Tag Archives: Treatment

God Help Me

Where does my help come from?

How do I heal and move forward?

Am I strong enough to overcome this?

I am going though a really hard time right now. After a while with stable moods, my bipolar disorder  is causing major issues in my life.

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My previously helpful medication and treatment plan have not worked to push this mania away. It crept up over a year ago. There have been ups and downs, but for the most part I have been hypomanic. Stress and other triggers cause it to flare up. This is the case these last few weeks. I am battling anxiety, struggling to sleep, my mind is scattered, memory disabled, and thoughts are constantly racing.  Although I try to contain them, my words keep spilling out.

I try to do what I know works. I set A schedule, try and get enough sleep, prioritize tasks, spend time with God, and avoid triggers such as caffine. If I suddenly get the urge to organize everything, I need to step back and think about my thinking. Why do I suddenly have a desire to do the chores I usually put off because I dislike them so much?

I know I need to put God first. They only way for me to get better is to rely on Him. He loves me and wants what is best for me. When my mind is scattered and I struggle to make good choices. God leads me along the right path and carries me when I am too week to walk.

God also helps me through others. My family loves and supports me. I try to listen to their advice and accept their help. Normally, I try  to do everything myself. Obviously that has not worked. I need to let go of my pride and take care of myself. I know I will come through this and be better for it. My pain serves A purpose and I will persevere!

What Comes First in Your Life?

Do you  value love most? God is love. By putting God first, everything else will fall into place. We will best love and support ourselves, our family and our friends. By choosing love, we put God first. He is a light in the darkness, our helper in the storm. If we seek Him first, He will help us and show us how to love others and how to take care of ourselves.

God loves us more than we can imagine and only wants the best for us. God does not cause bad things to happen. We live in a lost and broken world plagued with darkness. The good news is that light has overcome the darkness. This is not our home. and as the song says, “We are just taking the long way home”  (Steven Curtis Chapman-lyrics) There is something better. God sees the whole story beginning to end and He has defeated death. We only need to have faith. We can never earn His love. We are all broken in our own way. No one is perfect and God doesn’t expect us to be.

However, He knows our heart and true motives. If we honestly pursue God first and want His will for our lives, He will use all things for good. That terrible heartache, health problem, broken relationship, anxiety, depression, addiction, or other struggle give you a power you did have before. We grow through our pain and our character is strengthened in the hard times. We are overcomes. Mandisa says it best in her song Overcomer

Staring at a stop sign
Watching people drive by
T mac on the radio
Got so much on your mind
Nothing’s really going right
Looking for a ray of hope
Whatever it is you may be going through
I know he’s not gonna let it get the best of you
You’re an overcomer
Stay in the fight ’til the final round
You’re not going under
‘Cause God is holding you right now
You might be down for a moment
Feeling like it’s hopeless
That’s when he reminds you
That you’re an overcomer
You’re an overcomer
Everybody’s been down
Hit the bottom, hit the ground
Ooh, You’re not alone
Just take a breath, don’t forget
Hang on to his promises
He wants you to know
You’re an overcomer
Stay in the fight ’til the final round
You’re not going under
‘Cause God is holding you right now
You might be down for a moment
Feeling like it’s hopeless
That’s when he reminds you
That you’re an overcomer
You’re an overcomer
The same man, the great I am
The one who overcame death
Is living inside of you
So just hold tight, fix your eyes
On the one who holds your life
There’s nothing he can’t do
He’s telling you
You’re an overcomer
Stay in the fight ’til the final round
You’re not going under
‘Cause God is holding you right now
You might be down for a moment
Feeling like it’s hopeless
That’s when he reminds you
That you’re an overcomer
You’re an overcomer
You’re an overcomer
You’re an overcomer
See don’t quit, don’t give in
You’re an overcomer
Don’t quit, don’t give in
You’re an overcomer
Don’t quit, don’t give in
You’re an overcomer
You’re an overcomer
Songwriters: Benjamin Glover / Christopher E. Stevens / David Arthur Garcia

Prayer: You are Holy, Lord. Thank you for the Blood of Jesus to wash us and cleanse us from sin. As a born again believer I ask You to help me to put off these things that hinder my life from being completely surrendered to You and show me the ways to put on Christ so that I may please You. Amen.

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Persistence

I will not give up. I know I can get better; not in my strength, but through God’s strength. He is my rock and my foundation. How awesome is it that the creator of the universe loves me and cares about me more than any human can imagine. He gave me life through His son Jesus.

Jesus is my best friend. We walk together and talk together. He knows me deeper than anyone else. He knows all about my past and the worst parts of me. Yet, He still loves me and wants a relationship with me. He is there for me through every trial and I am eternally grateful. Thank you God for your unending love and grace.

I Am Human. I Need Help.

It was close to midnight when I drove into an empty mall parking lot. The sound and sight of rain is distinct in my memory. “Where are you, God?” I shouted, pain coiling itself around my heart, torment gripping my mind. “Where are you?” I sobbed again. I parked my car and began to write the truth in my journal: I am absolutely terrified. My life is completely out of control. God, I need help.

Fourteen years ago I was struggling with an eating disorder (among other things, hello). But in that parking lot, I finally pressed beyond denial and admitted to myself and to God that I had a problem I couldn’t fix. I wasn’t ready to admit the same to others, but at least the pressure of pretending began to lift.

It took a few years for me to open my pain to close friends, and for my life to actually change, but I gained a level of freedom that night as I gave myself permission to say it, to write it: I am human. I am broken. I need help.

Brokenness opens a path for obedience. Not because it’s more spiritual to be jacked up across fourteen areas of life, but because of the humility it takes to engage in an honest relationship between the Holy Spirit and us. It takes guts to say, “I don’t have it all together and I’m not going to wait until I have it all together. Jesus, I need you now. Where are you? Can you please come to me now?”

He has all wisdom. He has all power. He is at peace with our humanity, with our brokenness. He comes to us in our pain, not in our pretense. He gives grace to the humble, but he resists the proud. And the Holy Trinity is the only force able to transform our lives completely, for good.

How I hated those first few times I risked taking off my mask. How I loathed giving up control of my environment and of how others saw me. How I despised living in that grey space between who I was and who I wanted to be. Denial was so much easier – at least my coping mechanisms were familiar, and pretending I had it all together was so much better than sitting in the ugly truth.

But truth-telling started the process of freedom. I began walking wholeheartedly towards integrity. And this opened my heart to receive the truth of the word of God as well. This opened me up to a life in the Spirit.

Jesus said, “If you abide in my word, you are my disciples indeed. And you shall know the truth, and the truth shall set you free.” And when we make the simple, albeit difficult, decision to be honest with where we are, we can obey Jesus at each step of our discipleship journey, on our way to where we’re going. We tap into the power of the Holy Spirit and, by His grace, we can respond to our past with His love, remain present where we are, and look to the future with hope.

Humility in obedience is hard; but, oh, my friend, you’re worth it. Eugene Peterson, in his book, A Long Obedience in the Same Direction:

“I Am Human. I Need Help.”

It was close to midnight when I drove into an empty mall parking lot. The sound and sight of rain is distinct in my memory. “Where are you, God?” I shouted, pain coiling itself around my heart, torment gripping my mind. “Where are you?” I sobbed again. I parked my car and began to write the truth in my journal: I am absolutely terrified. My life is completely out of control. God, I need help.

