needs are, and what else is going on in their life. Again, every clinician delivers it differently. I respect every clinician to know what’s best for their clients, but it’s something that we can look out for.
Mistake #6: Moving on without exploring what was getting in the way
Let’s say you had a treatment plan and the client said, “Ah, that doesn’t work for me.” And then you just say, “Okay, fine,” and you move on without slowing down and getting curious. Tell me about that. What’s getting in the way of you being able to do this exposure? Is there an obsession I’m not aware of? Is there something else happening that’s happening relationally, or is there a trust issue or rapport issue between you and I that might be getting in the way of us not completing that part of the treatment plan that we had originally agreed would be helpful for you?
It’s really important, and I’ve seen this with my own staff, with my own consultation with other clinicians. Moving on too quickly can allow OCD to get sneaky and help them engage in avoidant compulsions. We have to be really careful about not engaging in compulsions with our clients. Sometimes our client’s OCD can be very convincing in getting us to not address certain issues because of an avoidant compulsion.
Again, complete transparency. I’ve been there a million times, so absolutely no judgment here. These are all things we just have to keep an eye out for and do the best that we can. Consult as much as we can. Do a little check-in with ourselves. I try to do a check-in every week. How is each client going? How are they doing? Where am I stuck? Where are they stuck? Am I having any blind spots here for this client? And this could be one where there’s a real big blind spot.
Mistake #7: Not assigning homework to clients
This one is so hard. Again, I’ve been there. Often, when clients are in a lot of distress and they have a busy life, a family, or a job, we might assign homework, and they might show up on Tuesday at nine o’clock and say, “I’m so sorry, I didn’t do my homework.” You say, “Not a problem. Let’s try and get it done this week.” Send them home with the homework. Next Tuesday at nine o'clock, they show up and still haven’t done their homework. Sometimes, I see this a lot, therapists go, “Okay, they’re not someone who does their homework. I’ll pivot, and I’ll make sure we’re doing extra exposures in session.”
That’s a really great pivot. But I would usually stop there and have a conversation with the client and really help them understand, not from a place of judgment or shame, but that their success in treatment goes way down when they stop engaging in their homework assignments. We have to really stress to clients that one hour a week is not enough and that we have to find creative ways and motivation tools to help them make sure they’re engaging in their assigned homework.
I have allowed clients to send me the thumbs-up emoji in an email to show me that they’ve done it, or maybe they’ve called into my voicemail to confirm that they’ve completed their homework. Again, I don’t make them do this, but I always offer them, what can I do? What service can I offer you that will help you stay accountable for your homework? Because for every minute of homework you do, you have massively pushed the needle in the success of your treatment.
I often see a lot of clinicians just disregard homework and say, “It’d be great if they did it, but they won’t.” I would stop and pause there and really explore with the client and make sure they understood that treatment won’t be that super successful if they’re not engaging in homework.
Again, we want to get creative. We want to collaborate with them as much as we can.
What can we do to help get that homework done?
Can we set more realistic goals?
Can we stack it onto another routine that you do?
Can we help with accountability?
Can we bring in a loved one or someone who can support you?
What can we do to help increase the chances of you getting better?
Because I always say to my patients, my hope for this treatment is to teach you everything I know so that you can be your own therapist. Not to say that I don’t want to treat you, and I think you shouldn’t need a therapist. I just want you to be trained to think about it so that when you’re at home and you’re struggling or maybe you’re in recovery, but you have a little lapse, you can recall, “Oh, I remember the steps. I remember what I need to do. I feel empowered. I know this works. I’m going to get to it and trial that first.”
There are the seven mistakes some OCD therapists are making in 2024. Please know, there is zero judgment here. Please also know, this is just my opinion. I fully respect that every clinician is going to come from a different perspective. I fully believe that every clinician comes and sees their client and has the ability to really meet them where they are. I just wanted to bring this up because these are topics I’m discussing with my staff, and I think that it’s something that maybe would help you today.
I’m going to send you off with a big, loving hug and remind you that today is a beautiful day to do hard things.
If you’re a client and your therapist is engaging in some of these behaviors, don’t be afraid to bring it up. We’re a collaborative team here. I always tell my patients, I want to hear your honest feedback. I want to hear if something’s not working for you because that helps you, and I’m in the business of helping.
Have a wonderful day. I’ll see you next week.
