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Habit Reversal Training for BFRBs in Orlando
Hair Pulling & Skin Picking Therapy

At GroundWork in Orlando we are pleased to offer specialized, compassionate, and evidence-based care for Body Focused Repetitive Behaviors (BFRB) utilizing Cognitive Behavioral Therapy (CBT)  and Habit Reversal Training/Therapy (HRT). Our therapists truly specialize in effective treatment and provide comprehensive therapy for BFRBs such as trichotillomania, skin picking, and more.

What is A Body Focused Repetitive Behavior (BFRB)?

Body Focused Repetitive Behaviors (BFRBs) are a group of mental health conditions that include hair pulling (Trichotillomania) and skin picking (Dermatillomania). There is often significant distress along with a strong urge or tension to perform the behavior. BFRBs often start in adolescence, but can begin earlier or later in life for some individuals. BFRBs can be harmful to physical and emotional health because there is usually a desire to stop engaging in the behavior but a difficulty in actually stopping. BFRBs often co-occur with other mental health conditions, such as OCD, depression, and anxiety. BFRBs can have a wide range of severity and symptoms may vary. In one documented study approximately 20% of participants with OCD also had a BFRB.

Common BFRB symptoms include recurrent, intentional pulling or picking of one’s own hair, skin, and nails. Symptoms can also include repetitive behaviors such as biting the skin around the nails, chewing on the inside of the mouth, or rubbing an area of skin until it is raw. BFRBs can be associated with feelings of shame, guilt, and embarrassment due to their visible nature or the damage caused by BFRB behaviors. There is a strong correlation and co-occurance between BFRB and OCD. BFRBs can be accompanied by OCD-related thoughts and rituals, or happen independently from the disorder.

Most Common BFRB Types:

  • Hair pulling (Trichotillomania) – the most common BFRB symptom. This characterized by an irresistible urge to pull out hair from any part of the body where hair grows (head, brows, eyelashes, facial/body hair), resulting in noticeable bald patches.
  • Skin picking (Dermatillomania / Excoriation) – is characterized by an irresistible urge to pick at one’s own skin, often resulting in skin damage and scarring. Skin picking can occur anywhere on the body, but is most common on the face and arms.
  • Lip or Cheek Biting – Biting of the lips or cheeks is a BFRB symptom. An individual will bite their own lip or cheek until it bleeds, or until the area is raw. Biting can leave visible marks and may lead to skin damage.
  • Nose Picking – BFRB nose picking is characterized by repetitive, compulsive picking and digging in the nose. Nose picking can lead to visible damage and scabs.
  • Nail Picking – BFRB nail picking is characterized by an irresistible urge to pick at one’s own nails; often resulting in damage to the skin and nails.
  • Knuckle Cracking – BFRB knuckle cracking is characterized by an irresistible urge to repeatedly crack one’s own knuckles; often resulting in soreness and pain.
  • Teeth grinding – BFRB teeth grinding is characterized purposeful by someone grinding their own teeth; often resulting in jaw pain and possible tooth damage.

Though BFRBs are common mental health disorders, they often remain undiagnosed or untreated due to a lack of awareness about BFRBs in society and among medical professionals. It is important to seek help from a mental health professional if BFRB behaviors are causing distress or interfering with daily life.

Treatment options such as cognitive behavioral therapy, habit reversal therapy, and stress management techniques can be effective in reducing BFRB symptoms. With the right support, people living with BFRB can learn to manage their symptoms and lead healthier lives.

Habit Reversal Training & Therapy for BFRB

Habit Reversal Therapy (HRT) is an evidence-based treatment for Body Focused Repetitive Behaviors (BFRB) such as hair pulling (trichotillomania) and skin picking (excoriation disorder). HRT helps to empower clients by teaching them how to become aware of their BFRB, manage their urges and respond differently to BFRB triggers. HRT consists of four components: awareness training, competing response training, relaxation techniques, and cognitive-behavioral therapy (CBT).

Cognitive Behavioral Therapy for BFRB in Orlando

Cognitive Behavioral Therapy (CBT) is an evidence-based treatment for BFRB. CBT helps clients become aware of and challenge their BFRB-related thoughts, feelings and behaviors in order to reduce BFRBs’ frequency, intensity and duration. CBT includes teaching practical self-management skills such as problem solving, relaxation and stress management, communication and emotion regulation. CBT also helps to identify BFRB triggers, learn to respond differently when BFRB urges occur, and manage BFRB-related anxiety.

Comprehensive Behavioral Treatment is also interwoven with CBT and HRT for the most evidence-based treatment.

Finding The Right Help

It is important to find someone specifically trained to treat BFRB. A BFRB specialist can help develop an individualized treatment plan that takes into account the client’s unique BFRB triggers and context. A therapist specifically trained to treat BFRBs will not only evaluate and diagnose the disorder appropriately but treatment will be structured and goal oriented. HRT and CBT are vastly different than talk therapy. If BFRBs are impacting your life, GroundWork Counseling in Orlando can provide the support and guidance necessary to help you overcome Body Focused Repetitive Behaviors BFRB.

At GroundWork we offer HRT, CBT, and Comprehensive Behavioral Treatment for Body Focused Repetitive Behaviors; initially providing a thorough evaluation, then creating an individualized treatment plan that takes into account the unique BFRB triggers and context of each client. Therapists at GroundWork Counseling are also up to date on the current holistic and supplemental BFRB treatments. These range from lifestyle changes, nutrition changes, to research supported supplementation protocols. We utilize evidence-based HRT and CBT to help clients learn to manage BFRB-related distress and lead healthier lives. With the right help, BFRB can be managed and even eliminated. At Groundwork, we offer both virtual and in-person visits for BFRB treatment.

Ready To Make A Change?

GroundWork is proud to offer both in-person &
virtual Telehealth appointments.

In-Person Sessions: Central Florida
Virtual Sessions: Florida, Maine, South Carolina, Montana, Vermont



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GroundWork Cognitive Behavioral Therapy
341 N Maitland Ave #330
Maitland, FL 32751


411 Congress St #3292
Portland, ME 04101

Burlington, VT 05043

Virtual & In-Person Appointments

Virtual / Telehealth appointments available for individuals residing in: Florida, Maine, Vermont, South Carolina & Montana

In-person appointments available in Central Florida. By appointment only.

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