Fourteen years ago I was struggling with an eating disorder (among other things, hello). But in that parking lot, I finally pressed beyond denial and admitted to myself and to God that I had a problem I couldn’t fix. I wasn’t ready to admit the same to others, but at least the pressure of pretending began to lift.

It took a few years for me to open my pain to close friends, and for my life to actually change, but I gained a level of freedom that night as I gave myself permission to say it, to write it: I am human. I am broken. I need help.

Brokenness opens a path for obedience. Not because it’s more spiritual to be jacked up across fourteen areas of life, but because of the humility it takes to engage in an honest relationship between the Holy Spirit and us. It takes guts to say, “I don’t have it all together and I’m not going to wait until I have it all together. Jesus, I need you now. Where are you? Can you please come to me now?”

He has all wisdom. He has all power. He is at peace with our humanity, with our brokenness. He comes to us in our pain, not in our pretense. He gives grace to the humble, but he resists the proud. And the Holy Trinity is the only force able to transform our lives completely, for good.

How I hated those first few times I risked taking off my mask. How I loathed giving up control of my environment and of how others saw me. How I despised living in that grey space between who I was and who I wanted to be. Denial was so much easier – at least my coping mechanisms were familiar, and pretending I had it all together was so much better than sitting in the ugly truth.

But truth-telling started the process of freedom. I began walking wholeheartedly towards integrity. And this opened my heart to receive the truth of the word of God as well. This opened me up to a life in the Spirit.

Jesus said, “If you abide in my word, you are my disciples indeed. And you shall know the truth, and the truth shall set you free.” And when we make the simple, albeit difficult, decision to be honest with where we are, we can obey Jesus at each step of our discipleship journey, on our way to where we’re going. We tap into the power of the Holy Spirit and, by His grace, we can respond to our past with His love, remain present where we are, and look to the future with hope.

Humility in obedience is hard; but, oh, my friend, you’re worth it. Eugene Peterson, in his book, A Long Obedience in the

Same Direction: Discipleship in an Instant Society, said, “And yet I decide, every day, to set aside what I can do best and attempt what I do very clumsily–open myself to the frustrations and failures of loving, daring to believe that failing in love is better than succeeding in pride.” Yes and Amen.

PRACTICE: What thoughts come into your mind as you think about leaning into the grey space of where you are now and where you want to be? Are you uncomfortable, afraid, lonely, angry? Share your thoughts with the Lord. He wants to hear you. Discipleship in an Instant Society, said, “And yet I decide, every day, to set aside what I can do best and attempt what I do very clumsily–open myself to the frustrations and failures of loving, daring to believe that failing in love is better than succeeding in pride.” Yes and Amen.

PRACTICE: What thoughts come into your mind as you think about leaning into the grey space of where you are now and where you want to be? Are you uncomfortable, afraid, lonely, angry? Share your thoughts with the Lord. He wants to hear you.

ACT Therapy: Acceptance

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ACCEPTANCE: allowing urges, emotions, thoughts and feelings to occur without attempts to control them.

Acceptance does NOT mean a hopeless acceptance of the fact you have trichotillomania.

ACT is an acceptance-based, behaviorally oriented therapy.  It was first proposed by Hayes et. al. (1999), but I believe Dr. Woods is the first to study treating ttm with ACT.

ACT Therapy � TLC Retreat Notes
Credit Sue Price notes – TLC Conference Session

TLC Retreat Session September 2002
Acceptance and Commitment Therapy
Douglas Woods, Ph.D.

Why work on acceptance? Dr.Woods conducted an online study which showed that pullers who are less accepting of private events tend to have stronger urges to pull and more severe pulling. [I found the concept of “private events” confusing at first. From what I can tell, it’s anything that happens inside you that you experience privately. As he said: thoughts, feelings, emotions, urges].

People follow rules not experience. He cited a study where people played a slot machine that was rigged to never pay off for the player. The people who were told that the machine WOULD pay off eventually, played longer than the people who were not told anything. The point is, people follow rules over their experience.

Where this fits in with trich: the rule is, “if you feel bad, get rid of it.” This is what society teaches us. This works well in many situations (if the kids are too noisy, send them outside; if someone is tailgating you, change lanes, etc.).  But this does not work with private events such as feelings. Trying to just get rid of bad feelings, urges, etc. does not work long term. But we keep doing this anyway because that’s the rule we’ve been taught.

ACT breaks down rules by emphasizing experiential exercises over verbal rules. The idea is that the person accepts that while the rule they’ve been taught is “get rid of it”, their experience shows that this has not worked, and then they can learn a willingness to experience those private events. [Side note: the addiction book that I’ve found so helpful makes similar points: that our society teaches us that feeling bad is intolerable, to be avoided, and if you feel bad you must do something to stop feeling bad RIGHT AWAY. This is the kind of thinking that fosters addiction, and changing this way of thinking and being willing to FEEL bad is a major part of combating addiction.]

Steps to Acceptance

1. Creative Hopelessness

Focuses on getting the person to see that attempts to stop, alter or avoid private events such as thoughts, emotions or feelings have been unsuccessful. Pulling is often another way to avoid or control private events. He asked us to think about an uncomfortable private event that we’re dealing with right now. He asked how we tried to deal with it. The common answers people gave were: avoided thinking about it, distracting themselves from it, and denial. We confirmed that none of these things work long term in dealing with the private event. It comes back.

2. Willingness

Focuses on getting the participant to be willing to experience negative or uncomfortable private events. If trying to control private events is the problem, willingness to experience uncomfortable feelings may be a solution.

– Willingness is not the same as “wanting”. He had a “Joe the Bum” metaphor (acknowledging that “bum” is not PC.) Say you are having a party that all your neighbors are invited to, and everyone is having a great time. Then Joe the Bum shows up. You don’t want him there, nobody likes him, he’s dirty, he’s smelly. But if you spend your time trying to physically keep him out, you won’t be enjoying your party. But if you are WILLING to accept that he’s there and not fight it, even though you don’t WANT him there, you can still enjoy your party.

– Willingness is all or nothing

3. Diffusion

He said that even if urges etc. are not originally language-based, they become so because WE are language-based. (There was a lot of clinical stuff he went over making this point.) We need to understand language for what it is, and that words are powerful only because we let them be. This step is about de-literalizing private events. We did two exercises to illustrate this.

First he asked us what we associate with the word “milk”. We said white, cold, frothy, things like that. Then he has us say, out loud,”milkmilkmilkmilkmilkmilkmilk. . .” over and over. (Try it, it’s physically not easy to keep this up!) Picture an entire room of us saying it over and over, and he had us keep it up for what seemed like forever. When he finally stopped us, he said, “I bet you’re not thinking of that white frothy stuff anymore.”

The idea is that “milk” made us think of the white frothy stuff, but only because of what WE associate with that word. By repeating the word over and over, we de-literalized it. It became just a word, the letters m-i-l-k. Similarly, an urge that’s felt as “I need to pull” can be de-literalized by repeating “I need to pull I need to pull I need to pull” until they are just words, not something that must be acted on. Those words don’t have power unless we give it to them.

The second exercise is to imagine you are watching a parade and a band is marching by. Imagine that your thoughts, whatever’s bothering you, are written up on cards that the band members are carrying. And just watch those “thoughts on cards” go past you.  Acknowledge them but separate yourself from them.

4. Understanding the Self

Who are “you?” Who is your “self?”

