If you are sheltering in place, working from home, homeschooling, or socially distancing, you are probably navigating new triggers for your Trichotillomania and Excoriation disorder. I have helped clients through Body Focused Repetitive Behaviors (BFRBs) for almost 10 years and am amazed at the creativity of my clients in what they are trying and is working well for many of them! With new circumstances and triggers comes new sets of strategies.

MOVE YOUR BODY!

This is not just a walk a day or a video exercise. Throughout the day move around. Between Zoom calls do a few yoga poses. Walk a lap in between tasks. If you notice a pattern of how long before urges or habitual picking or pulling starts, set a reminder to start some big movement before that time. Get various muscle groups involved. Bend and hang so your inner ear (vestibular system) gets some stimulation. It doesn’t have to be a workout. Just engage, get some pressure on different joints, and wake up parts that have lost flow. The rag doll yoga pose is easy, releases tension, allows for swaying and shaking out your muscles and connectors and your body will thank you for it.

The “Jane Fonda” Technique

This is more movement, but specific to your BFRB. Sitting on your hands, making fists, and abruptly yanking your hand down away from where you pull or pick creating more tension. Your body has learned a soothing flow and movement completion can create so much relief! Of course, we don’t want to temp the “trichser” either. So how it works is to notice the repetitive flow of your hand/arm/posture as it goes toward the skin or hair that you most communing pick at. BUT, instead of stopping you PUSH your open hand past that spot and continue that momentum in an exaggerated movement away from your body, up and down back to your sides.

You may do this fast or slow, whatever feels right for you. This new movement is incompatible with actual BFRBs. I came up with this name because the motions start to look and feel like the 1980’s Jane Fonda aerobics videos. No, I don’t have permission to use her name. Hopefully, if discovered it is seen as flattery and that it feels good how many are benefiting from this idea. Luckily, in quarantine you can Jane Fonda all day long without your cube mates asking questions.

Wear your Mask where you Pick

This is for some people, those who benefit from the barrier of the mask for automatic picking at face, lips, mouth, or pulling nose hairs. With the skin protected the wandering hand does little harm and is often reminded to go back to the intended task at hand. Of course, if your mask is irritating, this may backfire, so use your own wisdom. There are many paths to recovery.

Joint Compression

Put a hand on each side of the joint and gently squeeze your hands towards each other. A Partner may do this to you as well. For arms you can apply pressure by putting weight on the hand or fist. Such as trying to do pushups on the wall, as if you were trying to push the wall over. Place your feet back a few feet to increase challenge. Press slow and keep breathing! Sometimes less is more; play with less effort and see how that helps you ground and feel more comfortable in your body.

Door Way Stretches

I have noticed a nearly universal posture linked to when my clients pick or pull. They are almost always leaning off center and hunched at the top and base of the spine. This is also known as the “shame posture.” There is already so much know about the benefits of good posture, but it’s a hard habit to create. To begin anew and thwart this old habit, throughout the day, stretch out the other way, slow and deep. Try this stretch: Stand in a doorway with your Forearms on a doorframe on each side of your body. Lunge through to open up so much of that over the keyboard slouch.

Sit Up, Arch back

When you are actively trying to manage urges, stretch your body up into a tall ballerina posture or even an exaggerated superhero arch. This is especially helpful when sitting on the toilet, home alone your coworkers don’t know how long you’ve been in the bathroom. The “bikini area” is one of the most common sites for pulling hair and picking skin from ingrown hairs.

Make Growling Noises and Funny Faces

Pretty much as it sounds. Much like the “Om” in yoga, play with an outward pressured sound like “voo” or anything resembling a growl. Make it a mediation and feel the vibrations throughout your body and the breath shift. Play with various and let yourself get silly! It is thought that this helps release “fight mode” in the brain. Even if not, it’s a good laugh and distraction.

Sticky Barriers

Honey, Olive Oil, Coconut oil, and other “masques” do not only soothe the tender scalp and irritated skin, but it will also make that area much less desirable to pull from or pick at. Even with online video meetings, you can really pile on gooey barriers the back of your head before it is noticeable to the computer screen during a video conference.

