Common BFRBs

Trichotillomania:

Trichotillomania is known as hair pulling disorder and is characterized by the behavior of pulling one’s hair. Examples include scalp hair, eyelashes, eyebrows, arm/leg hair, pubic hair, chest hair, and facial hair. People suffering from trichotillomania may experience significant hair loss and overall impairment due to the severity of their pulling.

Excoriation:

Excoriation disorder is known as skin picking disorder or dermatillomania. This disorder consists of repetitive behaviors centered around repetitive skin picking including touching, rubbing, scratching, and digging in the skin. This disorder can be debilitating to those suffering as it can cause damage to issues, discoloration of skin, and scarring.

Onychophagia:

Onychophagia is known as nail-biting and consists of habitual biting of fingernails. Nail biting commonly occurs in childhood and can develop into severity resulting in permanent damage tonails and skin.

Cheek Biting:

Cheek Biting is also known as “cheek chewing” and can create many complications such as redness, painful sores, and tears. In some cases when repetitive biting occurs, the lining of the cheek may feel irregular which can make the individual continue to bite to try and create a smooth surface.

Treatment at ***Calm*OCD**

At CalmOCD our clinicians are trained in a therapy approach called Comprehensive Behavioral Treatment (ComB) treatment to treat body-focused repetitive behaviors. The clinician works collaboratively with the patient, to identify and change relationships with BFRB triggers while addressing the variables that are maintaining the behaviors. Treatment includes a wide variety of techniques drawn from behavioral, cognitive, and CBT treatment modalities. Those suffering from BFRBs all their own very unique experiences with the disorder. Because of this, treatment is tailored to the individual's needs and is viewed as a creative and fluid process rather than a set of rigid treatment guidelines. ComB treatment addresses the complexities of treating BFRBs and helps to develop treatment fitting uniquely to the individual.

Phases of Treatment

Phase 1

Assessment (Functional Analysis): During this phase in treatment, the clinician will spend time understanding the factors that foster and maintain the BFRB in the individual. Behavioral, emotional, cognitive, and sensory variables will be explored in this phase. ComB uses a behavioral framework to identify which antecedents (A) make the behaviors more likely to occur, which behaviors (B) constitute the actual action of the pulling or picking, and the consequences (C) that make the behaviors more likely to continue to occur. Five domains are explored during this phase: Sensory (sensations), Cognitive (thoughts), Affective (emotions), Motor (Behaviors), and Place (environment).

Phase 2

Identification and Selection of Target Domains: During this phase an individualized plan is developed to try and interrupt problematic behaviors while implementing new healthier alternatives. These methods are developed using the five domains mentioned above. The therapist and patient work together to understand how the antecedents and consequences are linked and how to identify specific targets contributing to the problem behaviors.

Phase 3

Implementation of Specific Interventions: Patients will explore a variety of specific interventions used to decrease their BFRB symptoms. Interventions are chosen based on the information collected in Phase 1 and Phase 2. Many interventions include behavioral and cognitive strategies while also implementing sensory components. Having the patient develop new sensory substitution techniques will be a key part of treatment. When potentially helpful interventions have been identified the patient will try out several outside of the session. For example, someone that may pull or pick during driving may wear gloves while driving (stimulus control, response prevention), listen to relaxing music (sensory distraction), do breathing exercises (controlled breathing), and keep hands on the steering wheel (competing response). The usefulness of the techniques will be assessed when the patient returns to their next session. At this time, the patient and therapist can determine what was successful and what was not, and what they can modify to maximize control of their BFRB.

Phase 4

Evaluation, Termination, and Relapse Prevention: In the final phase, the patient continues to assess for progress and modify interventions when needed. The patient begins to self-manage their symptoms by utilizing the skills used in their treatment. The focus moves to maintenance and preparing for setbacks that can occur during recovery. Relapse prevention planning occurs so the patient feels confident in navigating their symptoms independently.

What Is Body Dysmorphic Disorder?

