Overcoming Body-Focused Repetitive Behaviors: A Comprehensive Behavioral Treatment for Hair Pulling and Skin Picking

by Charles S. Mansueto, Sherrie Mansfield Vavrichek, Ruth Goldfinger Golomb

“The definitive guide for those who pick or pull.”
—Reid Wilson, PhD, author Stopping the Noise in Your Head

A comprehensive treatment plan grounded in evidence-based cognitive behavioral therapy (CBT) to help you overcome body-focused repetitive behaviors for good! If you have body-focused repetitive behaviors (BFRB) such as hair pulling (trichotillomania) or skin picking (dermatillomania), you may feel embarrassed about seeking help. But there are proven-effective strategies you can use to overcome these behaviors and improve your overall quality of life—this book will show you how. In this evidence-based resource, three renowned experts and clinicians offer powerful CBT skills to help you move past BFRB. You’ll learn why you engage in these behaviors, and how to identify your own sensory “triggers”—places, things, or experiences that cause your behavior to become worse. Finally, you’ll learn strategies to use when faced with these triggers, and develop your own customized “plan of action” for moving beyond BFRB for good. With time, practice, and solid skills for managing stress, anxiety, urges, and other triggers, this book will help you break free from BFRB and feel more in control of your life.

Genres: Nonfiction, Self Help, Psychology, Mental Health, Audiobook, Health, Personal Development

216 pages, Paperback

Published January 2, 2020

Reviews

[Silvia · Rating 5 out of 5]

After +- 15 to 20 years of skin picking, and feeling quite powerless and hopeless about it, I can now finally say I'm really recovering, for the first time. This is a gem of a workbook with a very compassionate, insightful and no-nonsense approach. Even if you don't do the exercises and make an action plan, I think just reading this book can help you gain self-understanding and -acceptance. It sure did for me. But the approach is so easy to work with, that I think anyone can do it - and without needing the help of a therapist, which is a good thing considering that therapy is sadly inaccessible for many people, and that very few therapists are familiar with BFRBs, let alone with best practices to treat them. I am easily discouraged by self-help books or therapy approaches that involve endless exercises (think mindfulness, meditation, etc.), or detailed excursions into every life experience you've ever had, your youth and family, digging up possible traumas, etc. etc. Thankfully this book is not like that at all! It's short, non-intimidating, practical and on-point. All it takes to work with the proposed method is a willingness for self-observation, experimenting with small changes, and seeing what works and what doesn't. This is facilitated by filling out a few simple forms to monitor your progress and to try out new ideas. I felt it was actually fun to do this work. And now I have gained much more control over my BFRB and for the first time in all these years, I feel hopeful and empowered because I understand how I can approach this to continue further recovery and to prevent relapse.

I highly recommend this book for anyone struggling with (a) BFRB(s)!

[Alan · Rating 4 out of 5]

Great explanation of the SCAMP model of body focused repetitive behaviours (Sensory, Cognitive, Affective, Motor, Place).

[Olivia Loccisano · Rating 5 out of 5]

This is an incredibly comprehensive book on body-focused repetitive behaviours from an approach that covers so many angles. This is an excellent book if you’re either beginning to notice a problem with a BFRB; just starting to identifying your triggers; or if you’re already in recovery and want to learn how to maintain it, and how to prevent and attack mistakes so that they do not turn into relapses.

If you struggle with skin picking or hair pulling that leads you with frustration, sadness, and anxiety, you’re going to relate to this book and it’s going to work for you if you apply what you’ve learned. It stands out from other BFRB psychology books with it’s different kinds of approaches- it discusses different approaches in detail which is so helpful since one approach is obviously not going to work for everyone. This book is a resource for an incredible treatment plan from the basis of scientific evidence.

[Dani (The Pluviophile Writer) · Rating 5 out of 5]

BFRBs affect 1 in 5 people. That means that someone you know is dealing with a BFRB.

5/5 stars.
ebook, 216 pages.
Read from April 7, 2020 to April 16, 2020

Review at The Pluviophile Writer: https://bit.ly/3fnNoyC

What is a BFRB you ask? BFRB stands for Body-Focused Repetitive-Behaviours and they include excessive hair pulling (trichotillomania), excessive skin picking (dermatillomania) as well as a bigger spectrum of other repetitive behaviours. If you've never heard of these conditions before and your first reaction is reluctance or disgust, I beg you to do some more reading as chances are that someone close to you is hiding their behaviour due to that exact fear and stigma. I can assure you that these conditions are very real and cause very real trauma for those that have to deal with it.