– Conceptualized Self: who do we say we are? What do we stand for? How do we see ourselves? (we typically think of this as our only self, and defend it)

– Knowing Self: the “self” that is experiencing events as they are occurring

– Observing Self: the “self” that has always been and always will be. He made an analogy to a chessboard: I am the board, not the game that is happening on it. Whatever happens on the board does not have to affect me.

5. Valuing

– You have the ability to choose your behavior. You must choose to move in your valued direction.

– What do you value? What do you want your life to stand for?

– Need to make psychological room for private events while you move your life in the valued direction.

[I think an example of what he means by the last item is: a valued direction for me, is not pulling. By trying to move my life in that valued direction, I will have uncomfortable private events and I need to accept this and be ready for this.

He also said:

-Committed Action Invites Obstacles (disguised as private events)

– The Journey in the Valued Direction involves fear and action. So I take it as, anything I do to move my life in a direction I value(trich-related or not) can bring up private events that will be uncomfortable. He is saying “choose to move in your valued direction” while experiencing these private events.]

**The idea is to combine acceptance techniques with other behavior therapy procedures. A clinical study showed this is effective, based on five different measures of pretreatment and post treatment hair pulling.

For more info, this book is very helpful:

Trichotillomania: An ACT-enhanced Behavior Therapy Approach Therapist Guide (Treatments That Work), March 31, 2008, by Douglas W Woods and Michael P Twohig

Inositol

Studies show that Inositol helps many Trichotillomania suffers. I find that it reduces the urge to pull, which helps with my focused pulling. The Inositol also increases my awareness, which decreases my unfocused pulling.

Leading Trichotillomania specialist Dr. Penzel’s wrote, Inositol and OCD. He recommends the following regimen to begin Inositol: 

(1 teaspoon=2 grams, and be sure to use a measuring spoon) for an adult:

Week 1 – 1 teaspoon/2x per day
Week 2 – 1 teaspoon/3x per day
Week 3 – 1.5 teaspoons/3x per day
Week 4 – 2 teaspoons/3x per day
Week 5 – 2.5 teaspoons/3x per day
Week 6 – 3 teaspoons/3x per day

Following this regimen, I worked my way up and now take 18g each day. I do this by mixing 3 teaspoons (1 tablespoon) of inositol in water 3 times a day. I have found the Jarrow brand powder (shown above) to dissolve well. It is available on amazon for reasonable price. I mix it with warm water as it dissolves better that way. You can add it to fruit juice or other sweetened drink. I simply mix the powder with ~3oz of warm water and drink plain as it has a mild sweet taste that I actually like. In addition to Inositol, l I take 1800mg of  NAC, which I started several months before the Inositol. I did not see much progress with that alone, therefore I added the Inositol. If you are considering both supplements, choose one to start with, otherwise you will not know which is helping and or causing side effects.

I have taken Inositol on and off for 2 years. When I first started the recommended regimen over 6 weeks, I noticed many GI side effects. When I unexpectedly became pregnant a couple months later, I had to lower my dose because it increased my nausea. That did not help so I discontinued the Inositol until my morning sickness passed. Reassured by my OB that Inositol is safe while pregnant and breastfeeding, I slowly reintroduced the Inositol. I only took 1-2 because it aggravated epigastric pain I had while pregnant. The lower dose helped a bit, but not nearly as well as the recommended 3 TBSP. Now that I am back to 3 TBSP per day (which I take in one large dose at night to help my insomnia), I am definitely feeling the benefits. It decreases my urges and makes me more aware of pulling.

Here’s more details information I copied from the article about Inositol use for trich sufferers, written by trich specialist Fred Penzel:

“Obviously, before you run out and try anything new, you should always consult your physician. If your physician recommends trying this, you might also want to mention the following information to him or her:

  1. It cannot be taken together with Lithium, as it seems to block its action.
  2. The chief side effects of inositol are gas and diarrhea. Some people get this for the first few days and then it clears up. Many of those taking it never have this side effect, and some only get it when they take more than a particular amount.
  3. I have heard reports that caffeine lowers inositol levels in the body, so if you are a heavy coffee drinker, you might consider cutting down or eliminating this from your diet. Actually, stimulants such as caffeine can sometimes contribute to anxiety, jitteriness, etc.
  4. It should be purchased in powdered form, and taken dissolved in water or fruit juice. It has a sweet taste, and is chemically related to sugar. If it is allowed to stand for about 10 minutes after mixing it, it seems to dissolve better. Vigorous mixing for a few minutes also helps. If it still doesn’t dissolve well (not all brands do), stir it up and drink it quickly before it settles. The use of powder is recommended, as the larger doses required could require taking as many as 36, 500 mg. capsules per day.
  5. Inositol is a water-soluble vitamin, so although the doses appear to be large, it will not build up to toxic levels in the body. Whatever the body doesn’t use is excreted. The average person normally takes in about 1 gram of inositol each day via the food they eat. There are no reports of any harm associated with the long-term use of inositol. Some of our patients have been taking it as long as eight years now, with no problems.6. It can be built up according to the following schedule (1 teaspoon=2 grams, and be

sure to use a measuring spoon) for an adult:

  • Week 1 – 1 teaspoon/2x per day
  • Week 2 – 1 teaspoon/3x per day
  • Week 3 – 1.5 teaspoons/3x per day
  • Week 4 – 2 teaspoons/3x per day
  • Week 5 – 2.5 teaspoons/3x per day
  • Week 6 – 3 teaspoons/3x per day

A child can be built up to 3 teaspoons per day over the same six-week period. Dosages for adolescents can be adjusted according to weight. In either case, it is best to allow side effects to be the guide. If they begin to occur, it is not considered wise to increase the dosage unless they subside.

Once a person has reached either the maximum dosage, or the greatest amount they are able to tolerate, it is best to try staying six weeks at that level to see if there is any noticeable improvement. If there is none by the end of that time, it should probably be discontinued. As with any treatment, those who are absolutely positive that it will help are only setting themselves up, and may wind up more than disappointed. Everything works for someone, but nothing works for everyone.”

Persistence not Perfection

Trichy Insights

Let’s strengthen those weak muscles!  

Just persist until you are successful!

My solace tonight as I persist in my journey to recovery from trich comes from comments of some of the people on the Fairlight Bulletin Board posted on Amanda’s Trichotillomania Guide.

Definition of Success

I just wanted to add another observation to all that has been said about making a commitment to not pulling. Think of it as exercise. When I started walking a couple of months ago, I thought a mile was forever. Now that I’ve been walking regularly, my stamina has increased, and a mile goes by quickly. I can’t run a marathon (yet!), but I am stronger. In the same way, as we practice not pulling, we’re building “muscles” that make it easier not to pull. The first couple of weeks are horrible, but then it gets easier–if you persist. I’ve slipped a couple of times…

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Treating the Whole Person

imageTreating the Whole Person:

A Personal User’s Guide

By Renae M. Reinardy, PsyD., LP

There are many different ways for us to understand our experiences in life. I have not found it helpful for clients to be overly harsh or punishing in their efforts to produce the changes they want to make. Rather, it is good practice to take a comprehensive, wise and compassionate approach toward getting unstuck on the path to change. Everyone’s path is different, so I want to offer a few tips that might help you to write your own Personal User’s Guide. This includes taking care of your mind, body and spirit in a comprehensive manner, which I will briefly outline in this article. Please have a pen and paper handy for taking notes as we go along.