Body dysmorphic disorder (BDD) is a mental health condition in which individuals have a preoccupation with one or more areas of their appearance they perceive as defective.

Those struggling with BDD spend a great deal of time camouflaging their appearance, avoiding the outside world, mentally reviewing, ruminating, and seeking reassurance due to high levels of anxiety and depression. BDD causes significant impairment within the individual as they search for any methods that offer relief.

BDD is often misdiagnosed and under-diagnosed as the cause and symptomatology behind it are still greatly misunderstood. The disorder has similarities to eating disorders and obsessive-compulsive disorder.

Common Symptoms Include:

Extreme preoccupation with a body part or aspect of appearance that to others seems minor or is not visible

Belief this defect makes them deformed and unattractive

Belief others are staring, paying attention, and thinking negatively about this body part or aspect of appearance

Like obsessive-compulsive behaviors, those who struggle with BDD engage in behaviors in an attempt to reduce distress (avoiding, checking, reassurance seeking, grooming, skin picking, hair pulling, seeking out cosmetic procedures, wearing makeup or clothes to camouflage perceived flaws, and many more.

Often these individuals do not leave their homes and are unable to attend school or work

ANY area of the body can be perceived as a defect, but primary areas include- the nose, ears, hairline, wrinkles, hair texture and appearance, skin and veins, breast size, muscle size, and genitalia

**Treatment for Body Dysmorphic Disorder at CalmOCD:**

Currently, evidence-based treatment for BDD includes medication and psychotherapy. At CalmOCD we offer a combination of approaches to help those suffering from BDD.

Cognitive Behavior Therapy:

CBT is a psychological treatment found to be effective in treating many mental health disorders, including body dysmorphic disorder. CBT for BDD begins with the therapist conducting an in-depth assessment and providing psychoeducation on BDD. Cognitive behavior therapy involves helping the individual identify their current cognitions and work through unhealthy thought patterns that are leading to avoidance and ritualistic behaviors. Through cognitive work the individual starts to understand their safety behaviors are not keeping them safe, they are instead creating a larger problem. The avoidant behaviors reduce painful feelings temporarily; however, they negatively reinforce the disorder and maintain their belief system and unhealthy coping skills.

Acceptance and Commitment Therapy:

ACT assists those with BDD in increasing psychological flexibility, helping patients enter the present moment in a meaningful way and either alter or continue a behavior while moving in connection to a person’s values. ACT helps to alter functions of private experiences that are keeping people entangled such as their thoughts, feelings, memories, or bodily reactions. ACT can be a very powerful tool for those suffering from BDD as it assists individuals suffering to develop a different relationship with their thoughts and feelings. Instead of engaging in avoidance and ritualistic behaviors when they feel emotions, they can embrace uncomfortable emotions and move in alignment with those things that are important to them. By choosing action, those suffering from BDD learn the behaviors keeping them ‘safe’ only lead to depression while the behaviors that move them closer to their values lead to freedom.

WHAT TO EXPECT

At CalmOCD, the therapist will work with the patient as a team to develop a deep understanding of their struggles and barriers preventing them from feeling better.

Mindfulness Based Therapy:

MBT assists those suffering from BDD by helping them practice being present without passing judgment. Those with BDD are constantly judging themselves and feel others are as well. Learning to incorporate noticing without judgment can serve as another tool for those struggling. Mindfulness-based interventions help BDD sufferers have internal experiences without viewing them as inherently wrong or bad.

Dialectical Behavioral Therapy:

DBT is a psychological treatment that is helpful for those suffering from BDD. The treatment focuses on distress tolerance, emotional regulation, interpersonal effectiveness, and mindfulness. The ‘dialectic’ in dialectical behavior therapy acknowledges life is complex and continuously aimed at balancing the existence of two opposites. First, acceptance of their experiences and behaviors as valid, and second, the ability to change and manage these emotions and behaviors.