You don't read a book like this unless you're looking for help yourself. Over the last few years, I've made it no secret about my skin picking disorder and have been actively volunteering with an organization in Canada called the Canadian BFRB Support Network (CBSN) to help others with BFRBs as well as to aide in my own recovery. I also contributed to a book called Project Dermatillomania as well as some blog posts on BFRB Relapses and Dermatillomania Makeup Tips.

Lately, this little demon of mine has started to become a problem for me again and I've realized that I've been denying that fact. I've not talked about it like I used to as I've felt too ashamed to deal with it or acknowledge again.. My last breakthrough with dermatillomania was when I opened myself up to the BFRB community and my loved ones. It was lifechanging. I have to see again that trying to hide or acknowledge these issues again is only going to make my shame grow and is not going to help my progress.

So here I am, being as proactive and forward as I can.

Overcoming Body-Focused Repetitive Behaviours is the book that BFRBers have been waiting for. When I first began my BFRB journey, skin picking wasn't even in the Diagnostics and Statistics Manual of Mental Health Disorders and all three of the health professionals I spoke to didn't have a clue about my condition (though they were still pretty helpful). BFRB awareness has come a long way and its thanks to organizations like CBSN and The TLC Foundation for BFRBs for their constant work and dedication. The author of this book as well as the contributors are health professionals and researchers that have worked closely with the TLC Foundation to help learn more about BFRBs and come up with an effective program to help combat and deal with them.

This book talks about the specifics of BFRBs, what makes them different from just a bad habit, what they do to our brains, thought processes and feelings, and how we can try and rewire our patterns of behaviour. The method that Dr Mansueto and his team have found to be effective in working with many people with BFRBs through the TLC Foundation is called the Comprehensive Behavioral Model (ComB), which combines aspects of Cognitive Behavioural Therapy (CBT) and Habit Reversal Therapy (HRT).

What makes this book exceptional is that it gives you all the tools you need to tackle your BFRB on your own. Worksheets are provided using a SCAMP model (Sensory, Cognitive, Affective, Motor, Place) to help you determine your very own pattern of behaviour when it comes to your BFRB. The book then gives you to the tools to create an action plan for all the different aspects that you've identified where you engage in your BFRB so that you have real tools to support you no matter how intense your urge. While I've always advocated for 'habit tracking' and have had great success with it before from Annette Pasternak's book Skin Picking: The Freedom to Finally Stop, this particular book is so much more robust as it identifies just how rooted our BFRB behaviours are.

I've restarted the process of tracking my behaviour and I look forward to creating some action plans to help get me back on track. The thing with BFRBs that there is no easy fix. If you have a BFRB like I do, you've probably got years of practising your BFRB so it's going to take a lot of dedication and hard work to break free from your BFRB,  but if you're willing to put in the work you will see results with this book.

This book is now my top recommendation to anyone that is battling a BFRB. It's concise, reassuring, easy-to-follow, supportive, progressive, with feasible accomplishments that you can track if you put the work in. If you're fed up and ready to tackle your BFRB head-on, waste no time and pick up this book as soon as possible.

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[Lizzie S · Rating 4 out of 5]

A very useful overview of the ComB approach to targeting Body-Focused Repetitive Behaviors (BFRBs) through identifying sensory, affective, cognitive, motor, and environmental triggers for these behaviors, increasing awareness, and identifying interventions to interfere with/otherwise prevent unwanted hair pulling/skin picking.

[Jennifer M. · Rating 5 out of 5]

The two main issues this book covers is hair-pulling and skin-picking. I am cursed to have one of these afflictions. And so many of the things covered in this book spoke to me and the life I've had since I was about 8. It's been a very hard road, but the thing I loved about this book the most, is how normal it made me feel. Despite being not normal. OBFRB goes over examples of the compulsion, how to avoid it, and how to continue self-care when you feel like you're a freak.

I've been in therapy for many years and hope to eventually overcome my BFRB. There is hope out there.

Published 1.2.20 and was written by Charles S. Mansueto, PhD; Sherrie Mansfield Vavrichek, LCSW-C; Ruth Goldfinger Golomb, LCPC

5/5 Stars

[Amelia · Rating 4 out of 5]

As a therapist I found this a very helpful resource for working with skin-picking and hair-pulling. The book sets out a clear and structured protocol for a cognitive behavioural approach and seems straightforward to use for both clinicians and individuals using the book for self-help. This is a book I'll be coming back to and recommending.