Before reading on, take a few minutes to write down what your pulling or picking means to you. Questions to help you start include: How did this journey start, what directions has it taken you in, what have you gained and what do you feel like you have lost, what works, what doesn’t, when did the behavior start, and what function does it serve?

The way that I conceptualize BFRBs is that they are like a friend who is trying really hard to make a person feel better, but they do not offer the best advice. Pulling and picking are often ways for one’s body to sort out sensory, emotional, cognitive, spiritual, and physical deregulation. This friend may offer some quick relief or distraction from these experiences, but often there are no lasting gains. Rather, it can lead to a vicious cycle of behavior which can feel out of control.

Somewhere along the way, many people lose track of what they need and have stopped listening to their inner core. Instead, they tried to quiet it with distracting and impermanent forms of relief or pleasure. Let’s look at a few components of the Personal User’s Guide to see if it is helpful in hearing one’s self better.

One of the first things that I work on with my clients is the “pillars of health”. This is learning how to take care of one’s body through proper nutrition, sleep, exercise and general self-care. Again, if a person has any deregulation in their body, there is a good chance that the BFRBs will pick up on that imbalance and try to fix the problem. Let’s try in a new way, by looking at what might be contributing to the problem in the first place. Please ask yourself to honestly answer the following questions:
Nutrition: What do I eat?

List some typical items you consume on a daily basis for the following meals:
Breakfast
Lunch
Dinner
Snacks
Caffeine
Vitamins:
Exercise: How and when do you exercise?

Sleep: What time do you wrap up your day?

How long does it take to fall asleep?
Do you wake up at night?
What time do I wake up in the morning?
Well, how does it look?

If you are like most of us, at least some improvement can be made in how we care for our bodies. Perhaps there are one or two things from the lists above you’ve always wanted to change, or believe if you COULD change, it would help with your BFRB management. Can you identify one small difference you could make to begin?

Over the past few years, there has been more research to support the role of nutrition in BFRBs, including sugar intake, and dietary supplements. Some people have had great success with the supplements N-acetylcysteine (NAC) and/orInositol (B- vitamin) decreasing urges to pick or pull. Work with your healthcare provider to determine if these might be appropriate for you. I have also found that my clients experience great benefit when sugar intake is reduced.

In our typical diet, we are often starving for good nutrients. Our diet must contain 5 essential items to be truly healthy: carbohydrates, proteins (1/5 of our calories), fats, water and minerals. Amino acids are the building blocks of protein which plays a role in every cellular function of the body. Out of 20 amino acids present in the body, 9 are essential, meaning that they must come from diet. Clinical nutritionists have found that deficiencies in B1, B2, B6, folate, B12, C, magnesium and zinc are related to a number of mental health conditions. Since many people do not get what they need from their diet, vitamin supplements are often needed in addition to dietary changes. Be sure to get a good natural vitamin that your doctor approves.

The “E” word. Research has proven the mental health benefits of exercise. It is believed that exercise stimulates the production of endorphins—the feel good hormone. Serotonin, dopamine, and norepinephrine are also released during exercise. (Do these sound familiar? Yep, these are same chemicals that are targeted with many psychotropic medications.) Other benefits of exercise include improved blood flow, increased brain function, increased oxygen, and removal of toxins through breathing and sweat. Time to dust off those shoes with the laces. Start gradually and set realistic goals. For example, if you’d like to exercise more, maybe start with just ten minutes of exercise every day. Ten minutes of walking at a faster pace, ten minutes of jogging, ten minutes on the treadmill or the elliptical….then when that gets easy, add five more minutes. Before you know it, you are exercising for an hour. Talk to your doctor if you have any medical conditions that would restrict exercise.

Sleep is another thing we all know is important, yet is one of the first things to go in our busy schedules. The average adult needs 7-9 hours of sleep each night. Research suggests that people who do not get adequate sleep tend to live shorter lives than those who do. Chronic sleep deprivation also leads to increased risk of obesity, diabetes and heart disease. When we sleep, we produce extra protein molecules to help us fight off infection, stress and toxins by helping the immune system mend our bodies. Take good care of your body and your body will take good care of you. Again, remember that picking and pulling serve a function. If any of these areas are out of whack, you may notice urges on the rise in attempts to self regulate.

Take the time to evaluate your pillars of health. When we rush things, they tend not to be effective. In working with my clients, I’ve found that focusing on the pillars of health can be a big factor in getting someone unstuck when a traditional behavioral and cognitive plan are not enough.
How I Live My Life

Another piece of the Personal User’s Guide that I want to cover in Part One is how we live our life. So many times people plow through the day, just to work toward another goal—the weekend, a long-awaited vacation, or milestones such as graduation, retirement, etc. Yikes! There is often quite a bit of time spent waiting for something good to happen!

Draw two circles in your notebook. Label one circle “real Life” and the other circle “Ideal Life.” In each circle complete a pie chart: one on how you spend your typical day and the other on how you would like to spend your day.

How do they compare? Is there anything that you can take from your ideal and build into your everyday/real life? It is important to take time now to spoil yourself a bit—listen to music, get and receive hugs, sing, pet an animal, smile, pray, make good wishes for others, take a nap, get a massage, acknowledge yourself and your accomplishments, or try to find a quiet place to rejuvenate. We often cannot live every moment in the ideal, but it is good to not get stuck in long patterns of unfulfillment.

Can you think of a few ways you can incorporate goals from your ideal life into your real life? Write them in your notebook.

Okay, one more thing to think about in Part One of your Personal User’s Guide: Spirituality.

Pretty big topic and I am not talking about religion, although that can fall into this category. Focusing on one’s spirituality involves developing an inner life to experience greater connectedness through practices such as prayer, meditation and contemplation. These practices help us to experience a more comprehensive sense of self and the interrelatedness to others, nature and/or religious experiences. Recent research has shown the medical and emotional benefits of these practices including a more complex range of brain activity, stress relief, decreased heart rate, improved lung capacity, and decreased anxiety, to name a few. Please take a few moments and think of how you might summarize your spiritual life.
My Spirit: Take some notes on the following questions

What gives me inner strength and connectedness to things outside of myself ?
How can I build on this?

In Part Two of the Personal User’s Guide, we will discuss emotions, thoughts, and behavioral strategies that can help give your body what it needs. By learning and listening to ourselves it is possible to improve one’s overall well-being and decrease undesirable behaviors and patterns. In the meantime, best wishes in reinforcing or changing any experiences that you may have realized in completing.

This is part 1 of a two-part article. Read part 2, here >>

Dr. Renae Reinardy is the founder of the Lakeside Center for Behavioral Change in Fargo, ND. Prior to opening her own practice, Dr. Reinardy worked as a psychologist at the Behavior Therapy Center of Greater Washington in Silver Spring, Maryland. Dr. Reinardy specializes in the treatment of hair pulling and skin picking disorders, obsessive compulsive disorder, compulsive hoarding, and related conditions. She has been an adjunct professor at the doctoral level and has presented numerous times at national conferences and at local meetings and trainings, including The TLC Foundation for Body-Focused Repetitive Behaviors’ Annual Conferences and Retreats. Dr. Reinardy has been interviewed on Good Morning America, the Joy Behar Show, Dateline NBC, and A&E’s Hoarders. For more information, visit http://www.lakesidecenter.org.

