An Early Psychologist’s Reactions to the 25th Annual Trichotillomania Learning Center Foundation for Body Focused Repetitive Behaviors Conference

by Hannah Sommer Garza, PhD

Wow! What a weekend! I’m flying back to Houston from San Francisco reflecting on my experiences this weekend at the 25th Annual Trichotillomania Learning Center (TLC) Foundation for Body Focused Repetitive Behaviors (BFRBs) Conference (http://www.bfrb.org/find-help-support/events/annual-conference) with a content smile on my face. From inspirational talks, shared experiences, new information, and good times with friends and colleagues, the weekend was jam packed with great moments. It’s hard not to leave the Annual TLC Foundation for BFRBs Conference feeling inspired and connected with other members of such a warm and collaborative community. If you’ve never been to the TLC Foundation for BFRBs conference YOU MUST GO!! Like, for real, you must go! There are events/talks/workshops/support groups for young children, adolescents, adults, supporters of those with BFRBs, researchers, and clinicians. There is something for everybody at all times during the Friday through Sunday conference, including social events and entertainment. I wish I could have been in multiple places at once, because it was hard to narrow down what events to go to this year. I will share some of my stand-out experiences from this year’s conference, and will just have to catch the ones I missed at next year’s rendezvous.

Friday’s Keynote

Daaaaaang…Milcho is a powerhouse! What a wonderful role model for what it means to love yourself and live your best life. Milcho is a musician and motivational speaker from Miami. She is a dynamic and sassy Latina who owned the stage. She would periodically pause for a photo op, showing off her best angles with a hip pop. She was full of energy and love, and offered some truly, truly, truly inspiring words to the group about working hard for yourself (and nobody else), loving yourself, and doing what makes you thrive. After her light-hearted and touching video compilation of some of her friends practicing talking to themselves in positive ways while looking in the mirror, she prompted the audience to open the provided handheld compact mirror and say supportive words like “I like you” and “I have a crush on you” #selfcrush. She rocked it!

Saturday Talks

Early Career Award & ECAP Research Data Blitz

I had the very special honor of being selected by the TLC Foundation for Body Focused Repetitive Behaviors as a recipient of the Early Career Award Program (ECAP) for Clinicians. There were 5 clinician recipients and 6 researcher recipients. As part of the award, the eleven of us were able to meet with Saturday’s keynote speaker, Susan Swedo, MD, and several of the TLC Foundation for BFRB expert clinicians and researchers to learn from their experiences and how to continue our careers within the TLC community. What a fabulous opportunity to learn from some of the greats and to share ideas about how we can continue to grow our community and our ability to effect meaningful change.

As clinicians, we were paired with an expert mentor to continue to consult and network with after this weekend’s activities. I am so thrilled to have been paired with Charles Mansueto, PhD, Director of the Behavior Therapy Center (BTC) of Greater Washington (http://www.behaviortherapycenter.com) and developer of the Comprehensive Behavioral (ComB) Treatment model for BFRBs. In addition to the obvious WOW factor of his accomplishments and influence on the BFRB community, he is one of the most hilarious people I have ever met. He’s one of those people who is so engaging and friendly, and has so many laugh-cry-inducing stories that it is a true pleasure to have him as a new mentor.

Later in the day, I attended an ECAP data blitz where three of the ECAP research award recipients shared their research proposals and preliminary results. Their research topics are so exciting and promising for the field, and I am very much looking forward to what they find. From genetic sequencing of parent-child trios, drug trials of intranasal glutathione (GSH) on mice with barbering and ulcerative dermatitis (proxies for trichotillomania and chronic skin picking in humans), and implementation of a self-help online application for chronic skin picking, these ideas have some phenomenal and far-reaching potential for the BFRB community. I’m excited to see what they find, and excited to see the future faces of BFRB research. Stay tuned!

CBT 101 Talk to Teens & Adults

My colleague at Psychology Houston, PC, Dr. Tyson Reuter, and I did two talks this year—our first ever talks at this conference. As clinical psychologists with specialties in cognitive behavioral therapy (CBT), adolescents, and BFRBs, we were PUMPED to share our knowledge about CBT and tips/tricks for challenging and changing pesky thoughts. We introduced principles of CBT, briefly introduced behavioral strategies for managing BFRBs, and emphasized practice with challenging and changing unhelpful thoughts. We were especially impressed with our adolescent group who were eager to share their experiences and to practice using some of the principles we were outlining. They were awesome at recognizing their own thinking traps and helping each other challenge them. Dr. Reuter and I intend to offer the talk year after year at future conferences, as long as there is demand for it.