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9 Ways to Stop Picking Your Skin This Summer
As summer approaches and the weather gets hotter, many of us are eager to wear shorter sleeves and enjoy the sun. However, this often leads to increased skin exposure and, unfortunately, a greater temptation to pick at our skin. In today's article, we'll explore nine strategies to help you stop picking your skin this summer. These tips have been helpful to many of my clients, and I hope they will be just as beneficial for you.
Understanding Skin PickingBefore we dive into the strategies, it's important to understand what skin picking is. Clinically known as dermatillomania, skin picking is a type of body-focused repetitive behavior (BFRB). People with this condition may pick at their skin, arms, lips, scalp, nails, and even more sensitive areas like the pubic region. It's similar to trichotillomania, which involves hair pulling.
It's crucial to note that skin picking and hair pulling are not forms of self-harm. People who pick their skin are not trying to hurt themselves or seek attention. They often do it because they are either understimulated (bored) or overstimulated (anxious or overwhelmed). Understanding this can provide insight into the strategies we'll discuss.
Strategy #1: Awareness LogsAwareness logs are a powerful tool in any stage of recovery. By logging every time you have the urge to pick, noting how much you picked, where, and for how long, you gain a better understanding of how this condition impacts your life. Many people find that having to document their behavior reduces the frequency of picking.
Awareness logs are a key component of habit reversal training, a cognitive-behavioral therapy technique specifically designed for BFRBs.
For more information about BFRB School, our online course for skin picking and hair pulling, CLICK HERE
Strategy #2: Keep Your Hands BusyEngaging in a competing response can help divert your urge to pick. Competing responses might include using fidget toys, holding a stone, or playing with soothing textures. You can find many affordable fidgets online or at dollar stores.
Create a basket of tactile items that you can use to keep your hands busy. Place these items around your house, in your car, and at work to ensure they are easily accessible when you need them.
Strategy #3: Create a Skincare RoutineA good skincare routine can help prevent irritation and dryness that might tempt you to pick. However, it's important not to overdo it, as too much attention to your skin can also trigger picking. Consult with your doctor to develop a routine that keeps your skin healthy without exacerbating your condition.
Strategy #4: Use Physical BarriersUsing physical barriers (called habit blockers) like gloves, band-aids, or long sleeves can prevent you from touching and picking at your skin. Some people find that keeping their nails short or wearing fake nails can reduce the tactile satisfaction of picking. Identify what works best for you and use these barriers consistently.
Strategy #5: Self-CompassionPracticing self-compassion is vital. Beating yourself up for picking only increases negative emotions like shame and guilt, which can lead to more picking. Instead, practice radical acceptance and reduce self-criticism. This approach can help you feel more motivated and improve your overall well-being.
Strategy #6: Manage Stress and AnxietyManaging stress and anxiety is crucial, as many people pick their skin to cope with these feelings. Cognitive-behavioral skills can help address faulty cognitions and behaviors that exacerbate stress. Consider taking an online course, like Overcoming Anxiety and Panic, to learn effective stress management techniques.
Strategy #7: Establish a Support SystemHaving a support system can make a significant difference. Whether it's family, friends, or online support groups like those at BFRB.org, having people to check in with can help you feel less alone and more accountable. Some people find it helpful to text or call a support person when they feel the urge to pick.
Strategy #8: Stay Hydrated and HealthyGood nutrition and hydration can impact your skin's health. Speak with your doctor about how to maintain healthy skin through diet and hydration. Additionally, consider looking into over-the-counter medications like N-acetylcysteine, which has been shown to help with skin picking. Always consult with your doctor before starting any new supplement.
Strategy #9: Set Realistic Goals and Track ProgressSet achievable goals and track your progress. Instead of aiming to completely stop picking, focus on gradually reducing the behavior by a small percentage each week. Tracking your progress helps you see improvement and identify what strategies are working. Remember, small steps lead to significant changes.
ConclusionThese nine strategies can help you stop picking your skin this summer. Whether you use awareness logs, keep your hands busy with fidgets, or establish a support system, each step you take brings you closer to managing this behavior. Remember to practice self-compassion and set realistic goals. If you need additional support, consider enrolling in courses like BFRB School or Overcoming Anxiety and Panic.
TranscriptToday we’re going to cover nine strategies to stop picking your skin this summer. It’s getting hotter. You want to start wearing shorter sleeves or have your skin exposed to the sun more often, which means you’re more likely to start picking at your skin. Let’s talk about nine strategies that you can use right away. Hopefully, you find them as helpful as my clients have.