Radical Acceptance

This is a tricky one and a mindfulness concept Tara Brach teaches about in depth. It includes making peace with, of course not actually liking, the worst-case scenario you are fearing. Radical acceptance is about acknowledging. Once you name it and acknowledge it, you can channel your energy and focus on creating the change you wish for next or grieving what is truly over. This is not about passivity or defeat or weakness. It takes great courage and noticing the pain felt is part of the process, without drowning in the misery or discomfort.

Creating doubt in Catastrophe Thoughts

Yes, your worst-case fear might happen. There, I said it. AND there is a fair possibility that part of the scenario will turn out better or differently. Try to come up with 4 alternate conclusions with reasonable likeliness, from not as bad to totally fine or even positive. Example: Someone may have declined a video call because they hate you for that thing you said last time. Or maybe they are so maxed out with zoom meetings all day that they can’t bare another moment of screens. Or maybe they left their phone and are enjoying a walk. This helps us bare the unknown with more ease.

“What is Real Now”

Ask yourself what IS known right now. What IS happening right here and right now. What can I do right now, just the next step, toward meeting the needs of my self and my family? With so much unknown in the world around us and what the next few weeks or months may look like, our tendency to create a sense of safety by having a plan can backfire. With trusted resources or simply what is seen in your own space, focus on what is in your control.

Wandering Mind is Wandering Hands

If you are struggling to focus and find yourself starting to space out or reading the same thing over and over again, it’s time for a break and to use the healthy strategy to focus. Maybe you’re bored or hungry? Maybe you need help to understand how to take the next step? Maybe it’s been too long of a day and your body is done. When your mind wanders, you aren’t working anyway, but are VERY likely to pick your skin or start pulling out hairs in unconscious effort to override your system and force some more focused time.

Parts of Self

I see so much picking and pulling when a client is in limbo struggling to reconcile an inner conflict. Maybe a major dilemma. Usually an everyday life decision such as to lay down or take a walk. To exercise or to clean. To procrastinate or “adulting.” Imagine 2 or more separate parts of yourself each invested in their side of the dilemma. Let them express themselves and help meet their authentic needs. Parts that you may be frustrated with are likely trying to serve a vulnerable part of you.

Stop ‘Shoulding’ on Yourself

Say it out loud, yes, exactly as it sounds. The word ‘should’ is used to motivate yourself to “adult” or be well but all it does is keep us stuck and make us feel guilty for what we aren’t doing. There are many alternatives to the word should that have more innate self compassion and effective motivation. And at times, it simply changes to “I won’t today.” If you aren’t going to do it, suffering won’t make it better. Maybe “I want to…” or “I could choose to…”

“It’s just the toaster”

See this article to explain this metaphor that brings insight and mindfulness into your brain throwing you off your balance.

Challenge your Narrative

That voice in your head is not always inner wisdom. Sometimes it is internalized messages from childhood or old survival strategies that no longer serve your adult well self.  It helps to hear them out loud or write them out. They make sense in your head like a weird dream makes sense while asleep.

Tedious Task

Indulge in a jigsaw puzzle or something that has a similar function as your BFRB, where your hands scan something, fix something, you get to intensely look closely and tunnel in. Beading jewelry, cross stitch what you really want to say, pick the pills off your favorite leggings, scrape label sticker goo off glass and book covers. Personally, I have taken to slowly pulling weeds out of the lawn. Not a true chore, just bit by bit “removing the flaws.” See how that is like pulling the bad hair or “fixing” a clogged poor via picking, yet without it being on your body. No, it’s not the same, but channeling it somewhere else for your greater goals.

Trich as a Well-Meaning Messenger

Trichotillomania and Excoriation urges are rarely trying to actually hurt us. Under the urge is usually some unmet need. Metaphor: think of each urge as Lassie. Yes, the dog who barked and people heard a more important alerting to how help was needed. When your inner trichster barks, “Pick! Pull! Bite!” Pause with curiosity to mindfully consider what help you may need. In time you’ll get better at interpretation of these barks. Hints: What does your body need? What relationship tension may be lingering? What emotion are you not wanting to feel right now that may need nurturing?

