How CBT can treat Body-Focused Repetitive Behaviors (BFRBs)

Body-focused repetitive behaviors are more common than most people realize. Hair pulling, skin picking, nail biting, and cheek biting can bring brief relief, then leave shame, damage, and stronger urges. Cognitive Behavioral Therapy provides people with a practical approach to understanding why a behavior occurs and how to modify the routine that perpetuates it.

Here are the key takeaways before we dive in:

• CBT targets the full loop: the triggers, the urges, the beliefs, and the routines that follow.

• Habit Reversal Training (HRT) and the Comprehensive Behavioral Model (ComB) are well-known CBT approaches for BFRBs.

• Core tools include awareness training, stimulus control, and practicing competing responses.

• A good plan distinguishes between automatic episodes and focused episodes, as each requires different strategies.

• Skills practice between sessions, with simple tracking, is where change takes hold.

• Relapse prevention matters; slips are reviewed without shame, so progress continues.

Keep these points in mind as you read; the rest explains how CBT methods typically work for BFRBs.

What counts as a BFRB

BFRBs are repetitive grooming behaviors that a person feels driven to do. The two most studied conditions are trichotillomania, characterized by hair pulling, and excoriation disorder, which involves skin picking. People often describe some episodes as automatic, where hands move without awareness, and others as focused and intentional. This mix is why flexible, skills-based care helps. Education helps reduce shame, and a clear plan replaces trial and error.

Why CBT fits BFRBs

CBT looks at behavior in context. What happened right before the urge? What did you do next? What did you feel afterward? A brief functional analysis reveals the job the behavior is doing in the moment, such as easing tension, evening out a texture, or alleviating boredom. Once the function is clear, you can test healthier ways to meet the same need. Over time, the loop changes, and urges feel less powerful.

CBT also stays practical. You get small steps to try this week, not just insight into why the behavior shows up. The plan is built from your real life, so it is easier to follow.

What CBT often looks like in practice

Early sessions focus on assessment, education, and a first round of tools. People leave with a brief plan to use during the week, typically consisting of one awareness cue, one stimulus control change, and one competing response to practice. The following meetings review what worked, adjust the plan, and build momentum. As urges drop, attention shifts to confidence, self-image, and lingering beliefs that pull you back to old patterns. Some people also consult a medical prescriber, especially when other conditions are present. Many improve with behavioral methods alone.

Getting help

Change is possible. If you are dealing with hair-pulling, skin-picking, or related behaviors, you are not alone, and you are not broken. If you have questions about CBT for BFRBs or want help sorting out next steps, reach out to The Center for Collaborative Behavioral Health. We can answer questions and help you consider options that best fit your situation.