Welcome back. I am so excited to talk with you about nine strategies and skills that you can use to stop picking your skin this summer. But before we do that, let’s just first do a little deep dive into what skin picking is. Clinically, we call it “dermatillomania,” and it’s a kind of body-focused repetitive behavior. Often, people with skin picking will pick out their skin, their arms, their lips, their scalp, and their nails. There’s really no limit to where someone can pick their skin. Some people even pick pubic areas under their arms or around their genitals. There is, as I said, no off-topic area that people will pick. It’s completely normal for people to pick in one or all of these areas. It’s similar to a condition called trichotillomania, which is hair pulling. Again, hair pulling is another type of body-focused repetitive behavior, and people may pick at any area where there is skin on their body.
It is important for us to first highlight that skin picking and hair pulling are not self-harm. People who pick their skin aren’t trying to hurt themselves. They’re also not trying to just get attention. They do not want to be damaging their skin or giving their skin abrasions and such. It’s just a part of a condition, and we have a little bit of insight as to why they’re doing it. Often, people with skin picking, or dermatillomania, are skin picking either because they’re understimulated, they’re bored, or we know they may be overstimulated. Maybe they’re very anxious, they’re feeling hyper-reactive to feeling overwhelmed with either emotions, stimulation, or thoughts. We do know that people who engage in this skin-picking behavior are more likely to pick either when they’re overstimulated or understimulated. That’s something to think about, and there is a clue there into some of the strategies that we’re going to use today.
Let’s get to it. Let’s start talking about some of the strategies that you can use to stop picking your skin this summer.
Strategy #1: Awareness Logs
Awareness logs can be so helpful at any stage of recovery. An awareness log is either a piece of paper or a document on your computer or on your phone, where you log every time you have the urge to pick your skin, how much you picked your skin, where you picked your skin, and how long you engaged in skin picking. What this does is, number one, it helps us really understand to what degree this condition is impacting your life. Secondly, people often report that when they have to document it, they’re less likely to engage in the behavior because nobody wants to have to spend all their time logging it as something they don’t want to deal with.
Awareness logs can be a very helpful skill for us in understanding our own condition and our own symptoms, and in addition, they can help us with motivation to slowly reduce this behavior.
Awareness logs are something we use in a very well-known and researched way of using cognitive behavioral therapy, and the type of therapy is called habit reversal training. It’s the specific modality that we use for skin picking and hair pulling, and it is a key component of that cognitive and awareness work.
Strategy #2: Keep Your Hands Busy
Now again, when we’re using habit reversal training, we engage in something called a competing response. A competing response is a behavior that competes with the feeling of picking our skin. Now, a competing response might be fiddles or fidget toys. It could be holding a stone or maybe stroking a feather. It could be playing with other fidgets that we have. The cool news is that you can get so many fidgets online these days for a really low price, or you could easily go to your dollar store and look around for textures that feel beautiful to you, feel soothing to you, or help you with either the understimulation or overstimulation.
What we want to look for here is, what are the specific tactile experiences that you can use to keep your hands busy? We actually have an online course called BFRB School, which is a specific course for people with hair pulling and skin picking, using skills like habit reversal training and cognitive behavioral therapy. We talk all about the core importance of using competing responses.
I often tell my patients and my students to always have a bucket or a basket in the house of different tactile experiences, different tactile things that you can play with objects, so that at that moment, if you’ve identified in your awareness log that you’re feeling bored, you can engage in something that stimulates your creativity, stimulates your awareness. However, if you’re the opposite and you’re feeling overstimulated, you might dig into the basket and find something that’s quite soothing. Maybe it’s more like a silly putty, a gel, or something else that’s more soothing for you.
These competing responses are going to be so important for you in getting very clear on what you need at that moment and having it readily available. I often say to my patients and my students, don’t just have it in one area of the house because, in that moment, you’re still going to want to just pick your skin. What we prefer to do is to have little pieces over the house, in your car, or in your office so that they’re easily accessible. Some people have it on their key rings, some people have it in their purses—whatever works for you.
Again, that awareness log will help us identify specifically where you are when you’re having these urges to pick your skin. And then we can put in competing responses to compete with the skin-picking behavior.
Strategy #3: Create a Skincare Routine That Helps You
This is a little bit of a fine line, though, because we don’t want to engage in a skin routine that has you putting too much attention on your skin because, again, too much attention on your skin is going to mean that you’re more likely to pick your skin. However, we also want to make sure that we are not ignoring your skin, letting it get really dry, especially in the summer. Maybe you’ve had a sunburn or such, and you’ve got some wind chafing or something.
