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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 youâre constantly running on empty, juggling a never-ending to-do list, and battling that nagging voice that tells you youâre not doing enough?
Youâre 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 ratioâa game-changing approach to ensure youâre resting enough to fuel your productivity and thrive without burning out.
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In todayâs discussion, weâre 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. Itâs vital to ensure clients understand why theyâre 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 weâre 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 Iâve 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 Iâm saying here today.
However, I am going to give you my opinion on some of the things that I hear that deeply concern me. Iâm just here to share what I think is helpful. I hope, if anything, itâs here to really reassure clinicians that theyâre 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, Iâm here to hopefully bring some goodness into the world. Letâs 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 letâs talk about it. My guess is youâre probably going to agree with everything I say. If not, Iâm 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, âLetâs just go.â I get that. I love an eager therapist. I love a therapist thatâs not going to waste peopleâs 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 whatâs coming, what treatmentâs 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 whoâs engaging in this treatment feels a sense of mastery over whatâs about to happen. They feel like they can make decisions as they go because theyâve got a plan. They can see them crossing the finish line. They can keep that. They know what thatâs 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 itâs an experiment. We donât have to get it perfect the first time. This is a collaborative experience. Thereâs a lot of hope here that by us collaborating and by us talking through whatâs working and whatâs 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 isnât that effective. The treatment doesnât 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 itâs so scary. Theyâre already in so much pain. Theyâve 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, Iâm not here to tell anybody what their treatment should look like. Thatâs 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 Iâve been public in saying, I see no reason to abandon that.
Now, thatâs not to say that I havenât 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 theyâre having self-harm or suicidal ideation. Absolutely. As time continues, weâre 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 Iâm skilled at doing too.
The other thing is there is some research on other treatment modalities besides ERP. I think thatâs wonderful. I mean, my hope is that one day we have something that is a sure thing, 100%, and we can absolutely promise that weâve got guaranteed results. This is going to be something that I continue to learn and educate myself on, but my opinion is that Iâm 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. Itâs Episode 365. We talk specifically about this very sensitive and important topic, âIs ERP abusive?â What came from that episode, which is very similar to this one, is I donât actually feel like ERP is an abusive treatment modality. I think that sometimes how itâs delivered can be concerning, but thatâs 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 youâre having someone face their fear without giving them the education that they need and not explaining to them why theyâre doing it -- believe me, guys, let me also disclose here. Iâve made a lot of these mistakes myself as a clinician. Letâs just be open. I have been in this particular situation. Actually, if Iâm going to be really honest with you, number one, that mistake of not educating your clients, I learned that by a client telling me, âKimberly, I do not understand why youâre having me do what youâre doing. Iâm someone who needs to know what Iâm doing, or Iâm not going to trust you. Slow down and tell me what this looks like.â Again, no judgment over here. Iâve 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. Thatâs what makes them good clinicians. In no way do I want clinicians to feel blamed or judged here. Weâre human beings. Weâre 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 doesnât feel right, that this crosses my values, my limits, and my boundaries. This doesnât feel like itâs something that lines up with my values. We can have a conversation about that and be respectful about, âThis is what works for me in this relationship, and this is whatâs not,â or âHere are my concerns about ERP. Could you help me to work through this, or could we consider having a conversation before we move forward?â I think thatâs 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 itâs 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 youâre ready to take this next step? Whatâs getting in the way of you taking this next step? Letâs 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 donât want to follow a rigid plan unless thereâs 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 weâre really going with that is it has to be individualized. We have to understand the clientâs needs in order to make a plan. And then from there, we can decide whatâs best. But we have to stay away from rigidity.
I also donât love any treatment modality that has modules that make the clients go through modules because, again, I think it misses the client, where theyâre 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 whatâs best for their clients, but itâs something that we can look out for.
Mistake #6: Moving on without exploring what was getting in the way
Letâs say you had a treatment plan and the client said, âAh, that doesnât work for me.â And then you just say, âOkay, fine,â and you move on without slowing down and getting curious. Tell me about that. Whatâs getting in the way of you being able to do this exposure? Is there an obsession Iâm not aware of? Is there something else happening thatâs 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?
Itâs really important, and Iâve 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 clientâs OCD can be very convincing in getting us to not address certain issues because of an avoidant compulsion.
Again, complete transparency. Iâve 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 thereâs a real big blind spot.
Mistake #7: Not assigning homework to clients
This one is so hard. Again, Iâve 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 oâclock and say, âIâm so sorry, I didnât do my homework.â You say, âNot a problem. Letâs try and get it done this week.â Send them home with the homework. Next Tuesday at nine o'clock, they show up and still havenât done their homework. Sometimes, I see this a lot, therapists go, âOkay, theyâre not someone who does their homework. Iâll pivot, and Iâll make sure weâre doing extra exposures in session.â
Thatâs 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 theyâre engaging in their assigned homework.