Exposure and Ritual Prevention:

(E/RP) At CalmOCD, before implementing any exposure and ritual prevention, the therapist will build a strong foundation of skills with the models discussed above (Cognitive behavior therapy, Acceptance and Commitment Therapy, Mindfulness-Based Therapy, and Dialectical Behavioral Therapy). The therapist will help the client develop an understanding of all the behaviors that are reinforcing their fears. Examples include (excessive mirror use, avoidance behaviors, checking rituals, reassurance seeking, doctors’ appointments, and more). Once a full analysis is completed the therapist helps the client reduce these safety behaviors through exposure and ritual prevention. The goal of E/RP is to help patients practice tolerating distress and learn new information to help evaluate beliefs.

Perceptual Retraining:

Those struggling with BDD often have complex relationships with mirrors and reflective surfaces. Some individuals may spend too much time with mirrors while others may avoid mirrors. Those using mirrors most commonly focus on the area of concern and will zoom in closely to the mirror to magnify imperfections which tends to reinforce their belief system. During their time in front of the mirror, BDD sufferers tend to be extremely critical of themselves and may automatically start judging themselves. Perceptual retraining helps those with BDD engage in healthier interactions with mirrors. This may include a therapist helping guide the patient in describing their body without using judgmental language and more objectively. The therapist helps the patient refrain from their safety behaviors during this experience and assigns exposures for the client to do on their own. Through this training, the patient is encouraged to have experiences where they are present and focus on other areas in their environment as opposed to just their appearance.

Treatment at ***Calm*OCD**

At CalmOCD we treat Generalized Anxiety Disorder with a combination of therapeutic approaches. Cognitive Behavioral Therapy (CBT) is used to treatment GAD and helps patients understand how their thinking patterns, behaviors, and reactions impact their overall functioning. This type of treatment helps the patient gain insight into their anxiety symptoms and what current behaviors are making them worse and alternative ways to process anxiety triggers. Exposure Therapy is another treatment modality used to treat GAD. Exposure therapy helps anxiety sufferers confront the fears and worries that are holding them back in their daily life. Exposure therapy incorporates helping the patient to reduce safety behaviors.

Typically, the anxiety sufferer is participating in behaviors to ‘stay safe.’ However, when the patient relies on internal or external safety behaviors to help maintain safety and manage their anxiety this is communicating to the brain there is a problem when there is not one. Acceptance and Commitment Therapy (ACT) helps individuals fully embrace the wide range of emotions and experiences they encounter. The goal is to help the patient develop greater psychological flexibility rather than working to eliminate or suppress their struggles and experiences. Mindfulness-Based Therapy can assist GAD sufferers in bringing awareness to what they are directly experiencing in the present moment and not what has occurred in the past or could occur in the future. Through bringing awareness to the present moment with one’s senses for example, the brain can focus on the inner workings of ones mental, emotional, and physical processes.

Treatment at ***Calm*OCD**

At CalmOCD we treat Social Anxiety Disorder with a combination of therapeutic approaches. Cognitive Behavioral Therapy (CBT) is used to treatment social anxiety and helps patients understand how their thinking patterns, behaviors, and reactions impact their overall functioning. This type of treatment helps the patient gain insight into their anxiety symptoms and what current behaviors are making them worse and alternative ways to process anxiety triggers. Exposure Therapy is another treatment modality used to treat social anxiety. Exposure therapy helps anxiety sufferers confront the fears and worries that are holding them back in their daily life. Exposure therapy incorporates helping the patient to reduce safety behaviors.

Typically, the anxiety sufferer is participating in behaviors to ‘stay safe.’ However, when the patient relies on internal or external safety behaviors to help maintain safety and manage their anxiety this is communicating to the brain there is a problem when there is not one. Acceptance and Commitment Therapy (ACT) helps individuals fully embrace the wide range of emotions and experiences they encounter. The goal is to help the patient develop greater psychological flexibility rather than working to eliminate or suppress their struggles and experiences. Mindfulness-Based Therapy can assist social anxiety sufferers in bringing awareness to what they are experiencing in the present moment and not what has occurred in the past or could occur in the future. Through bringing awareness to the present moment with one’s senses for example, the brain can focus on the inner workings of ones mental, emotional, and physical processes.

