BFRBs & Journaling: An Exercise with Journal Prompts

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People who struggle with body-focused repetitive behaviors (BFRBs) like skin picking or hair pulling often primarily focus on different tactics to replace the picking or the pulling with a healthier habit. This is understandable and even obvious: of course, you want to reduce your symptoms! But there’s more to change than that, and when we put our complete focus on symptom reduction, we fail to consider the source of those very symptoms.

The little research that we have points us to emotional regulation as an issue to work on to deal with BFRBs in a more fundamental way. Once you get to the messy emotional part, things get increasingly difficult because there are no strict rules to make sense of what we feel. It’s easy to fall into the trap of denouncing our emotions as irrational or feeling discouraged since there’s no way to escape one’s biology. 

The Story is the Problem

I propose a third way. Nothing that arises in our experience is a problem. The problem is the story we weave around those experiences and the spectrum of actions that these stories allow us to take. If you are going to have some new options in front of you, according to this logic, then you need an alternative story.

Keeping a journal is not just a way to keep track of your urges or vent about the miserable day you’ve had. Sure, a journal can do both of these things and it can be a useful, healthy thing to do, but they can help with much more than that. 

Two People, Two Different Stories

Here’s an exercise that you can try along with journal prompts. The idea behind this exercise is to give you a different narrative of your existing picking/pulling problems, as well as to give you a seed of another possible narrative that you can then use to craft practical techniques and set goals for yourself.

I always like to mention that you shouldn’t rush and instead take your time, so here I am mentioning that again. Let go of any logic or preconceived ideas on what the right answer ought to be and see what comes out. When you journal, leave your critical mind aside and focus on what spontaneously comes.

Whatever spontaneously comes in response to a prompt may seem strange or irrelevant, but roll with it. Come back to that entry a day later, read it and write any additional thoughts. We are looking to dislocate you from your habitual thinking, so a dose of confusion is not necessarily bad.

Step 1 

Before you start journaling, you will do an exercise using active imagination. If you have several different scenarios to imagine – even better, you can repeat the whole process several times over. Sit in a comfortable position, take a few deep breaths. If you practice mindfulness, it’s not a bad idea to meditate for a few minutes before you start. 

Close your eyes. Visualize a common pulling/picking scenario. You can recall a specific episode too if that works better. Recall the place with as many details as you can, recreate the atmosphere with any sensory detail that matters to you: temperature, sounds, smells, etc. Then allow your mind to play out a scene as if it were a movie. You are looking at yourself in third person, if it will make it easier for you to watch without identifying yourself with the “you” from the scene, give the character a name. Frank or Joyce. Whatever. Allow the scene to unfold and watch it until you are done and you leave the room. It’s a movie so you can include a voice-over. Imagine the specific sequence of events that unfolds, what the character looks like, what they’re wearing, what their emotional state of mind appears to be, if you can hear their thoughts – what are the thoughts, etc. 

When you feel like the exercise is done, simply open your eyes. Then, take your journal and start working on the prompts. You can repeat the visualization for each prompt. I can’t emphasize how important it is to pace yourself and not rush through these.

Journal prompts:

• The person I see in my mind's eye is feeling...

• Imagining this person pulling makes me feel...

• This person’s body language tells me…

• If I were to walk into that room right now, this is how my dialogue with her would be like...

• What is it that I as an observer see and the person in the scene doesn't?

• Were there any unexpected details that your mind added or emphasized? List them and reflect on what the might mean.

Step 2

Once more, sit back and relax, prepare yourself for another visualization. The scene takes places in the exact room where the first one did. Only now, you're playing a drastically different scene with a different outcome. The person you are imagining is coming back to the room, doing whatever it is that they need to do. The same thing grabs their attention and triggers discomfort, but this time around, even though there is some visible indication of distress, there is no picking/pulling. Instead, the person finishes what they started and go out.

Journal prompts:

• Imagining this scene felt…

• As I was imagining the scene, I was thinking…

• The person in the scene was feeling…

• What allowed this person to move past the triggering discomfort without reacting?

• Keep that person’s facial expression and posture in your mind’s eye. Imagine their story. Write their biography.  

• Did your mind add anything to this scene? 

• The atmosphere of this scene was…

Step 3

In this step, you can repeat both scenes, compare and contrast them. The second scene didn’t present a completely opposite scenario where the person comes and goes without feeling triggered. A scenario like that wouldn’t give us anything new. What we want to reflect on is how someone deals with the urge in a different way – how to feel it but not be reactive. 

The reason why I suggested a biography of “person 2” is because it’s a good way to get your mind to think in terms of long story arcs and how different life circumstances and experiences may create different people. If you can imagine a scenario and a person that can persuasively play out that role, it means that you’re able to slowly incorporate parts of that role into your own life. Mind you, there are many difficult points surrounding the incorporation (perhaps a topic for another blog), but you have to start with another narrative if you are going to find new solutions. 

If your journal entries end up being vague, add more entries over the next days and weeks. Each time, a new piece of the puzzle will be added and you’ll get a clearer picture. 

• When I put person 1 and person 2 next to each other, they are similar in the following ways...

• When I put person 1 and person 2 next to each other, they are different in the following ways...

• What can person 2 learn from person 1?

• What skills do you need to go from person 1 to person 2?

A few more ideas

• If you like to draw or paint, you can use your skills and paint both scenarios and then journal about the experience.

• Consider revisiting journal entries every week: you might get inspiration to expand the entries with more details, but you can also see where you are on the spectrum from person 1 to person 2.

• Instead of using generic “person 1” and 2 names, you can instead assign these two people different names.

• You can imagine and write dialogues between them. The more they talk, the more you learn about how to get to where you want to get.