Stimulus Control for BFRBs
Some adults find Habit Reversal Training (HRT) doesn’t always work because the urges to pull/pick can feel overpowering at times, and at other times the mix of pleasure, relief, and soothing that comes from a pull/pick incident is hard to resist. Therefore, combining HRT with use of Stimulus Control is optimal. Stimulus Control functions to eliminate temptations and reduce the strength of urges to pull/pick, by modifying the environment. Stimulus control involves changing how you behave and interact in your home, work, and other environments to make pulling/picking harder. The following is a list of ideas, although it is not exhaustive.
- Use Silly Putty, Rubik’s Cube, or other fiddle gadgets to keep hands busy
- Draw, color, paint, clay, or do other crafts that keep hands busy
- Play with a smooth stone
- Use a pot scrubber, sand paper, dried glue, or emery board on the fingers to provide a rough/picking sensation rather than actual skin picking
- Brush a fluffy pet
- Chew gum, raw pasta, toothpick, sunflower seeds, or other items to keep hair out of mouth
- Wear Band Aids on finger tips or gloves to prevent finger grip
- Wear a hat to cover head or forehead
- Use lotion on hands or Vaseline on eyebrows/lashes to make pulling slippery
- Cover mirrors in paper to prevent looking at skin
- Get rid of, or give away for safe keeping, any implements used to aid in the pulling and picking, such as tweezers, needles, cleaning solution, etc.
- Sit in the middle of the couch when watching TV or reading, so elbows are not resting on the arm chair allowing hands to be closer to the head or face
- Study, read, or watch TV with others to prevent being alone when pulling or picking may occur
- Keep the bathroom door open to prevent long, private stays that can lead pulling or picking
- Sleep with hands in gloves or under the pillow
- Drive with both hands on the steering wheel
- Wear a specific scent or a charm bracelet on your wrist to alert you to your hands moving closer to your face/head.
- Using a variety of these ideas, create “kits” to place in rooms where pulling/picking most often occur. Include the car and your office.
- Consider rewarding yourself for using your kit, such as buying a magazine or treating yourself to a nice coffee, for every 10 kit uses.
Once you have chosen a handful of ideas, begin to implement these. Some individuals like to have a partner or friend subtly prompt them to use their skills (e.g., a look or a gentle shoulder tap), while others prefer to do this independently. Consider help when you need it.