Treatment at ***Calm*OCD**

At CalmOCD we treat Panic Disorder with a combination of therapeutic approaches. Cognitive Behavioral Therapy (CBT) is used to treatment panic disorder and helps patients understand how their thinking patterns, behaviors, and reactions impact their overall functioning. This type of treatment helps the patient gain insight into their anxiety symptoms and what current behaviors are making them worse and alternative ways to process anxiety triggers. Exposure Therapy is another treatment modality used to treat panic disorder. Exposure therapy helps anxiety sufferers confront the fears and worries that are holding them back in their daily life. Exposure therapy incorporates helping the patient to reduce safety behaviors.

Typically, the anxiety sufferer is participating in behaviors to ‘stay safe.’ However, when the patient relies on internal or external safety behaviors to help maintain safety and manage their anxiety this is communicating to the brain there is a problem when there is not one. Acceptance and Commitment Therapy (ACT) helps individuals fully embrace the wide range of emotions and experiences they encounter. The goal is to help the patient develop greater psychological flexibility rather than working to eliminate or suppress their struggles and experiences. Mindfulness-Based Therapy can assist panic disorder sufferers in bringing awareness to what they are directly experiencing in the present moment and not what has occurred in the past or could occur in the future. Through bringing awareness to the present moment with one’s senses for example, the brain can focus on the inner workings of ones mental, emotional, and physical processes.

Treatment at ***Calm*OCD**

At CalmOCD we treat Phobias with a combination of therapeutic approaches. Cognitive Behavioral Therapy (CBT) is used in the treatment of phobias and helps patients understand how their thinking patterns, behaviors, and reactions impact their overall functioning. This type of treatment helps the patient gain insight into their anxiety symptoms and what current behaviors are making them worse and alternative ways to process anxiety triggers. Exposure Therapy is another treatment modality used to treat phobias. Exposure therapy helps anxiety sufferers confront the fears and worries that are holding them back in their daily life. Exposure therapy incorporates helping the patient to reduce safety behaviors.

Typically, the anxiety sufferer is participating in behaviors to ‘stay safe.’ However, when the patient relies on internal or external safety behaviors to help maintain safety and manage their anxiety this is communicating to the brain there is a problem when there is not one. Acceptance and Commitment Therapy (ACT) helps individuals fully embrace the wide range of emotions and experiences they encounter. The goal is to help the patient develop greater psychological flexibility rather than working to eliminate or suppress their struggles and experiences. Mindfullness-Based Therapy can assist those struggling with phobias in bringing awareness to what they are directly experiencing in the present moment and not what has occurred in the past or could occur in the future. Through bringing awareness to the present moment with one’s senses for example, the brain can focus on the inner workings of ones mental, emotional, and physical processes.

Treatment at ***Calm*OCD**

At CalmOCD we treat misophonia with a combination of therapeutic approaches. Cognitive Behavioral Therapy (CBT) is used in the treatment of Misophonia and helps patients understand how their thinking patterns, behaviors, and reactions impact their overall functioning. This type of treatment helps the patient gain insight into their anxiety symptoms and what current behaviors are making them worse and alternative ways to process anxiety triggers. Dialectical Behavioral Therapy (DBT) is a type of CBT that is also helpful in the treatment of Misophonia. The patient learns distress tolerance skills when their body is triggered by a misophonic sound or physical trigger. The individual learns to implement distraction and self-soothing skills when triggered. They will also learn progressive muscle relaxation to help with overall muscle tension and when identifying their automatic physical reflex to their trigger.