Again, if you have any irritation on your skin that isn’t taken care of with a skin routine, you are more likely to pick at that skin, especially if there’s already an open wound or a scab. If you already have an open wound that you’ve scratched or maybe you bumped into something and you’ve got a little scab there, we want to make sure that we’re engaging in a really healthy skin routine to help that heal and repair so that you’re less likely to go and pick that. I would encourage you to speak with your medical professional about skincare and what would be best for you. Maybe you have a skin condition. Very commonly, people with skin picking do. Speak with your doctor about a skincare routine that will help your skin picking but not be so extensive that it actually makes it worse. I would trust that your doctor will be able to help you in that area.
Strategy #4: Use Physical Barriers
Again, going back to the gold standard treatment for skin picking, which is habit reversal training, we use what we call a habit blocker. This is something that blocks you from the habit of picking, and this can involve anything that stops you from being able to touch your skin.
A lot of patients and students I have had have used things like gloves or band-aids to cover an area that they’re likely to pick. Maybe in the summer, they may wear longer sleeves even though it’s very hot because that actually stops them from getting to the area that they feel an urge to pick. You may also want to keep your nails really thin or cover your nails. Some people keep nails on, like actual fake nails, as a barrier to being able to touch the skin. Maybe it doesn’t give them that same tactile feeling of picking when their nails are medium-length.
What we want to do here is identify for yourself the specific barriers that are helpful. The thing to remember here about skin picking is that everyone is different. Not one strategy that I’ve used for one client is going to be the strategy we use for another client. It’s going to be very much dependent on those awareness logs that you logged out of in that first strategy. Getting clear on specifically what are the triggers that cause you to pick your skin and what specific behaviors and habit blockers are helpful to reduce the skin picking that you feel the urge to engage in.
Strategy #5: Self-Compassion
We have to engage in not beating yourself up, not judging yourself, not punishing yourself if, in fact, you have picked or recently picked despite all of these strategies. Beating yourself up actually does not motivate you to stop picking. In fact, it usually brings up more emotions such as shame, guilt, sadness, anger, and humiliation. Those emotions can send us into overstimulation, making us want to pick again.
Again, we want to engage in a practice of self-compassion. We want to engage in a sense of radical acceptance of ourselves, whether we pick or not. This is so important because we want to reduce our suffering, not make our suffering higher. We do find that people who practice self-compassion tend to have higher levels of motivation, decreased levels of procrastination. They tend to feel better about themselves and have higher self-esteem. They’re more likely to get out there and do the things that they love. Every moment that you’re engaging in in your life is a moment you’re less likely to be picking. It’s very, very important that you practice a self-compassion routine, even if it’s once a day. Anything is better than nothing to reduce that self-criticism where you can.
Strategy #6: Manage Stress and Anxiety
I cannot stress this enough. It is so important when it comes to skin picking that we manage our stress. Again, a lot of people pick their skin because it is a way in which they can manage their stress. A lot of people with skin picking say once they start picking, they can exit out of reality and go into a trance-like mode where everything disappears and they feel relaxed and in the zone, and it takes away all of the stress. We can now understand why there is actually an urge and a pull towards picking and pulling, because who really wants to stay in stress and anxiety? Of course, it makes total sense. The more we can manage our stress using strategies, skills, and other tools like cognitive behavioral therapy, the less likely we are to use skin picking as a coping strategy.
When it comes to managing stress, again, the most important thing we’re going to do here is what we call cognitive behavioral skills. It’s going to be taking a lot of our cognitions that might be faulty, leading us to have more anxiety, and also looking at our behaviors and the things that we do that may be actually exacerbating the stress and anxiety that we experience.
If you’re someone who struggles with anxiety and stress, I strongly encourage you to check out our online course called Overcoming Anxiety and Panic. We go through all of these steps. You can do it from home, and it may help you to get an idea of what might be some of the things that are triggering your stress response, triggering your anxiety response so that you can manage that, so that then you can move on to manage your skin picking as well.
Strategy #7: Establish a Support System
We want to have a community of people who can support us as we go through these steps. It’s not an easy thing to overcome skin picking, so I really want to encourage you to find a support system, whether that be family or friends, or you can go to BFRB.org. They have a whole array of online support groups that you might be interested in looking at to get support, so you feel like you’re not alone and that you have the support that you need.