I have allowed clients to send me the thumbs-up emoji in an email to show me that theyâve done it, or maybe theyâve called into my voicemail to confirm that theyâve completed their homework. Again, I donât 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, âItâd be great if they did it, but they wonât.â I would stop and pause there and really explore with the client and make sure they understood that treatment wonât be that super successful if theyâre 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 donât want to treat you, and I think you shouldnât need a therapist. I just want you to be trained to think about it so that when youâre at home and youâre struggling or maybe youâre in recovery, but you have a little lapse, you can recall, âOh, I remember the steps. I remember what I need to do. I feel empowered. I know this works. Iâm going to get to it and trial that first.â
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 Iâm discussing with my staff, and I think that itâs something that maybe would help you today.
Iâm going to send you off with a big, loving hug and remind you that today is a beautiful day to do hard things.
If youâre a client and your therapist is engaging in some of these behaviors, donât be afraid to bring it up. Weâre a collaborative team here. I always tell my patients, I want to hear your honest feedback. I want to hear if somethingâs not working for you because that helps you, and Iâm in the business of helping.
Have a wonderful day. Iâll 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 weâre going to cover nine strategies to stop picking your skin this summer. Itâs getting hotter. You want to start wearing shorter sleeves or have your skin exposed to the sun more often, which means youâre more likely to start picking at your skin. Letâs 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, letâs just first do a little deep dive into what skin picking is. Clinically, we call it âdermatillomania,â and itâs 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. Thereâs 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. Itâs completely normal for people to pick in one or all of these areas. Itâs 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 arenât trying to hurt themselves. Theyâre also not trying to just get attention. They do not want to be damaging their skin or giving their skin abrasions and such. Itâs just a part of a condition, and we have a little bit of insight as to why theyâre doing it. Often, people with skin picking, or dermatillomania, are skin picking either because theyâre understimulated, theyâre bored, or we know they may be overstimulated. Maybe theyâre very anxious, theyâre 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 theyâre overstimulated or understimulated. Thatâs something to think about, and there is a clue there into some of the strategies that weâre going to use today.
Letâs get to it. Letâs 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, theyâre less likely to engage in the behavior because nobody wants to have to spend all their time logging it as something they donât 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. Itâs 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 weâre 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 youâve identified in your awareness log that youâre feeling bored, you can engage in something that stimulates your creativity, stimulates your awareness. However, if youâre the opposite and youâre feeling overstimulated, you might dig into the basket and find something thatâs quite soothing. Maybe itâs more like a silly putty, a gel, or something else thatâs 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, donât just have it in one area of the house because, in that moment, youâre 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 theyâre easily accessible. Some people have it on their key rings, some people have it in their pursesâwhatever works for you.
Again, that awareness log will help us identify specifically where you are when youâre 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 donât 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 youâre 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 youâve had a sunburn or such, and youâve got some wind chafing or something.
Again, if you have any irritation on your skin that isnât taken care of with a skin routine, you are more likely to pick at that skin, especially if thereâs already an open wound or a scab. If you already have an open wound that youâve scratched or maybe you bumped into something and youâve got a little scab there, we want to make sure that weâre engaging in a really healthy skin routine to help that heal and repair so that youâre 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 theyâre likely to pick. Maybe in the summer, they may wear longer sleeves even though itâs 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 doesnât 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 Iâve used for one client is going to be the strategy we use for another client. Itâs 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. Theyâre more likely to get out there and do the things that they love. Every moment that youâre engaging in in your life is a moment youâre less likely to be picking. Itâs very, very important that you practice a self-compassion routine, even if itâs 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 weâre going to do here is what we call cognitive behavioral skills. Itâs 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 youâre 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. Itâs 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 youâre not alone and that you have the support that you need.
Another option here is to also look for accountability bodies. Somebody who mightnât even have skin picking. They might be a loved one, a friend, a parent, or a siblingâsomeone who you can check in with when your urge is really high.
A lot of my students have said that itâs been very helpful when they have the urge to text somebody and say, âI have a strong urge. Iâm texting you to let you know.â 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, âHey, you told me to remind you of this one thing if you have this urge.â
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, Iâm 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 whoâs 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, letâs say, youâre having a lot of nutrition thatâs causing a lot of breakouts and youâre someone whoâs 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 theyâre having. Now, Iâm 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 weâre 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. Iâll leave a link in the show notes for you to take a look, but there is a vitamin thatâs 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, Iâm not a doctor. I would strongly encourage you to speak with your doctor about that, but again, Iâm 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 isnât 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. Itâs such a scarier experience than if you say, âHey, Iâm just going to reduce this by 3 to 5 percent each week,â or month or day, whatever is right for you. We want to set realistic goalsâgoals 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 weâve done that first awareness logâand we do this in BFRB School, I do it with my patients as wellâis that once weâre off and running, we then track how well weâre doing. How well did you use your tools? What tools didnât 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 whatâs getting in the way of your recovery and what your progress looks like. Some people may say, âIâm not making any progress,â but when we actually look at their logs, weâre 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. Itâs 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. Youâll 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. Iâd 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 Iâll see you next week.
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