Emotion Regulation Talk

I also attended Nancy Keuthen’s, PhD talk on Emotion Regulation and BFRBs. Dr. Keuthen is a Harvard psychologist. Her talk and skills primarily focused on dialectical behavior therapy (DBT) skills, tailored to people with BFRBs. I loved her overview and explanation of the skills, which was a nice review for me, with sprinkles of planned practice and intention with how to implement them after leaving the conference. She asked each of the participants in the audience to write in their provided PowerPoint handouts their personal goals in various emotion regulation areas. I found her talk to nicely bridge the gap between talking about certain strategies and helping people to actually implement them. It’s one thing to talk and talk and talk about swimming, but until you actually get into the pool, you have no idea how to swim.

Readiness for Change Talk

Into the meat of the afternoon on Saturday, I attended our very own Psychology Houston, PC Director, Dr. Suzanne Mouton-Odum’s talk on Readiness for Change. She talked about the Prochaska & DiClemente (1983) Stages of Change model and what that may look like for someone with a BFRB. She talked about steps for moving yourself along the stages of change, and differences between motivation and readiness. One of the most powerful things I took away from her talk related to the importance of acceptance as part of the change process. Because behavior change is hard, in additional to being motivated AND ready to change, you must also be able to accept the fact that your life will transform from what you know it to be now. Now really think about that. Your life will transform from what you know it to be now. It’s unrealistic to think that the only thing that will change in your life is to stop the BFRB behavior. If you’re holding onto that idea, you’re not ready for change. Working on acceptance and readiness at that stage will help move you along toward behavior change. She also normalized frustrations with getting stuck and the cyclical nature of BFRB recovery, alongside skills for problem-solving and acceptance to move toward change.

Dinner and Fundraiser

Although I wasn’t able to attend the fundraising dinner at this year’s conference (due to my only opportunity to catch up with a good friend in San Francisco), I heard from colleagues and friends that the food and entertainment was fabulous. The fundraising dinner is an integral part to the ability of the TLC Foundation for Body Focused Repetitive Behaviors to provide outreach services and to fund research. Federal funding for psychological research is sparse in general, and is even less likely to go to BFRB research for various reasons. That leaves the TLC Foundation for BFRBs organization to essentially stand alone in order to continue to study the etiology of BFRBs and potential mechanisms for recovery. That means that in order for us to continue making forward progress, we RELY ON YOU. If you’re interested in donating to the cause, I encourage you to reach out to the TLC Foundation for BFRBs (https://www.bfrb.org/donate). Give what you can give, whether that’s $20 or $1000. Any bit moves us forward in hopes of helping more and more people find relief. For that, we thank you!

Reactions and Takeaways

One of my reactions may sound controversial on the surface, but I hope I can express my thoughts clearly enough to avoid them from being misunderstood. Perhaps I’m also biased as a behavioral psychologist, but I do notice myself feeling somewhat discouraged when I hear the results of some of the drug trials searching for a medication treatment for BFRBs or a “cure.” I find that the proposals sound extremely promising, and I get my hopes up about an “easy” fix. Then the results are described by the research experts, and there’s kind-of-sort-of some support…but we’re still left without clear answers.

However, there is support for behavioral treatments for BFRBs as outlined by the TLC Foundation for BFRBs Scientific Advisory Board, a panel of expert BFRB clinicians and researchers. Because behavior change is hard and involves a profound personal transformation (among other factors), my fear is that many of the folks with BFRBs are waiting for this magic medication (or supplement) to change their lives. I fear that in some way this reliance on finding a medication encourages people with BFRBs to “wait to live their lives” for when this “cure” is discovered. Since this “cure” could be around the corner, there is in some way a sort of excuse or lack of urgency to change a behavior that you may want to change. If this is the case, my heart hurts a bit. I feel so much connection to this community and want so desperately to be a resource for people who want to change this behavior to find their version of recovery (whatever that means to them). I can feel the strong desire to find a solution, and I want to help people find that as soon as possible. The truth is that the “cure” could be around the corner, but it also may not be. Why wait? Why not work toward change, learn some skills and ways to manage your BFRB? Borrowing from Milcho’s message, empower yourself. Do this for you. Love yourself enough to take things into your own hands.

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