Medications are to remain stable for the duration of treatment

  • If this creates a problem, please notify our clinic to discuss.

Following Session One

  • Clients will be provided documents supporting the “facts and myths” of BFRBs and will gain a better understanding of what BFRBs are
  • Clients are provided with a Model of BFRB to understand their own unique pulling/picking habits
  • Clients can begin tracking their pulling/picking at home and school by using the Self-Monitoring Forms provided or the TrichStop and SkinPick apps
  • Introductory handout sheets (e.g. “Putting the Brakes on BFRB”) are given to guardians in Session One; guardians are free to make additional copies of these handouts for others (e.g. teachers).

Following Session Two

  • Participants have begun to learn more about their unique pulling/picking habits through the daily tracking and are encouraged to continue their detective work by continuing to fill out the tracking forms/apps
  • An even greater understanding of the client’s pulling/picking habits is learned through completion of a thorough Functional Assessment
  • Goals for how things might be better and rewards for effort are developed

Following Session Three

  • Participants begin to learn and identify the impact the BFRB can have on their self esteem and identity
  • Participants have the opportunity to focus on their positive characteristics and attributes and all the things that make up who they really are
  • Participants review the “BFRB Book of Fame” which highlights many “famous” people who also have a BFRB supporting the fact that they are not alone
  • During the week clients will complete the Self Esteem journal to continue to foster the positive characteristics and experiences they have

Following Session Four

  • Participants are introduced to the STEP model; STEP – place and posture (Stimulus Control)
  • Participants have begun to learn strategies to assist in making it more difficult to pull/pick (Stimulus Control). Many tangible examples are provided.
  • Strategies to improve awareness are reviewed for those participants that have difficulty recognizing urges (i.e. warning signs, olfactory cues, auditory cues)
  • During the week clients are encouraged to practice Stimulus Control strategies when they become aware of their urges to pick/pull and when they’re in environments or situations where pulling/picking is more likely

Following Session Five and Six

  • Participants are introduced to the next step of the STEP model; STEP - Sensory (Competing Response/Sensory Distraction)
  • Participants are introduced to sensory assessment measures
  • Participants have begun to learn strategies to use instead of pulling/picking (Competing Response). Many tangible examples are provided.
  • During the week clients are encouraged to practice Competing Response strategies when the urge to pull/pick and triggers are present

Following Session Seven

  • Participants are introduced to the next step of the STEP model; STEP - Thoughts
  • Clients are introduced to “Trichy/Picky” Thoughts and how they can impact their pulling/picking.
  • Clients have begun to learn strategies to become aware of and address and challenge the Trichy/Picky Thoughts
  • During the week clients are encouraged to put their Trichy/Picky Thoughts “on trial,” weighing the evidence for and against the thought and replace it with a more helpful, realistic thought

Following Session Eight

  • Participants are introduced to the next step of the STEP model; STEP – Emotions (emotion regulation, relaxation, distress tolerance)
  • Participants have begun to learn strategies to assist in addressing the different states (i.e. boredom, restless, overwhelmed, etc) which might be a contributing factor to their BFRB. Many tangible examples are provided, and opportunities are given to share with others relaxation strategies they have already found to be successful.
  • During the week clients are encouraged to practice relaxation strategies such as the Breathing Triangle and Guided Muscle Relaxation demonstrated in this session. Guardians can remind clients of the relaxation strategies they’ve learned and model their use.

Following Session Nine

  • This is Celebration Time! The BFRB Treatment has finished. Guardians and clients are now familiar with the Model of BFRB and the STEP model and how each step contributes to the client’s BFRB. Adults should spend some time focussing on the gains made and reinforcing the efforts made by clients.
  • Continue practicing BFRB strategies from sessions 3 to 8.
  • Ensure that the 2 “Tune-Up” session dates are in your calendar!