[Mo]

Read this book because I have had issues with skin picking all my life and felt like I could maybe gain some more insight and get some tips. However, I did not hope for life changing advice because since I have tried a lot of stuff already I know bad behaviours are no quick fixes.

I felt like the book could have been a lot shorter. There is a lot of repetition. Moreover, it is not very refreshing in the sense that it offers a whole new treatment altogether. However, the combination between CBT (cognitive behavioral therapy) and creating sophisticated action plans might fight urges better than just one of these options. The methodology and steps are clear, with good examples, and the empty sheets help to motivate you to try it yourself.

I did not really put all ideas into practice yet, and since I think a rating for a self-help book should depend on how much it has helped, I’ll wait with rating until I have tried multiple methods.

[Poetic Diva504 · Rating 2 out of 5]

Repetitive information in this book made me skim through most of it. It was way too long for what could have been said in a few paragraphs

[A.C. Bauch · Rating 5 out of 5]

This is the first book I've read that's dedicated to what the psych industry calls "body-focused repetitive behaviors" (BFRBs). Though I haven't yet implemented any of the protocols they recommend, I'm giving the book five stars for this reason: nothing else I have ever read has made me understand my BFRBs the way this book has. Sure, certain aspects of it I was aware of (e.g., when I'm sitting & sedentary, I struggle not to indulge my BFRBs), but this book made me think about facets I'd never considered, such as the sensory needs being filled by the act or the sequence of events leading up to the BFRB, which I'm often unconscious of.

Equipped w/ this knowledge, as well as the numerous tools the book provides, I'm hopeful that I can finally overcome my BFRB, which has been a source of secrecy and shame for most of my life.

I recommend this book not only for people struggling w/ a BFRB but for anyone who wants to help or better understand someone w/ a BFRB. And perhaps for someone who is struggling to overcome a particular compulsive behavior, even if it's not a BFRB.

After I've had a chance to try out their method, I'll update this review! :)

[sima · Rating 5 out of 5]

Practical, comprehensive and compassionate overview. Great for individuals that are dedicated to the plan provided. Thank you

[Ruth · Rating 4 out of 5]

I was drawn to this book because the habits of hair pulling and skin picking seem to run in our family. Several members have succumbed to these self-harming habits at one time or another. As stated in this book, there is no simple fix. Each person needs to analyze what triggers their own sessions of hair pulling or skin picking. The book offers a plan of action along with suggestions to use in various scenarios. There are also references for support groups and other resources. Thanks to NetGalley and the publisher for the opportunity to read and review this book.

[Laura A. Barton · Rating 3 out of 5]

3.5 stars. I'm going to start off by saying that I think the content of this book is great and that it has the potential to help many people that struggle with BFRBs. But this book is not for me.

I was excited when I discovered Overcoming BFRBs earlier in the year, and although it took me many months to get to it, I was eager to dive in when I did. As someone who has lived with skin picking disorder since I was a toddler, all literature and knowledge about my disorder and others like it have come to fascinate me.

With this book, it was great to become familiar with the history of treatments, see their evolutions, and learn the whys behind them. Getting a full glimpse at the Comprehensive Behavioral (ComB) model is wonderful and I think it's a very valuable model that resonates not only with a lot of my beliefs about BFRBs, but also addresses the ways I feel are useful to overcome them, whether that means fully stopping the behaviour or not.. I liked reading about neuropathways and the science behind BFRBs and treatments alike.

You see, with this book, I liked the content a whole lot, but I was put off by the delivery of said content. I'll start with the BFRBs themselves.

The book is slated as a self-help guide for people with BFRBs, but focuses primarily on hair pulling and skin picking disorders, as the title and subtitle suggest. Yes, it does at times mention other BFRBs, like nail biting, but for a guide that's primarily titled Overcoming BFRBs, I had thought there would be more mention. It could simply be because hair pulling and skin picking are currently the only two diagnosable BFRBs and that there isn't as much research into the others. Not to say this guide wouldn't be helpful for those with other BFRBs, but there wasn't much representation of them.