Another option here is to also look for accountability bodies. Somebody who mightn’t even have skin picking. They might be a loved one, a friend, a parent, or a sibling—someone who you can check in with when your urge is really high.
A lot of my students have said that it’s been very helpful when they have the urge to text somebody and say, “I have a strong urge. I’m texting you to let you know.” They may have already set up a plan on what to do. Maybe they jump on a phone call together, they might text each other throughout it to help the person ride that wave of the urge. Or maybe that person might encourage them to say, “Hey, you told me to remind you of this one thing if you have this urge.”
Really, the importance of a support group can help you, or a support person can help you not only with feeling less alone, not only with beating yourself up, but also with putting these strategies into action, especially if you let them know about the strategies.
Strategy #8: Stay Hydrated and Healthy
Now again, I’m going to encourage you to speak with your medical doctor about this, but I just wanted to mention because I try to look at you as a holistic, full person, someone who’s not just your skin picking, but also, we want to have a look at things like your health. Take a look at your nutrition. Take a look at your hydration levels.
Again, these things can impact our skin. If, let’s say, you’re having a lot of nutrition that’s causing a lot of breakouts and you’re someone who’s prone to skin picking, those two things together could become a disaster. You want to speak with your doctor or a professional in that area about specific nutrition, things you may want to avoid eating, and how hydrated you need to stay to keep your skin healthy, to reduce the chances of you wanting to pick and pull.
A lot of patients I see, and a lot of students that have come through BFRB School, our online course for skin picking, have reported having skin conditions, acne, or certain things that have impacted how much their skin is irritated, how many pimples they’re having. Now, I’m not assuming that nutrition and hydration are the solution to all of that, but I would encourage you to speak with a doctor and just inquire about what you could do to make sure we’re addressing those skin conditions.
Another thing to know here, and this is like an inside scoop, is that there are specific over-the-counter medications you can get that have been proven to help with skin picking. I’ll leave a link in the show notes for you to take a look, but there is a vitamin that’s called N-acetylcysteine. It is an over-the-counter medication that has very few side effects and has been shown to help people with skin picking. Now again, I’m not a doctor. I would strongly encourage you to speak with your doctor about that, but again, I’m trying to give you as many resources today as we can to help you get to the goal that you want. These are all things that you can take a look at and speak to your doctor about.
Strategy #9: Set Realistic Goals and Make Sure You Track Your Progress
We want to set realistic goals. I always tell my patients at the beginning of treatment that the goal isn’t to completely stop skin picking, even though most people are coming for that goal. Because what I have found is, when you set that huge goal, it sets you up to fail. It makes you feel so bad if you slip. It makes you feel so much pressure. It’s such a scarier experience than if you say, “Hey, I’m just going to reduce this by 3 to 5 percent each week,” or month or day, whatever is right for you. We want to set realistic goals—goals that can help keep you motivated and goals that make you feel like they're achievable.
We also want to track progress. One of the most important parts of treatment, once we’ve done that first awareness log—and we do this in BFRB School, I do it with my patients as well—is that once we’re off and running, we then track how well we’re doing. How well did you use your tools? What tools didn’t work? How long did you pick for? Where were you? What went wrong?
We are not doing this to beat you up or to scrutinize you; we are doing it from a place of experimenting, gathering information to know specifically what’s getting in the way of your recovery and what your progress looks like. Some people may say, “I’m not making any progress,” but when we actually look at their logs, we’re starting to see progress in these small ways. Remember, small steps lead to medium-sized steps. Medium-sized steps lead to huge changes.
The last strategy is probably the most important. I could have spent a whole podcast episode talking about that. It’s about setting realistic goals and tracking your progress.
Again, if you are struggling with this and you want to take BFRBSchool.com, head on over to CBTSchool.com. You’ll get access to it there. It will take you through all of these steps. We also have modules on self-compassion, mindfulness, and healthy lifestyles that can really help you with this recovery as well. I’d strongly encourage you to consider that as a hopeful strategy as well.
All right, guys, thank you so much. These have been the nine strategies to help you stop skin-picking this summer. I hope you found it helpful, and I’ll see you next week.
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Today, we’re diving into a topic on how to become more self-confident, especially if you struggle with anxiety. Self-confidence is a quality we all desire, but for those of us with anxiety, it can seem particularly elusive. Let's explore how to cultivate self-confidence, even when anxiety is a persistent part of your life.