 

 

How Long Does it Take to Break a Habit?

image.jpegYes Trich is more than a ‘bad habit’. However, it is an unwanted behavior that I believe can be unlearned or changed.

My goal is to break this ‘habit’. I have been working at this since beginning this blog 2 years ago. Yes, I tried to stop pulling before that, but my mindset changed. I was willing to do everything I could, including changing my mindset.

Before a bad habit or unwanted behavior can be changed or stopped, I believe you need to change your thinking. Your thinking rules everything you do. This is why cognitive therapy is effective. The fist step of changing your thinking is to accept that you have a real disorder that causes you to pull your hair. It is not a lack of will power or discipline that keeps you in the cycle of hair pulling and self-loathing that often directly follows pulling. Click here for more information about Commitment and Acceptance Therapy.

Once you have changed your thinking, you can focus more on the unwanted behavior (hair pulling or any behavior). Cognitive Behavioral Therapy follows this approach (CBT).

According to The OCD Center of Los Angeles:

“The most effective treatment for Trichotillomania is a combination of various types of Cognitive-Behavioral Therapy (CBT). Perhaps the most important of these is called Habit Reversal Training (HRT). HRT is based on the principle that hair pulling is a conditioned response to specific situations and events, and that the individual with Trichotillomania is frequently unaware of these triggers. HRT challenges Trichotillomania in a two-fold process. First, the individual with Trichotillomania learns how to become more consciously aware of situations and events that trigger hair-pulling episodes. Second, the individual learns to utilize alternative behaviors in response to these situations and events.

Other Cognitive-Behavior Therapy techniques can be used as adjuncts to HRT in the treatment of Trichotillomania. Among these are Stimulus Control techniques and Cognitive Restructuring. Stimulus Control techniques involve utilizing specific physical items as “habit blockers” to restrict the ability to pull hair, while Cognitive Restructuring helps an individual with Trichotillomania learn to think differently in response to the urge to pull their hair.
Skin Picking and Hair Pulling – Reflections

One of the most effective CBT developments for the treatment of Trichotillomania is Mindfulness Based Cognitive Behavioral Therapy. The primary goal of Mindfulness-Based CBT is to learn to non-judgmentally accept uncomfortable psychological experiences. From a mindfulness perspective, much of our psychological distress is the result of trying to control and eliminate the discomfort of unwanted thoughts, feelings, sensations, and urges. In other words, our discomfort is not the problem – our attempt to control and eliminate our discomfort is the problem. For those with Trichotillomania, the ultimate goal of mindfulness is to develop the ability to more willingly experience their uncomfortable thoughts, feelings, sensations, and urges, without pulling their hair. To learn more about Mindfulness Based CBT for the treatment of Trichotillomania, click here.

Here’s how long it takes to break a habit, according to science
*You’re gonna need more than will power.
SIGNE DEAN 24 SEP 2015

From daily tooth-brushing to the 11am coffee, we all have dozens of habits that get us through our daily routine. Some are great – weekly gym visits are often encouraged – others not so much, like smoking a pack a day, or dialling the number of the pizza place way too often. Because we recognise our habits as useful or detrimental behaviours, we often strive to shape them accordingly.

There’s no shortage of apps out there designed to help you form a habit, and many of those are built on the assumption that all you need is 21 days. This number comes from a widely popular 1960 book called Psycho-Cybernetics by Maxwell Maltz, a plastic surgeon who noticed his patients seemed to take about 21 days to get used to their new faces.
However, according to a 2009 study, the time it takes to form a habit really isn’t that clear-cut. Researchers from University College London examined the new habits of 96 people over the space of 12 weeks, and found that the average time it takes for a new habit to stick is actually 66 days; furthermore, individual times varied from 18 to a whopping 254 days.

The take-away message here is that if you want to develop a new behaviour, it will take at least two months, and you shouldn’t despair if three weeks doesn’t do the trick – for most people that’s simply not enough. Stick with it for longer, and you’ll end up with a habit you can keep without thinking.

But what about trying to break an unwanted habit?

It turns out the two – habit forming and breaking – can be quite closely linked. As psychologist Timothy Pychyl explains to Alison Nastasi at Hopes and Fears, they’re two sides of the same coin: “Breaking a habit really means establishing a new habit, a new pre-potent response. The old habit or pattern of responding is still there (a pattern of neuron responses in the brain), but it is less dominant (less potent).”

From daily tooth-brushing to the 11am coffee, we all have dozens of habits that get us through our daily routine. Some are great – weekly gym visits are often encouraged – others not so much, like smoking a pack a day, or dialling the number of the pizza place way too often. Because we recognise our habits as useful or detrimental behaviours, we often strive to shape them accordingly.

There’s no shortage of apps out there designed to help you form a habit, and many of those are built on the assumption that all you need is 21 days. This number comes from a widely popular 1960 book called Psycho-Cybernetics by Maxwell Maltz, a plastic surgeon who noticed his patients seemed to take about 21 days to get used to their new faces.
However, according to a 2009 study, the time it takes to form a habit really isn’t that clear-cut. Researchers from University College London examined the new habits of 96 people over the space of 12 weeks, and found that the average time it takes for a new habit to stick is actually 66 days; furthermore, individual times varied from 18 to a whopping 254 days.

The take-away message here is that if you want to develop a new behaviour, it will take at least two months, and you shouldn’t despair if three weeks doesn’t do the trick – for most people that’s simply not enough. Stick with it for longer, and you’ll end up with a habit you can keep without thinking.

But what about trying to break an unwanted habit?

It turns out the two – habit forming and breaking – can be quite closely linked. As psychologist Timothy Pychyl explains to Alison Nastasi at Hopes and Fears, they’re two sides of the same coin: “Breaking a habit really means establishing a new habit, a new pre-potent response. The old habit or pattern of responding is still there (a pattern of neuron responses in the brain), but it is less dominant (less potent).”

“It’s much easier to start doing something new than to stop doing something habitual without a replacement behaviour,” says neuroscientist Elliot Berkman. “That’s one reason why smoking cessation aids such as nicotine gum or inhalers tend to be more effective than the nicotine patch.”

Experts agree that there’s no typical time frame for breaking a habit, and the right recipe is going to be a mix of personality, motivation, circumstances, and the habit in question. “People who want to kick their habit for reasons that are aligned with their personal values will change their behaviour faster than people who are doing it for external reasons such as pressure from others,” says Berkman.

According to psychology professor Susan Krauss Whitbourne, sometimes a habit can be broken quickly: “In extreme cases, the habit can be broken instantly, such as if you happen to become violently ill when you inhale cigarette smoke or nearly get hit by a bus when texting and walking.” But in most cases it’s going to take longer than that, and you should probably allow for at least two months.

To successfully break a habit, you need to think of your strongest motivation, which will drive you along. Think of a ‘replacement behaviour’ for the habit, but make sure it’s a positive one – replacing smoking with snacking is a common trap, for example. And be patient. The longer you’ve had a habit, the longer it will take to get rid of it.

“Longtime habits are literally entrenched at the neural level, so they are powerful determinants of behavior,” explains Berkman. “The good news is that people are nearly always capable of doing something else when they’re made aware of the habit and are sufficiently motivated to change.”

So stay strong, you can do it.

 

 

 

NAC for Trichotillomania

Research shows that nutritional supplements may help mental health including trichotillomania. Lately I have focused on inositol and NAC as I have heard about these supplements in many trichotillomania communities with varied success.