Again jumping off the self-help guide bit, I found the language, phrasing, and overall tone of the book leaned toward academic. Perhaps I'm just not familiar with the self-help genre, but to me, it's off-putting because it feels less accessible to those who might need the book. I expected the book to be an easier read than it was, but felt I had to switch on my academci brain to really get into it. Yet, ironcially, there were parts that didn't feel so academic at all, with a large use of exclamation points, a sprinkling of grammatical errors, and things like that.

Still on the topic of language, I didn't enjoy how BFRBs were positioned in the text. While there were parts that acknowledged the severity and capability of managing BFRBs happens on a spectrum, there were others that were more binary, in particular when it came to management of the disorders. Not engaging in BFRB at all = success, while engaging in BFRB instead of using the methods learned = failure.

From a clinical standpoint, I can appreciate that sort of thing. The term "failure," for instance, was used when showing how to challenge the congitive side of the disorder where thoughts like completing the pull or picking might feel like success. The authors challenged that with saying it's not actually a success, but instead a failure of control.

Don't get me wrong. I understand and agree with facing BFRBs head on and not downplaying them in any way. But for something that's supposed to be a self-help book for people who already struggle with feeling they have any say over these complex disorders, I feel it's a dangerous picture to paint. From a literary analysis standpoint, the negative words and phrases used (failure, BFRB problem, damaging, harmful, "life spoiled by pulling or picking," etc.) felt like a way to shape the reader to buy into the idea of ComB. I'm not saying that it was intentionally written that way, but it was something that I noticed. I think I'm attentive to language like because it used to completely discourage me when I was in the height of my struggles with skin picking.

There were also many cases of hope and encouragement throughout the text, but these were simply overshadowed for me by what I highlighted above. That being said, I know some respond to that kind of, for lack of a better term, negative reinforcement. Personally, I don't. Which is why this book is not for me.

This review isn't meant to disparage the great work done by the authors who put it together. I love that they've taken on the task of making what I know has been a ground-breaking approach in the field of BFRB research and treatment available for the public without having to go to a professional. My thoughts here are to bring an awareness to other readers about how they might receive the content and their readiness for the way its delivered.

[Annie · Rating 5 out of 5]

Originally published on my blog: Nonstop Reader.

Overcoming Body-Focused Repetitive Behaviors is a handbook and guide for understanding and modifying body focused repetitive behaviors (specifically hair pulling and skin picking). Due out 2nd Jan 2020 from New Harbinger, it's 216 pages and will be available in ebook and paperback formats. The authors are professionals in behavior therapy and modification and this book is a science based and comprehensive guide to identifying, contextualizing, and modifying repetitive picking or other damaging behaviors.

The language used is layman accessible, supportive (non-judgemental), and the advice for behavior modification is realistic and presented positively. The book is split up into logical sections, so the information the reader needs is easy to find. The introduction covers some of the history and development of the recognition of skin picking and hair pulling as treatable behaviors as well as the development of effective treatments, specifically ComB detailed in this manual.

The following chapters contain workable solutions for getting started, charting the behaviors, making a plan and following through. Part two contains an in-depth analysis of the different parts of the behavior puzzle, SCAMP (sensory, cognitive, affective, motor, and place) (charting tools) and putting everything together to make an individual plan.

The last section contains positive coping mechanisms, and maintenance mechanisms as well as troubleshooting, and keeping a healthy lifestyle.

The book also contains a number of links for support information for charting and troubleshooting. The references and further reading links are very well annotated and are probably worth the price of the book on their own. There's a wealth of further reading to be found here. The eARC I received does not contain an index, but that may change in the release copy.

Very well written and science based information here.

Five stars.

Disclosure: I received an ARC at no cost from the author/publisher for review purposes.

[Angela · Rating 5 out of 5]

More than a good read!

This book provides a well written and compassionate solution for anyone suffering from a BFRB. I would recommend this book to anyone suffering from a BFRB, anyone wanting to help a friend or loved one struggling with a BFRB, or mental health proffessional seeking more information and guidance to help their clients struggling with a BFRB. I gave this book 5 stars for the reasons stated above and as a mental health proffessional who has struggled with a BFRB for as long as I can remember. I loved that this book is not too lengthy. I read this book over the course of one week while on vacation and I was able to avoid engaging in my BFRB (SPD) for over one week, which I don't ever remember being able to do in the past. I'm not saying I was able to accomplish this just because of this book as I did not complete any of they self monitoring forms and interventions, which are crucial to successfully addressing a BFRB. My success with avoiding engaging in my BFRB is not typical or realistic. My objective was to read the book first because I was interested in what it had to offer both for my own personal reasons and as a mental health proffessional interested in building skills to help clients with BFRB. This book played a significant role in providing valuable information, increasing my own self-awareness and motivation for change. Being on vacation with a lot less stress helped me avoid engaging in my own BFRB. I plan to apply the ComB method to help me maintain my success and learn how to manage my own BFRB once I return to a stressful work environment.