Understanding Self-ConfidenceFirst, let’s clarify what self-confidence actually is. Many people mistake it for arrogance or an inflated sense of self. True self-confidence, however, is a deep trust in your own abilities, strengths, and judgment, even when faced with adversity. Anxiety can often undermine this trust, making us feel uncertain and vulnerable. But self-confidence is not something you’re born with—it’s something you develop over time.
Debunking Myths About Self-Confidence Myth 1: Self-confidence is InnateOne common misconception is that self-confidence is an inherent trait. This couldn’t be further from the truth. Self-confidence is a skill that can be nurtured and grown with practice and perseverance.
Myth 2: Success Equals ConfidenceAnother myth is that self-confidence only comes after achieving certain milestones or successes. While accomplishments can boost confidence, they are not the sole source. True confidence is built through the process, not just the outcomes.
Myth 3: Confident People Don’t Have AnxietyIt’s a widespread belief that confident people are free from anxiety. In reality, confident individuals often face anxiety just like anyone else. The difference lies in their willingness to face their fears and grow through the experience.
Building Self-Confidence: Practical Steps Embrace ChallengesSelf-confidence grows from facing and overcoming difficult situations. Initially, the thought of tackling a tough challenge can be overwhelming, but each experience strengthens your trust in your ability to handle adversity.
Practice Feeling Your EmotionsConfidence isn’t about the absence of fear but rather the ability to feel and manage your emotions effectively. By practicing feeling emotions like fear, inadequacy, or shame, you become more comfortable and resilient in facing them.
Identify Specific ScenariosPinpoint the situations where you feel least confident. Reflect on what emotions these scenarios evoke and work on becoming more comfortable with those feelings. For example, if public speaking makes you anxious, practice feeling that anxiety in smaller, controlled settings until it becomes more manageable.
Cognitive and Behavioral Strategies Cognitive RestructuringChanging your thoughts can significantly impact your confidence. Instead of telling yourself, “I’m going to fail,” try affirmations like, “I’m prepared and capable.” This shift in mindset can reduce anxiety and boost your self-assurance.
Behavioral ExposureFacing your fears head-on through repeated exposure can be incredibly effective. For example, if public speaking terrifies you, join a group like Toastmasters, or practice in front of friends and family. Repetition helps desensitize you to the fear and builds confidence in your abilities.
Reflect and LearnAfter facing a fear, take time to reflect on the experience. Ask yourself, “What did I learn?” This reflection helps you identify areas for improvement and reinforces your ability to handle challenging situations.
Embrace Failure as a Learning ToolFailure is an inevitable part of growth. Instead of viewing failure as a negative outcome, see it as an opportunity to learn and improve. The more you fail and learn from those failures, the more confident you become in your abilities.
ConclusionSelf-confidence is a journey, not a destination. It involves embracing challenges, feeling your emotions, and learning from both successes and failures. Remember, today is a beautiful day to do the hard thing. Face your fears, practice self-compassion, and celebrate your progress along the way.
Have a great day, everyone, and keep building that self-confidence!
TRANSCRIPTION:
Hello and welcome back. I’m so happy you’re here. Today we are talking about how to become more self-confident, especially if you’re someone who has anxiety.
Self-confidence is something that a lot of people talk about. It’s something we all want more of. But if you are someone who has anxiety, you might actually find that being self-confident is really, really hard. So I’m here today to talk with you about how you can become more self-confident even if anxiety is here. Let’s do it.
First of all, what is this thing called self-confidence? Some people think that it’s like thinking really highly of yourself and that you think you’re the coolest—sort of arrogance—but that is not the definition of self-confidence. Self-confidence is a deep trust in your own abilities, your own strengths, your own capabilities, and your own judgment in the face of adversity. I get it. When we have anxiety, it’s very hard to feel that sense of trust. In fact, I think anxiety can sometimes make us feel like we can’t trust anything. We’re in a heightened state of fight, flight, freeze, and fawn.
What we want to do today is take a look at how we can improve self-confidence in the face of anxiety. Now, in order to do that, we first have to look at some of the myths about self-confidence. A lot of people think that self-confidence is just something that you’re born with, and that could not be further from the truth. Self-confidence is something we grow over time. Other people believe that self-confidence is something you get once you’ve achieved something, like you’ve achieved some success, or you’ve lost enough weight. That was me when I had an eating disorder. When I’ve finished a course, then I can feel confident. Or, when I’ve done enough practice, then I can feel confident. I understand that. However, that if-then statement creates a lot of opportunities for us to feel out of control and like it’s something that we can’t create on our own. I actually want to really take that idea away and lean towards another strategy.