*Updated 3/17/18

I started taking NAC (N-acetylcysteine) about five years ago and have noticed a decrease in my urge to pull when I take it 5-6 days per week. I have gone though periods where I did not take it or did not take enough that I notice any benefit.

Currently, I take 2-600mg capsules in the morning and 2-600mg capsules in the evening, giving me a total of 2400mg of NAC. Doses between 1200-3600mg may be helpful according to this article,  N-Acetylcysteine, a Glutamate Modulator, in the Treatment of Trichotillomania

I recently added inositol to increase the benefits of NAC.  It is generally agreed that a large dose is needed for inositol to be effective with trich. I worked my way up to 18g per day. I do this by mixing 3 teaspoons or 1 tablespoon of inositol in water 3 times a day. I have found the Jarrow brand powder dissolves best. It is available on amazon for a reasonable price. I mix it with warm water as it dissolves better that way. You can add it to fruit juice or other sweetened drinks.  I simply mix the powder with ~3 oz. of warm water and drink it plain as it has a mild sweet taste that I actually like.

 

NAC and Trichotillomania

By Fred Penzel, Ph.D.

**Please note the following: This advice is purely informational, and not in any way meant to be a substitute for treatment by a licensed physician. Do not try this, or anything else, without first consulting your physician. If your M.D. has not heard about it, refer them to the following article and let them decide:

Jon E. Grant, JD, MD, MPH; Brian L. Odlaug, BA; Suck Won Kim, MD, N-Acetylcysteine, a Glutamate Modulator, in the Treatment of Trichotillomania: A Double-blind, Placebo-Controlled Study. Arch Gen Psychiatry/ VOL 66 (NO. 7), JULY 2009.

 

Over the years, it has become apparent that prescription medications, as remedies for trichotillomania (TTM), have proved to be somewhat of a disappointment. These meds have been employed since the early 1990’s, and although they may be seen to work occasionally for some individuals, research indicates that their overall effectiveness is not great for the majority of sufferers. When they do appear to work, it is most likely that they are actually helping with coexisting problems such as depression and anxiety that are impacting the pulling, but not directly causing it. The discovery of a new compound with a greater level of direct effectiveness would be considered a blessing to sufferers. If this compound were also an over-the-counter remedy, it would be even better.

This very thing was confirmed in 2009 with the publication of an article by Grant, Odlaug, and Kim in The Archives of General Psychiatry, titled “N-acetylcysteine, A Glutamate Modulator, In the Treatment of Trichotillomania.”This study, which lasted 12 weeks, investigated the use of the amino acid N-acetylcysteine (NAC) in 50 patients with TTM, and found that 56% of them were rated as improved or very much improved. A much smaller previous pilot study had also found positive results.

So what is this compound? NAC is a both a pharmaceutical drug and a nutritional supplement used primarily to treat Cystic Fibrosis, and also to treat individuals suffering from acetaminophen overdoses. In the former case, it thins mucus, making it easier for patients to cough it up, and in the latter case, has liver detoxifying effects. It has also been said to aid in the treatment of cocaine addiction. Some practitioners out there are also exploring the use of NAC in the treatment of OCD, although whether it is effective or not, is still unproven.

What exactly is NAC? NAC is a natural sulfur-containing amino acid that is a breakdown product of the amino acid L-cysteine, and is in turn broken down by the body and converted to a powerful antioxidant known as glutathione.Antioxidants can repair oxidative stress in the body. Oxidative stress occurs when cell metabolism produces an increased level of oxidants known as free radicals that tip the balance between themselves and antioxidants in the body.These free radicals can cause the breakdown of cells, damaging proteins, genes, and cell membranes. Substances known as antioxidants act by neutralizing free radicals, and some are produced naturally by the body. Some have theorized that hair-pulling may be the result of the effects of oxidative stress within the brain, and that NAC can help reverse this.

NAC is also what is known as a chelating agent. That is, it hastens the excretion of heavy metals such as lead, mercury and arsenic from the body by binding to them. While this is of course, a positive benefit of taking it, it also causes the body to excrete copper, zinc and other essential minerals when used over time. Some research says this effect may be minimal, but others have suggested that it is necessary to take supplements containing copper, zinc, and other vital minerals when using NAC. Until this is settled, it is advisable to take a daily multivitamin plus minerals along with the NAC. It is often recommended to take extra vitamin C, itself an antioxidant, along with NAC, as it can also assist in raising glutathione levels. The amount of vitamin C one should take has been said to be in the range of 500 mg. per day.

As far as taking NAC itself for a BFRB, we have been using the following approach:

1. Start by taking one, 600 mg. capsule of NAC daily for the first two weeks along with a daily multivitamin plus minerals, in addition to 500 mg. of vitamin C. You will most likely not see any changes on this dosage.

2. If the NAC appears to be well tolerated, increase it to 1, 600 mg. capsule, 2x per day. Again, wait two to three weeks to see if there is any reduction in pulling activity.

3. If there are no changes, or only minimal changes in pulling, increase to 1 capsule, 3x per day, and again wait two to three weeks to see if there is any noticeable result.

4. If there is only little or no change, you can then increase to 4, 600 mg. capsules per day, and wait another two to three weeks. Take 2 capsules for one of the three daily doses, to make a daily total of four.

5. If there is still little or no change, you can increase up to what is the maximum of 5, 600 mg. capsules per day. A total of 3,000 mg. is the maximum you should take as a daily dose. Take 2 capsules for two of the three daily doses, to make a daily total of five.

6. If after 4 weeks at the maximum dosage there is still no result, then it is likely that it is not working, and can then be discontinued.

As with all medications and supplements, there are no sure things. It is ultimately all trial-and-error. We hope that NAC will help, but just keep in mind that it will not necessarily work for everyone. Remember that it was shown to be effective for about 56 percent of the subjects in the original research study.

NOTE: There are some very important precautions that should be observed when taking NAC.

1. It should be noted that there are some individuals who suffer from cystinuria, a genetic disorder that causes cysteine to build up in their urine. If levels of cysteine molecules become high enough, they clump together to form kidney stones. It is therefore recommended that those with this problem not take NAC.

 

2. In addition, NAC supplementation might increase the side effects associated with nitroglycerin and isosorbide, two medications commonly used to treat angina.

 

3. Using NAC at the same time as the hypertension drugs ACE-inhibitors might cause blood pressure to drop too low. It might also excessively strengthen the actions of immunosuppressant drugs.

 

How N-Acetylcysteine (N-A-C) Cured My Depression and Anxiety

The maternal side of my family contains a history of severe mental illness. My maternal grandmother suffered from schizophrenia and died in a mental ward. My mother has been institutionalized repeatedly, suffering from a decades long battle with bipolar disorder.

My younger brother is a legitimate sociopath. He is not merely “dark triad.” He has actual antisocial personality disorder. He has no feelings of empathy or kindness or decency. Lacking the vision to rob banks or become a drug kingpin, he is currently free after spending 10 years in prison for shooting his one-armed drug dealer.

In other words, there’s some funny business in my DNA.

I used to get depressed and feel anxious. I never had full-on panic attacks, but I would have severe anxiety that would leave my brain spinning. My skin would break out in rashes.

I conquered this anxiety through two means, as anxiety and other mental illnesses have two components – physical and psychological.

The psychological components of anxiety come from society and the brain washing. That is where state controlreframing techniques, and other Mindset Training comes into play.