[Paige Christiansen · Rating 5 out of 5]

After having battled with Trichotillomania for the past 13 years, my self-confidence and time in its turbulently, senselessly acting hands, finally it appears that I will conquer this behavioral bane of my existence, control finally within my grasp. I owe this breakthrough much to this book, which is essentially innumerable, self-paced therapy sessions in book form for under $20. If one truly possesses the desire and discipline to reclaim her self-confidence and time, the best decision she can make is to pick up this book and commit time to taking full advantage of the thorough insights and stratagems explored within. It is a Godsend. If I had discovered it earlier, I would have been spared much suffering, and so it is my heartfelt desire that whoever reaps benefits from this book promotes it so that fellow sufferers can escape the vicious cycle of BFRBs.

[Emily · Rating 5 out of 5]

This one is a little bit more vulnerable but anyone who knows me well knows I’m not shy about chatting about my skin picking disorder. It’s something I’ve dealt w since middle school and had zero awareness of really until I went to college and lived with people who didn’t know me my whole life. When studying for boards two years ago I had a bad relapse, and it’s been bad ever since.

This read was digestible, quick, reasonable, and so so validating. This is not something that will just go away, it’s not something I can control, and it doesn’t make me a bad person with no self-control. I have already seen improvements and I highly recommend for anyone who struggles w skin picking or hair pulling.

[Teagan Stewart · Rating 5 out of 5]

As someone who has a BFRB (picking lip), this book is a godsend and one in a million. I have never had this problem taken seriously or heard of clinicians or psychologists really understanding that it is much deeper than a bad habit.

Reading this book at the same time as starting therapy for this is the perfect pairing. I feel understood, empowered, and hopeful by learning I'm not alone and it is something I can overcome with the right kinds of interventions. Hopefully this book will make its way to everyone who needs it!

P.S. I wish the audiobook had a way for me to access the exercises and examples it references in the back.

[Tiffany Clark · Rating 5 out of 5]

A Wonderful Gift

I found this book as a recommendation on a forum when I was looking up, “How can I stop picking off the dead ends of my hair.” I was so surprised in the opening of the book how it connected with my experience. I never thought anyone else did the things I did. It was comforting to know I wasn’t alone. This book was so informative and has already helped me so much. If you want to stop pick at your skin or pulling and breaking your hair, this is the book to read.

[Sylwia]

As a person with OCD who skin picks, I appreciated some of it and it did make a significant positive difference in my life, but I'm not wild about it and I think there might be better ones out there? Idk. I'm still reading it very slowly. Maybe I'll change my review later. Also, can we get an audiobook?? PLEASE.

[hope h. · Rating 5 out of 5]

super helpful overview of the comb method for treating BFRBs - unsurprisingly a bit dry and dense at times but overall really accessible! as someone who had no prior knowledge of this treatment method, i came away from it feeling like i understood the steps well and had the knowledge and resources to do further research.

[meliss · Rating 5 out of 5]

Very encouraging, eye opening and useful book. I learned a lot of things I can put into practice and more importantly I feel seen and understood in my skin picking and hair pulling in a way I hadn’t before.
Well researched and well organized… I’m glad to have this resource to guide me moving forward

[Ellen · Rating 5 out of 5]

I highly recommend this book for anyone dealing with a body-focused repetitive behavior such as skin picking or hair pulling. A very useful resource with printable forms and information available free on the publisher’s website.

[Jill · Rating 5 out of 5]

I have been pulling my hair out for, I'm embarrassed to say, at least 15 years. The worksheets are great and it gives you so many ways to try to fix these behaviors. I recommend this book to anyone who wants to not be a slave to these bad habits.

[Melody · Rating 5 out of 5]

I read this as one of my kiddos is a skin picker. We've started working through some of the forms in this book and are slowly developing a plan. I'm hopeful. I borrowed this from the library but will be buying a copy in hopes that my kid will read it on their own too.

[Jessica · Rating 5 out of 5]

Helpful book! My cuticles look better already.

