by Mark Bowers, Ph.D.
Habit Reversal is a behaviorally based treatment that is used to reduce repetitive and often self-harming behaviors. Such behaviors typically serve no adaptive function and are often performed on a habitual basis, with no real awareness of the behavior. An example of such a behavior is the ritualistic “skin pick”. When an individual picks or squeezes the skin, this behavior is typically performed for a number of reasons: 1) In an attempt to alter cosmetic appearance associated with whiteheads and blackheads, 2) To reduce pain or pressure associated with a cyst or large pimple, 3) It can become “fun” (or a stress relief) to see the “white matter” ejected from your skin (one need only search for “zit popping” on You Tube to view clips of individuals basking in the glory of a productive pimple-popping session), 4) We don’t really even think about it. Perhaps there is even a reason or two why you do it that was not included in this list. Nevertheless, the typical acne sufferer is drawn to the mirror throughout the day to check the status of his or her skin, and picking can ensue. This process, however, begins to morph into a habit that perpetuates an addicting and vicious cycle. The cycle goes a little something like this: A pimple appears-we feel it on our face or see it while inspecting our faces in the mirror-we experience the urge to squeeze and pick-we squeeze and pick-irritation from our actions fosters more acne-a new pimple appears-well, you get the idea.
The problems with popping a pimple include irritation and the potential that your hands may be oily and will leave that oil on the face. We know that irritation and prolonged exposure to oil are two big factors in acne formation. You are using the wealth of information available on Acne.org to inform yourself about acne, and working so hard to develop the perfect personal regimen-isn’t it time you incorporate some Habit Reversal into the mix? Habit Reversal works to increase awareness of one’s behaviors, and to provide relief with strategies that replace the unwanted behavior with a less bothersome behavior. Give it a shot. What do you have to lose? Hopefully, the habit of touching your face.
The first step is to keep track of the behavior as it occurs. This step is referred to as self- monitoring and is essential to your overall success. Begin by placing a small notepad and pen near the sink of the bathroom where you tend to inspect your face. If you don’t want others to see it, place it in a nearby drawer or cabinet, but be sure it is readily accessible. You will be using the notepad to record each time the behavior occurs. The log should include not only frequency of the behavior (i.e., how often you pick or touch your face, or pop a pimple), but also times of day in which it occurs so that you can begin to recognize when the behavior is more likely to happen. If the behavior is frequent, it may be helpful to begin monitoring a specified amount of time each day, such as 30 minutes. I would suggest having columns on the page for date, time, and what the behavior was (e.g., “7-7-07, 12:15 p.m., squeezed a new zit”). See example log below.
Keep this log for the first week to determine how often, on average, you are touching your face. Also, look over the log after a few days to see if any pattern stands out (e.g., Do you notice that you are touching your face more in the evening when you are tired or bored?). If you are absolutely opposed to the log idea or think it may be too time- consuming, consider purchasing a golf counter from a local sporting goods store. These are inexpensive and all you need to do is click the counter each time you touch your face. Then record the number on the counter at the end of each day. This does not give you as much information, but it’s a start at the self-monitoring process. The bottom line is that there are lots of ways to be creative with self-monitoring (e.g., keep tally marks on the notepad if you don’t like the columns idea), which keeps excuses for not doing it to a minimum.
The next step in Habit Reversal is developing a competing response. A competing response is a different behavior that you choose to do in place of the undesirable behavior. A competing response uses the same muscles used in the initial behavior so that you are unable to do the behavior while engaging in the competing response. For example, some individuals use two index fingers to pop a pimple. Instead of touching your face with the two fingers, you would touch them together (away from your face), as if popping an imaginary pimple. Or, you can try clenching your fists so that your fingers cannot touch your face. The competing response should be held for at least one minute. It may sound silly in theory, but give it a try and see what happens. Another competing response is to walk away from the mirror for one minute to see if the urge to pick or squeeze passes. If not, and you must touch your face or squeeze, it is recommended that you follow the tips on the Popping a Pimple page contained on the main page of Acne.org. The main point is to stay with your Habit Reversal efforts and avoid frustration if you give in to the urge to pick or squeeze. If you can decrease the frequency at which you touch your face by just one time per day, think of the amount of breakouts you may be preventing over the course of one week or one month.
Finally, because many unwanted and repetitive behaviors are often increased during times of stress or tension, it may be helpful to utilize strategies that can help alleviate tension. This is a win-win because lowering stress levels may even help reduce future breakouts! The simplest way to so this is to breathe in slowly through your nose and then exhale through your mouth. You can even use this breathing technique as a competing response where you focus on your breathing for a minute instead of touching your face.
The bottom line is to experiment with some different methods to keep your hands away from your face. Use this article to understand the basic principles of Habit Reversal and then personalize your approach so that it works for you, just like you do with your daily regimen. The information contained in this article is intended to serve as a basic introduction to Habit Reversal and should never replace the personalized guidance of a health professional trained in this area. For some of you, this information will be enough and you’ll be a natural at self-monitoring and competing responses. For others, some additional guidance may be useful. Typically, any social worker, counselor, or psychologist trained in behavioral interventions will have familiarity with Habit Reversal. If you have concerns that you are causing significant damage to your face by picking or scratching, please consult a mental health professional to thoroughly address your concerns.
About the Author
Mark Bowers earned his M.A. in Clinical Psychology from Washburn University and his Ph.D. in Clinical Child Psychology from the University of Kansas, which was awarded the Outstanding Training Program in Clinical Child and Adolescent Psychology by the American Psychological Association. Mark completed his Predoctoral Internship at The Children’s Hospital in Denver, Colorado. He is currently in private practice in Lawrence, Kansas. Mark has extensive experience in psychological assessment, as well as individual and group therapy. His areas of emphasis include diagnostic evaluations, cognitive/learning assessments, and psychotherapy for individuals with mood and anxiety disorders. He is currently a member of the American Psychological Association and the Kansas Psychological Association. In addition to Mark’s clinical experience, he has also published various articles in peer-reviewed journals and served on the Student Board of Editors for the Handbook of Pediatric Psychology (3rd Ed.). Mark’s ultimate goal is to educate the masses about mental health issues and the connection between mind and body.
Author’s website: www.kspsychsolutions.com