The physical components of anxiety and depression come from a variety of sources – poor nutrition, lack of sunlight, excessive oxidative stress, high cortisol, and heavy metal poisoning.

glutathione

N-Acetylcysteine (N-A-C) has been clinically proven to help treat symptoms of anxiety and depression.

N-Acetylcysteine is a powerful nootropic with still many unstudied benefits. N-A-C has been used by visionary doctors to help treat intractable depression and anxiety.

Why haven’t you heard about the magical effects of N-A-C? Simple. Go on Amazon and see how much a bottle of N-A-C costs.

My mom was on a $1,500 a month cocktail of drugs. No one would listen when I suggested they buy a $15 bottle of N-A-C. But the science is there.

See, N-acetyl cysteine for depressive symptoms in bipolar disorder–a double-blind randomized placebo-controlled trial(“NAC appears a safe and effective augmentation strategy for depressive symptoms in bipolar disorder.”) (PubMed.)

See also, N-acetyl cysteine as a glutathione precursor for schizophrenia–a double-blind, randomized, placebo-controlled trial. (“These data suggest that adjunctive NAC has potential as a safe and moderately effective augmentation strategy for chronic schizophrenia.”) (PubMed.)

N-A-C depression anxiety

Why does N-A-C help treat depression?

Acetylcysteine is a glutathione precursor. That is, acetylcysteine is converted into glutathione.

Glutathione is an antioxidant that used by your liver to detox your body. Emergency rooms give high doses of NAC to patients that have overdosed with Tylenol.

Resources:

  • The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine (Amazon).
  • Smash Chronic Fatigue: A Concise, Science-Based Guide to Help Your Body Heal, and Banish Fatigue Forever (Amazon).

Could mental illness be caused by toxins that your liver is unable to clear from your body, due to a glutathione deficiency?

That is not so far fetched, and in fact the cutting-edge of mental health research is on the role toxins and oxidative stress play in mental illness.

See, The efficacy of adjunctive N-acetylcysteine in major depressive disorder: a double-blind, randomized, placebo-controlled trial (“These data implicate the pathways influenced by NAC in depression pathogenesis, principally oxidative and inflammatory stress and glutamate, although definitive confirmation remains necessary.”) (PubMed.)

See also, The Glutathione System: A New Drug Target in Neuroimmune Disorders (“Glutathione depletion and concomitant increase in oxidative and neurological stress and mitochondrial dysfunctions play a role in the pathophysiology of diverse neuroimmune disorders, including depression, myalgic encephalomyelitis/chronic fatigue syndrome and Parkinson’s disease, suggesting that depleted GSH is an integral part of these diseases.” (PudMed.)

Do you know what else boosts glutathione?

Carrot orange pomegranate juice

How much N-A-C should you take?

That would be medical advice, which I don’t give. However, participants in the studies usually used between 1 and 2 grams daily.

Why take N-A-C instead of glutathione?

If N-A-C is a precursor, wouldn’t it make more sense to take glutathione directly? That seems intuitively correct. There is some evidence to suggest that N-A-C is more bioavailable than glutathione.

I personally use N-A-C because that was the compound studied. How much glutathione would one need to take to get the same benefits that one can obtain from 1 to 2 grams of N-A-C? As I don’t know, I went with N-A-C.

You are of course free to try both for yourself to see what works best.

What brand of N-A-C is best?

As the supplement industry is unregulated, I generally prefer to use use two brands of supplements – Life Extension Foundation and Jarrow.

I personally use Jarrow’s form of N-A-C Sustain, which is time released. (Amazon).

For more information on oxidative stress, nutrition, and various maladies, watch this video.

Minding Your Mitochondria

Change Your Thinking to Change Your Behavior

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Change Your Thinking, Change Your Behavior

 By Claudia Miles

I have been sharing my view that hair pulling & skin picking are most like “addictions” for many years.  I was not taken seriously by other professionals at first, but in recent years I’ve seen the term used more and more when other professionals talk about Body-Focused Repetitive Disorder (BFRD).  In fact, TTM & Dermatillomaia fit the criteria of addiction quite well. Think about the way we respond to an addiction like substance abuse (food, drink, drugs). We develop a craving, we try to talk ourselves out of it by saying: You don’t really want to drink again, you’ll lose your job. Don’t eat that whole box of cookies, you’ll feel sick and diagusted. Don’t keep pulling your hair out, there won’t be any way to cover it up.

The addict in you rebels against this kind of feedback. You want to do it, and all the consequences you are thinking about happen in the long term. You feel bad NOW. Gaining weight or losing hair happens later. You just want to feel better. So finally you  say, “Screw it. I don’t care about the consequences,” and we block out the fact that we missed work last time we drank, lost custody of our kids, took any number of actions that cause us shame, pain, financial loss or worse. You say, “I don’t care, I had a bad day and I’m going to do it.” Or “It doesn’t matter, I already ruined my hair, I’m already almost bald, That is how we give yourselves permission to pick or pull.

1) (Screw it.) It’s hopeless.
2) I don’t care
3) It doesn’t matter anyway.

And by convincing ourselves for just a few minutes that those lies are true, we rebel against what we really want. We pretend that we “don’t care” about pulling, that we’ve done so much damage it doesn’t matter if we pull or not, and finally we feel so hopeless about the idea of stopping forever, we don’t see the point in stopping NOW. (It’s quite similar to the process of procrastination which is often connected to BFRD behaviors: Denial, Delay (now we’ve waited so long it will never get done), Hopelessness)

Rather than trying to “FORCE” yourself to stop, the key is to understand and change the pattern of addictive thoughts. It doesn’t matter whether you are a picker who is aware that you are about to pick or a puller who has already pulled for ten minutes before you become aware of what you are doing. There will be a moment when you ARE aware of what you are doing and think to yourself: “I don’t care!” This thought comes in response to earlier thoughts like, You “shouldn’t” be doing this OR I can’t believe I’m doing this again. We think “I don’t care!” as a way to tell our inner bully to shut up, leave us alone & let us pull. Because let’s face it, pulling & picking are made less pleasurable when we simultaneously are attempting to shame ourselves for engaging in the behaviors.  (And SHAME does not help one bit, of course.)  So we say to ourselves by way of making the shame stop: I DON’T CARE! (In other words, leave me alone, Bully, I want to pull!)

The problem is we have dis-identified with the real reason we want to stop these behaviors, which is not that they are morally wrong or that we “shouldn’t” do them. Rather, it upsets us *THAT* we do them. And it is crucial to acknowledge that, but at the same time, not shame ourselves.

Here’s what I mean. See if you can become aware when you start to think to yourself: I don’t care! Once you do, apply what Mindfulness practice teaches us is the “observer” within and “note” the thought.

You: I don’t care
The Observer (You): Ah, there’s that addictive thought. Telling me I don’t care. Giving me permission to pull.

The problem is, you DO care. You care very much. If you didn’t, you sure as heck wouldn’t be reading this blog. You just want to forget that fact for a moment, an hour, two hours, so you can go to that familiar (and comforting) sense of “Numbness.”.  So what I’m asking you to do here is this: DO NOT bully or shame yourself into stopping. (What are you DOING?! What’s wrong with you?! You’re “pathetic”!) But DO acknowledge that the behavior is causing you pain. The example I give to my clients is this: Imagine an alcoholic who is living in a one room apt. after having lost his (or her) share of custody with his kids. He has to get sober and stay sober for 6 mos to get the issue revisited. Six months seems like FOREVER. So every night, to numb the pain of not seeing his children, he pulls out a bottle of whisky. He may say, You moron, what are you doing? But he feels compelled to continue. So he takes the pictures of his kids and turns them around. Puts them away. It’s too painful to look at his kids. He’s already “blown it” he thinks.