After CBT and DBT skills are implemented, slight and gradual Exposure Therapy is used. Exposure therapy helps misophonia sufferers confront the triggers that are holding them back in their daily lives. They will learn to reduce their safety behaviors and learn they can in fact tolerate the sounds their brain reports to be triggering. Acceptance and Commitment Therapy (ACT) helps individuals fully embrace the wide range of emotions and experiences they encounter. The goal is to help the patient develop greater psychological flexibility rather than working to eliminate or suppress their struggles and experiences. Mindfulness-Based Therapy can assist those struggling with misophonias in bringing awareness to what they are directly experiencing in the present moment and not what has occurred in the past or could occur in the future. Through bringing awareness to the present moment with one’s senses for example, the brain can focus on the inner workings of ones mental, emotional, and physical processes.

Treatment at ***Calm*OCD**

At CalmOCD it is very common for us to see patients struggling with an anxiety disorder as well as meeting the criteria for a depressive disorder. Cognitive Behavioral Therapy (CBT) is used in the treatment of depression and helps patients understand how their thinking patterns, behaviors, and reactions impact their overall functioning. CBT can help patients manage and modify their distorted thoughts and find new healthier alternative ways of thinking. In addition, CBT helps patients assess external situations more accurately and monitor their reactions and emotions. Acceptance and Commitment Therapy (ACT) helps individuals fully embrace the wide range of emotions and experiences they encounter.

What is an School Anxiety?

School anxiety is characterized by excessive worry, fear, and resistance about school and related activities.

School anxiety is often not limited to a specific test or project but is seen surrounding any element of schoolwork including heading off to school, completing homework, leaving the home, going to sleep the night before school, and identifying minor issues at school as significant. Children will often say they can’t go to school, feel sick, have a headache or stomach ache, feel they don’t have friends at school, or aren’t prepared for school.

What is an School Anxiety?

School anxiety is characterized by excessive worry, fear, and resistance about school and related activities.

Who does School Anxiety impact?

School anxiety impacts children of all ages, races, ethnicities, and learning differences.

For some, school anxiety can become so severe that it prevents a child from going to school all together, transition to online school, or withdrawal from their education.

What causes School Anxiety?

School anxiety can develop in children who have experienced...

School Bullying

Social Anxiety

Performance Anxiety

Separation Anxiety

Ongoing Chronic Illness

Experienced Trauma

When is School Anxiety an Anxiety Disorder?

School anxiety is appropriately treated as an anxiety disorder when its symptoms are caused by experiences based upon poor past experiences and linked to specific triggering events. For example, if a student was bullied during the previous school day, it makes sense that a child might not want to return to school the next day. If a child is fearful of giving presentations in class, it makes sense that they might have a stomach ache the night before a big speech. Once these symptoms begin impacting a child’s ability to fully participate, treatment through therapy is needed.

When is School Anxiety a part of Obsessive Compulsive Disorder?

Often overlooked, school anxiety may better be categorized as a subtype of obsessive compulsive disorder. Obsessive compulsive disorder is defined as a fear or doubt, called an obsession, that creates anxiety causing one to do something in response, called a compulsion. When someone has obsessive compulsive disorder, their fears are rarely limited to only one area but instead can be seen in various parts of their life.

For example, a child may have a fear of their parents dying. Instead of only being fearful of going to school, your child may also want you to always do a special handshake before you leave the house, promise you will pick them up, ask what time you will be back, have a ritualized bedtime routine to keep you safe, and other compulsions.

Another example may be a child having a fear of social rejection. Instead of only being fearful to go to school, the child may want to talk through social situations with you each day to seek reassurance they didn’t do anything wrong, avoid social interactions in which they might do something they perceive as wrong, not participate in sports or clubs, double check with friends to make sure they still like the child, or avoid wanting to share their own opinions out of fear they will be different from others.

What does treatment look like for School Anxiety at CalmOCD?

Treatment for school anxiety focuses on doing the opposite of what most naturally do when a child feels anxious. The most common response when a child feels scared is to help remove the scary experience and reassure them that everything will be okay. This is not helpful for the treatment of anxiety because it continues to make the child feel like anxiety is something to be feared.