Another common myth about self-confidence is that some people have it and some people don’t, and that it’s like an inherent piece of who we are—also not true. Anyone can work toward being confident. We have a lot of evidence. You probably know someone who’s really, really confident, and you don’t even think that they are warranted to have that much confidence—again, proof that we can grow self-confidence. It’s something that you can have that doesn’t require a certain accolade or level of success. It’s something that we can take on. Again, we are not using it in a way to hurt other people or to make other people feel bad. That’s actually not self-confidence. That’s usually coming from a place of insecurity.
Another myth is that confident people don’t have anxiety—also not true. Confident people are as afraid, if not maybe even more afraid, than the average person on the street. I don’t want us to believe that confident people don’t bring anxiety to the table, and we are going to take a look at how we can work with that.
Let’s now talk about how you can become more confident. Here’s the thing. As I have gone through some very difficult things, at the beginning of going through those difficult things, I too was overwhelmed with thoughts like, ‘I can’t handle it.’ ‘I don’t have what it takes.’ ‘This is going to destroy me.’ ‘This is going to ruin me.’ It’s like I’m just going to implode with this degree of suffering.
But what I found was that once I had been through that difficult season, I felt more confident. It wasn’t that I succeeded in it, though. It’s not that I conquered all during that difficult turbulence season. There was a different shift towards, again, trusting that I could handle hard things. Often we go into hard, scary things, saying, “If I only had been through this before, well, then I would feel confident.” But that’s actually not true.
A lot of self-confidence is your ability to feel the feelings you will have to feel when you do that hard thing, not the actual doing of the hard thing. The more we practice feelings of fear, threat, inadequacy, shame, or whatever it might be, the more we’re comfortable, open, and caring in feeling those feelings. That’s how we begin to feel self-confident in any situation, whether we’ve been through it before or not.
I had a friend who once told me that a very, very dear loved one, actually a child, had been through cancer. I had said to her, “How are you doing?” She said, “Oh, I’ve been through cancer. Nothing can take me down.” But what she meant by that is that it’s not that everything was in comparison to cancer; it’s that she had mastered feeling her feelings as she navigated something really, really difficult. She could go through something completely different. But because she’s already committed and gone through the willingness to have some really uncomfortable feelings, she had a sense of self-confidence, like, ‘I could handle anything at all.’
What I want you to think about here is, what are the things that you don’t feel confident about? What specifically are the situations, the scenarios, and the times in your life where you don’t feel confident? And then I want to ask you, what would you have to be willing to feel, and what would you have to build comfortability feeling in order to feel confident doing that thing? It’s just a question. Sometimes it’s like, “Oh, to be confident doing my exposure, I’d have to be confident feeling uncertainty.” “Oh, to go through seeing my child struggle, I’d have to be confident feeling maybe guilt or maybe sadness.” “Maybe to handle my parents’ aging, I’d have to be able to confidently and willingly feel grief.” Ask yourself these questions because they can help us identify the emotion that we need to practice feeling on purpose.
Now, when it comes to creating self-confidence, there are two ways we can target it. I talk to my clients about this all the time. We can create self-confidence by changing our thoughts, or we can create self-confidence by changing our behaviors. Let’s talk about creating or changing our thoughts. Let’s say you have something you need to do that’s creating a lot of anxiety. Maybe you have to do a public speaking event. You have a lot of anxiety. You could do some cognitive restructuring by changing your thoughts. Instead of saying, “You’re going to fail and this is going to be terrible,” you could practice saying, “It’s going to go great,” or “I feel like I know my stuff, I’ll be able to do it.” These are great strategies. We could use that.
Another strategy would be, if you have a fear of public speaking, go and do lots of public speaking, Maybe you would join Toastmasters. Maybe you would rehearse it in front of your family, your neighbors, or your colleagues. You would practice doing this behavior over and over and over again with repetition.