Now I would tell that guy, Go ahead and drink. But do NOT put away the pics of your kids. At the same time, you don’t get to berate yourself for doing something you feel so compelled to do despite all it has cost you. What you do is this: You look at your kids and think to yourself, wow, this drinking has cost me a lot. And it’s not because I don’t care about my kids cause I do! How powerful this addiction must be if it makes me ignore what truly matters. Now this makes the drinking FAR less enjoyable & shifts this man’s thinking from “I’m shit. I’m a loser.” to “This is a serious problem & it’s costing a lot.” That latter voice we can call the “Supportive Friend.” The friend you can be to yourself. The friend who wants to HELP you, not SHAME you.  It’s a completely different way of relating to the self.

Here’s how it translates for sufferers of TTM or Dermatillomania:

Your Inner Bully (You): Stop pulling you pathetic loser!
BFRB* Addict (You): I had a lousy day. I just don’t CARE right now!
NEW-Observer (You): Ah, there’s the inner addict trying to convince me I don’t care.
NEW-Supportive Friend (You): You know what? That’s not true. I DO care. I care very much.  It causes me  emotional pain to do this. It makes me feel bad about myself. I just want to acknowledge that.

Now at this point, I am not saying that you can (or should) instantly stop. Not at all. I am suggesting that you go ahead and pull or pick, while simultaneously acknowledging that you DO care.   Not that you’re an idiot or weak or pathetic. Rather, that you are a human being who’s desire or urge to do this is so strong that it eclipses the fact that the behavior causes you so much pain. Now that’s a HARD spot to be in, and until you can empathize with yourself, you remain stuck in a cycle of Blame, Shame, Addictive Thought, Numbness, More Shame, Emptiness, Self-Hatred.

Please note that I am suggesting you tell yourself that you DO care, NOT because of hair loss or scarring but because you will feel bad about yourself. That’s very important. We all know how long it takes for hair to grow back or skin to heal. It takes so long it’s hard to feel motivated. That’s why it is crucial you motivate yourself based on how you feel about yourself. That can become your immediate payoff. And when you consider the crippling shame and self-hatred that appears sometime after a pulling or picking session, perhaps you can see that there is another kind of cost to this besides hair loss and skin scars.  And when that can be replaced by actively telling yourself that you made an effort (even if the effort at first is just changing your thoughts), you will become a real support to yourself, a cheerleader, a caring friend and more able to continue on the path of recovery. A bully, a critic, a shaming, finger-wagging inner “bad parent” WILL NOT HELP YOU. That kind of thinking will tear down any efforts you make toward your goal. That kind of thinking SUPPORTS the addiction. And you do not deserve it, as one day you will surely know.

As I said for the “I don’t care” thought, the same goes for “It doesn’t matter,” and “It’s hopeless.” The thought “It doesn’t matter” is generally linked with the fact that you’ve done so much “damage” that it doesn’t matter if you do a little more. It’s the same irrational thinking behind, “I went off my diet and ate some cake! I ‘ruined’ everything. Well, I may as well eat everything in the house.” Because that makes sense, right? You ate an extra 500 calories so you may as well eat 5,000.

First of all, even when you break it down literally, I can tell you that it DOES matter. In the practical physical world, even though you may not see the difference right away, any lessened amount of pulling, (55 minutes and not an hour, 3 hours and not 4) is PROGRESS. And progress is what will help you reach your goal. But going back to my earlier point, it’s about shifting the focus in this moment away from what your hair or skin looks like and acknowledging that the shame and anger toward the self you feel is hurtful. It not only doesn’t help you pull less, it absolutely causes you to pull more. Please hear this: All attempts to attack, shame or SCARE you into less pulling or picking, whether done by you or someone else, do the OPPOSITE. Every “I can’t believe you’re doing that!” “Stop it, you’re making a mess of your face!” “Why can’t you.. STOP doing that??!!” and “What’s WRONG with you!!” will push you FURTHER from your goal. Please stop and think about that. You don’t want to “let yourself off the hook.” You falsely believe that loving yourself or, yes, accepting yourself, even while you are still pulling means you are “giving up” and just accepting this is how it is. That’s just plain wrong! Just like you love your kids even if you don’t love the behavior, just like you accept them (vs. rejecting them) when they make mistakes, so too you must accept yourself. Accepting and loving yourself NO MATTER WHAT is the ONLY way you’ll recover.

So you see, it does matter. New dialogue:

Inner Bully (You): Stop pulling! Stop picking! You’re pathetic.
BFRB* Addict (You): I’ve already messed up my hair (skin) so much it doesn’t matter anyway.
NEW- Observer (You): Ah, there’s the addict trying to snow me into believing it doesn’t matter.
NEW-Supportive Friend (You): You know what, it DOES matter. It matters because how you feel about yourself matters. It matters because  it’s about small steps, and even if your skin or hair won’t shift right away, it will eventually if you take those small steps. And it MATTERS because this pulling or picking makes you feel like shit, and recovery only happens a moment at a time.

That same point must be made when recovery feels hopeless. One can imagine that that’s very much how someone who has 100 or more lbs to lose might feel. Because no matter what one does, change doesn’t come overnight. Also, you cannot stop pulling “FOREVER” all at once. You can only improve a little in each moment. Those moments will add up, and believe me, they can become a total cessation of pulling or picking, or a nearly total cessation of pulling or picking over time. But any efforts you do make must be made for TODAY only. Forever feels too big. Forever feels hopeless. Today (or even “right now”) need not feel hopeless. You will be able to DO today. And it’s ok if you can’t quite do that right now.

Changing the dialogue is the first step. Working on self-acceptance and self-love, letting go of negative reinforcement and focusing on positive reinforcement, that must be done before any other efforts are made.

And, NO, you won’t have to fight the urges forever. If you change your thinking and change your relationship with yourself so you can support yourself and love yourself through the process, the urges will start to subside. Just like with any addiction, the urges and the desire takes time to subside, and once in a while may show up out of the blue. That’s why you’ll need that “Supportive Friend” with you. The part of you that encourages you and believes in you, just as you do for your friends who aren’t you. Imagine if you could be as helpful to yourself as you are to others.

With practice, you will see that making just a little progress on this (which is all you CAN do) will eventually get you where you want to go. Just like a person who needs to lose 100 lbs. Yes, they won’t be where they want to be after a day or a week of progress toward healthy eating. But they will have taken a step. And it’s one step, then another, then another, and then maybe a step or two back. That’s how it goes. If you can find a way to accept that, if you can find a way to encourage yourself based on “progress not perfection” (AA), you CAN recover. If you continue to believe that it’s all at once or nothing, Your inner addict wants you to believe this so you will give in and pull or pick. Your inner bully wants to tell you it’s hopeless. But your inner Supportive Friend knows the truth. It’s one day at a time, one moment at a time, one breath at a time. It’s taking one small step and focusing only on what you can do, not what you cannot. THAT, I can tell you, is one of the most important things to know about the journey of recovery from BFRB*s. The second is, You CAN do it!

*BFRB = Body-Focused Repetitive Behaviors