Treatment at CalmOCD focuses on supporting the child to re-engage in all parts of the learning experience. We will provide education to help understand how avoidance actually makes anxiety worse, and we will begin avoiding more and more things in response. Together, we make a personalized plan to best suit your child in successfully taking steps to return to school and confidently become a student again.

Family participation for School Anxiety

‍Family participation in treatment for a child with school anxiety and refusal is critical.

Family participation in treatment for a child with school anxiety and refusal is critical. CalmOCD provides visits in your home and school to support your child, but as parents, you are the most vital part of your child’s successful return. We take parents through the Supportive Parenting for Anxious Childhood Emotions (SPACE) curriculum to help you learn how to support your child while no longer supporting their anxiety.

HOME VISITS

Home visits can occur in the morning before school, during the day if your child does not make it to school, or after school.

These visits are focused on reducing the accommodation behavior in the environment it occurs. For example, we help your child use the skills they have learned in treatment during their time of high anxiety to ensure they are able to successfully attend the school day.

SCHOOL INVOLVEMENT

School involvement often involves a meeting with your child’s school support team that may include the teacher, social worker, counselor, nurse, or any other professionals that work closely with your child.

During this meeting, we discuss helpful ways to support your child when they are experiencing anxiety that do not include accommodating the anxious behavior. If a meeting is not able to occur, we have these conversations with parents for them to communicate with the school. We also go to school with the child to help with any avoidance or fleeing from school in situations where it is appropriate.

School Anxiety

School Anxiety

Common BFRBs

Trichotillomania:

Excoriation:

Onychophagia:

Cheek Biting:

Treatment at CalmOCD

Phases of Treatment

Phase 1

Phase 2

Phase 3

Phase 4

Body dysmorphic disorder (BDD) is a mental health condition in which individuals have a preoccupation with one or more areas of their appearance they perceive as defective.

Common Symptoms Include:

Treatment for Body Dysmorphic Disorder at CalmOCD:

Cognitive Behavior Therapy:

Acceptance and Commitment Therapy:

At CalmOCD, the therapist will work with the patient as a team to develop a deep understanding of their struggles and barriers preventing them from feeling better.

Mindfulness Based Therapy:

Dialectical Behavioral Therapy:

Exposure and Ritual Prevention:

Perceptual Retraining:

Treatment at CalmOCD

Treatment at CalmOCD

Treatment at CalmOCD

Treatment at CalmOCD

Treatment at CalmOCD

Treatment at CalmOCD

What is an School Anxiety?

School anxiety is characterized by excessive worry, fear, and resistance about school and related activities.

What is an School Anxiety?

School anxiety is characterized by excessive worry, fear, and resistance about school and related activities.

Who does School Anxiety impact?

School anxiety impacts children of all ages, races, ethnicities, and learning differences.

What causes School Anxiety?

School anxiety can develop in children who have experienced...

When is School Anxiety an Anxiety Disorder?

When is School Anxiety a part of Obsessive Compulsive Disorder?

What does treatment look like for School Anxiety at CalmOCD?

Family participation for School Anxiety

‍Family participation in treatment for a child with school anxiety and refusal is critical.

HOME VISITS

Home visits can occur in the morning before school, during the day if your child does not make it to school, or after school.

SCHOOL INVOLVEMENT

School involvement often involves a meeting with your child’s school support team that may include the teacher, social worker, counselor, nurse, or any other professionals that work closely with your child.

What is PANS?

What is PANDAS?

Treatment for Pans/PANDAS at CalmOCD

Ready to Start Your Healing Journey?

Connect

Response

Intake Session

Quick Links

Resources

Contact

Our Locations

Scottsdale, AZ

Tucson, AZ

Sandy, UT

Treatment at ***Calm*OCD**

**Treatment for Body Dysmorphic Disorder at CalmOCD:**

Treatment at ***Calm*OCD**

Treatment at ***Calm*OCD**

Treatment at ***Calm*OCD**

Treatment at ***Calm*OCD**

Treatment at ***Calm*OCD**

Treatment at ***Calm*OCD**