These are two very good ways to help with confidence building. However, let’s compare and contrast them. Let’s say that before this public speaking event, you spent a lot of time doing cognitive restructuring. “I’m going to do great. I’m going to do great. Nothing’s going to go wrong,” which we don’t actually know is true. But the thing is, when you walk up onto that stage, you don’t have a lot of proof that it is going to go well. You don’t have a lot of proof. If it doesn’t go well, you mightn’t leave there with a ton of confidence. However, if you’re somebody who instead practices facing that fear over and over and over and over again, as you go to walk onto that stage because you’ve changed your behavior repeatedly and you’ve practiced, you actually have trust in your ability. You have trust in your capability to feel fear. You know what fear feels like, you’ve practiced feeling it, and therefore you’re a little bit desensitized, or you’re a little bit feeling a sense of mastery over that feeling, and you are able to walk up onto that stage.
My advice is that the better way, the more superior way to build self-confidence, is to practice facing that emotion as much as you can. In exposure and response prevention, which we use as the gold standard treatment for OCD and many other anxiety disorders, we’ve practiced facing fears over and over. What clients often tell me is, “I actually start to feel confident doing that thing. I start to feel confident taking flights. I’m starting to feel confident going to the post office. I’m starting to feel confident driving my car by actually doing the thing.”
The real moral of the story here is that confidence comes from repeatedly facing the thing that is hard for you. Identifying the specific emotion that makes it more difficult and practicing being willing to have that feeling.
Now, here is where, going back to that cognitive changing of your thoughts, it might be very, very beneficial, particularly at the end of when you faced your fear. Meaning, after you faced your fear, you can actually stop and go, “What did I learn? What did I learn about facing my fear?” Let’s say the public speaking example. You go up in front of your partner, your mom, or your dog, and you present your presentation. You might say, “I learned that I don’t know the script well enough,” or “I learned that I’m still anxious, but I can handle the anxiety.” “I learned that when I have anxiety, I beat myself up.” Oh, interesting. So we have an opportunity to make another tweak in behaviors because if beating yourself up doesn’t work—PS, it never does—then we might want to change our behavior in that area. The next time we’re going to go and do that presentation, we’re going to work at not beating ourselves up this time. What else did we learn? “I learned that my body didn’t explode when I gave the presentation to my dog and then to my mom and then to my neighbor.” We’re starting to learn things, and we’re starting to change the way we think because we changed our behavior.
This is a really great strategy for anyone. There’s, again, an important cognitive era that we have that gets in our way of building self-confidence, and it’s this: “I’m a failure if it doesn’t go well.” This belief and this thought could create so much suffering. If I can leave you with one core thing to keep in your back pocket as you practice this, it’s that we need to fail a lot of times to get confident. We need to fail a lot of times to be good at something. That doesn’t mean there’s something wrong with us.
I create these podcasts and these YouTube videos all the time. I sucked at them when I first started, but I didn’t stop, and I didn’t say, “That’s because I’m terrible at it.” It basically meant I had some learning to do. I had some practice to do, and it’s okay to suck at things until you get better. The only way I got better was by doing it over and over and over again. I got a little more comfortable and a little more confident in myself as I strategized how I could tweak it a little bit to be better and not be like, “When I’m better, I’ll feel good about this.” Again, that’s a myth. Self-confident people still have anxiety. They just bring it with them, and they know in their hearts that there’s no emotion I’m not willing to feel. Again, as we get better at this, we can start to have a sense of mastery over the emotions that we have to feel.
Another thing I want you to think about here is if, as you do these scary things, you feel guilt, self-criticism, and shame. What we want to do is soften around that emotion, not add to it and be like, “Oh yeah, you’re right. I am the worst. I’m terrible. This is the worst thing ever. I’m bad and I shouldn’t be doing this and all the things.” Instead, we want to soften into it and change our belief around failure and learning and say, “It’s okay. I’m not bad at this. It’s okay that I’m not perfect at this.”
Everyone starts at zero. The people with a million followers on Instagram originally started with zero followers. The people who win Olympic awards in races were once not the fastest runner. They were once in their school and maybe getting beaten by people in their elementary school, high school, or college. We all start somewhere at the beginning, so give yourself permission to start at the beginning. Don’t let yourself give up trying a couple of times, and expect yourself to feel confident. Confidence comes from the repetition of doing the thing and practicing having the emotion that is uncomfortable in relation to that task or activity.
That is where I want you to change the way you think of self-confidence. It’s how I want you to change the way you lean into a task and an emotion as you do that task. I also want to remind you that today is a beautiful day to do the hard thing. This is why I say it on almost every episode. Today is a beautiful day for you to do the hard thing. I want you to go on after that thing that you want to do and practice this. Let the anxiety come, let whatever emotion come. I’m so impressed and proud of you for trying.
Have a great day, everyone.
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