Be kind to yourself, go easy, this is a learning curve we are all on. It’s ok to be doing better and worse at the same time or oscillate like a fan from ok and not. It’s a long-game played a moment at a time. Find your authentic needs, deep down, and try to nurture those parts. You don’t have to do it alone. And you are not broken or less than because of your BFRB. Even if you set aside recovery goals and work on higher priorities right now, it is ok.  Groups are still meeting online at Courage Counseling to remind you of this.

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Please check your judgement. This is a very vulnerable time. Before you judge someone, act out and/or make accusations, know that

judgmental attitudes and thoughts come from avoiding your own vulnerability. Before you just in to “help” in a harsh and shaming way, please consider other possibilities of how they may be doing the best they can, despite it being below your standards and capabilities. The list below is for your consideration of how you may show more kindness to others.

1. If someone isn’t Wearing a Mask: They may have PTSD triggered by covering their mouth. Wearing a mask may completely render them unable to function, thrown instantly into flashbacks or panic attacks when a mask is put on.

2. If a person Passes or Stands Too Close: First, do you know how far 6-feet is? Many are assuming it is much farther than it actually is. Also, they may be neuro-divergent, thus unable to keep track of a social context. This very new boundary rule may not stick, and although informed, may keep falling out of their working memory. For many with ADHD or on the Autism spectrum (not all) staying compliant with social distancing, despite their best efforts is not much different than demanding someone in a wheelchair climb stairs.

3. If they Buy what You Think is Too Much: They may be making their single outing for a month, reducing risk of more errands. They may be buying for multiple families and at-risk persons who are unable to get out to the store. Delivery right now is unreliable and can take more than a week’s notice to plan, usually more expensive, and can require implementation that not everyone is capable of doing. This is especially if it requires technology that many do not have or are not familiar with how to use.

4. If they seem Amped up or Irritable: Maybe they are sensitive to their asthma or rhinitis medications. These medications are often steroids that when on top of anxiety or caffeine, hijack their whole nervous system. Especially sensitive persons. So, it may not be about you; they may be thinking the kindest thoughts. But their jitters, shaky hands, voice intensity or speed, or being quick to be annoyed may simply be a product of them keeping their airways open during not only this respiratory system threat but central Texas’s Oak blooming season.

5. Be Patient, Plan Ahead, give the Benefit of the Doubt: Everyone is feeling differently right now. Many are grieving. Many are disoriented leaving their homes so rarely and entering a surreal public setting. Prepare in a way so you feel like you’re in a hurry.

6. Set Boundaries with Tact: Assertiveness and Compassion can coexist. Practice being clear and concise without being harsh. We are learning together and from each other.

7. Visit your own Vulnerability: When you are judgmental of others, it usually means there is some vulnerable emotion that you are avoiding. Maybe you know it’s there, maybe it’s so, very well hidden. I am not asking you to drown in this emotion or runaway with an unpleasant thought. Visit it. Sit with it for a moment. Let it percolate with a soft lens while taking a daily walk. Name it. Identify the message within this feeling. Admit to yourself what you may be fearing or grieving. Find healthy ways to flow through this vulnerability, share it with someone you trust, and nurture yourself the way you would a dear loved one.

Be Kind. To other others and yourself.  We are physically distanced, but not socially disconnected. Get support. Be support if you have bandwidth. Our well-meaning survival brain can interrupt this sometimes. Courage Counseling is still offering telehealth services, so please don’t hesitate to reach out if I can be of support to you.

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Psychotherapy is still considered both medical and essential. Of course discretion and minimization of face to face contact is still recommended.

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Courage Counseling is moving right after Thanksgiving. Don’t worry, we aren’t going far! We will be in the same building, just a new suite upstairs. To get there, look for the stairwell closest to the front door of my current (soon to be former) suite #102. Take those stairs to the very top, turning left at the top, and you will arrive at #303, my new office.

The new address effective November 29, 2015:

3625 Manchaca Road, #303

Austin, TX 78704

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Less frequent than alternating week sessions can become problematic. We end up spending more time getting caught up on events since the last session than making progress on your goals. Times when less frequent attendance works is when tapering off counseling once goals are met, to make sure progress is maintained instead of sliding into old patterns and habits. Also, occasional check in sessions when on a sabbatical from counseling can help stay connected with the counseling process until ready to return to progress.

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