[Liz · Rating 4 out of 5]

This book is an extremely friendly, readable, and helpful guide in walking readers through the creation of a personalized plan to address BFRB's and improve their physical and mental health. If you struggle in this area too, I would really recommend it.

[Cara · Rating 5 out of 5]

I FELT SO SEEN and EMPOWERED! [This review contains more personal stuff than actual things about the book, but I wanted to get it all out there!] So glad I pushed myself to read this! While its content is great, it's not exactly my kind of pleasurable escapism book, so I decided to use Christmas day to double down. I've been struggling with a skin picking disorder for 16-17 years - over half my life. It's mostly picking of acne and the dry skin left behind from old acne wounds I created, but mosquito bite scabs or other scabs are fair game. I am going to be starting a new job soon that will have me working remotely for an unknown amount of time and moving at some point. Stress and being alone are big triggers for my picking and now that I'll be working from home, it'll be easier to slip into the bathroom and pick when feeling anxious. I think it's a critical time for me to really start working on interventions to help! Over the years it has caused me to feel immense amounts of shame, lack of confidence, avoiding eye contact, less willing to swim for fear of make-up coming off, avoiding the hairdresser because of scabs in my scalp, feeling undesirable with a partner, and frequent trips to the bathroom at work after noticing blood on my fingertips. I purchased a keen HabitAware wristband to help about a year or so ago but haven't been wearing it diligently, though after reading this book, I will make a serious effort with it.

The authors discuss how often people assume that such a behavior is a bad habit that can be overcome with willpower. I've gone through phases of being so upset with myself for not being able to just stop. But as this book explains, I have practiced these scanning and picking behaviors for untold hours across 16 years or so. That many years of doing a behavior creates an automatic response. It's become so ingrained that even when I'm aware of what I'm doing, I find it nearly impossible to stop. The book repeats these things a lot, but it really helped me to feel less judgmental with myself and less alone. Over the years, I've been on SO many treatments for acne: oral and topical sulfonamides in high school, oral clindamycin or other antibiotics in college, Accutane in grad school, Curology in my postdoc, and countless over-the-counter options. While Accutane cleared things up for a year or two and I don't often have cystic acne anymore, as soon as small acne came back, the picking began immediately. My mom often says, well if we get rid of your acne, then the problem is solved! Well actually, it won't be and it's not the root cause of the problem!! I grew up watching my Dad scan and pick his skin and my Mom also has some motor fixations with feeling specific fabrics, so the nature and nurture cards have been stacked against me! None of my dermatologists told me I had excoriation/dermatillomania/skin picking disorder. Not a single one gave me a questionnaire or anything. I only found out what I was struggling with through google searches and I think found out about this book by following #skinpicking on instagram.

My favorite part about the book were the shared stories of people and examples for how they monitored their behavior and followed through with interventions. To begin a comprehensive behavior program (ComB), the authors want you to monitor yourself for a few days and jot down what you notice when you have an episode (they provide worksheets online). Then make a master list of interventions and create an action plan! While becoming aware and creating your plan, they introduce the SCAMP acronym which stands for Sensory, Cognitive, Affective, Motor, and Place domains and have a chapter dedicated to each. For me, a sensory stimulus that triggers picking would be seeing or feeling rough skin or acne. Cognitive for me is the thought that if I squeeze that zit, it'll make everything better. The Affective domain deals with the emotions that can cause you to engage in your behavior, such as anxiety or boredom. Motor would be physical movements that are involved in picking - I often scan my skin with my fingertips while reading and this triggers picking when I find something unsmooth. The Place domain involves spaces where you are more vulnerable to initiate picking, like a bathroom with a mirror and bright lights. I removed the mirror lightbulbs in my bathroom after reading about that intervention!! :D They also suggest that if you use implements like tweezers - I've started doing this more recently - you can put them in another room or put them in a baggy of water and freeze them! I think I'm going to do the freezing technique. For cognitive and affective interventions, you can practice deep breathing and leaving notes on mirrors to read. I also bought myself some lace gloves to wear to help stop picking while reading and I'm so excited for them to come in! Overall they suggest having an intervention for 3 different domains at a time. They also are incredibly honest that setbacks are likely to happen and be prepared for them. I'm excited to start making my master plan and gain some control back!

[Claire (find me on Storygraph) · Rating 5 out of 5]

Incredibly helpful.

[Chet Taranowski · Rating 5 out of 5]

A truly excellent CBT-based self-help guide about this challenging problem