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Don’t Touch Your Face: Tips from a Habit Reversal Therapist!

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The message is everywhere. From the CDC and public health officials to memes on social media, we’ve all heard it: Don’t touch your face. It’s one supposedly simple step you can take towards “flattening the curve,” but it’s not the only step. By taking preventative measures like social distancing and appropriate hand washing, we can work to slow the spread of Covid19 and not overwhelm our health system. 

However, as widespread attention has been brought to the importance of not touching your face, people are becoming increasingly aware of this pervasive habit. So many friends, family members, and co-workers have shared a common sentiment: “I never realized how often I touch my face.”

As a therapist who specializes in Habit Reversal Training (HRT) for body focused repetitive behaviors, I am much more aware than most of how often people touch their face. Body focused repetitive behaviors, like trichotillomania or compulsive skin picking, are part of a set of complex disorders in which an individual touches or manipulates their skin or body in a way that causes damage. We use behavior therapy to learn how to change the habits of the disorder. Given that the most common sites for these behaviors are the face and scalp, a crucial and difficult part of this therapy is becoming aware of how frequently your hand raises towards your face and head. 

Now that the importance of “not touching your face” is emphasized as a way to flatten the curve, here are some lessons worth sharing on behavior therapy and Habit Reversal Training which can help you manage that urge to touch your face. 

Tracking

To change any behavior, we have to be aware of when and why we do it. Writing down the times you engage in the unwanted behavior has multiple effects. First, forcing yourself to write it down may deter you from doing it. Second, you will become more aware of situational factors that make you more vulnerable to the behavior. 

Are you more likely to touch your face when reading? Are you more likely to do it when bored versus actively engaged? Do you tend to have any spots on your face that itch more than others? Over the past few weeks, I, personally, have become aware that I tend to touch my face when writing on my laptop (as I’m doing now), particularly if I’m pausing to think of what to say next. With tracking, you can start to develop interventions based on your particular vulnerability factors. 

Stimulus control

Stimulus control refers to identifying the factors that trigger the behavior (stimulus) and trying to change those factors. It may not make the behavior impossible, but it helps to create a little more distance between the impulse and the actual behavior. Once you become aware of when you’re more vulnerable to face touching, you can start to put in obstacles to avoid it. 

You may notice that you tend to do more face touching when you’re bored or when your mind is elsewhere. Here are some tips for changing common situations:

  • If you notice that you tend to touch your face when scrolling through your phone on the couch, make sure you have a fidget toy to play with in your free hand. 
  • If you notice that you tend to touch your face when zoning out to a movie, set regular reminders throughout to notice the location of your hands. 
  • If you find you rest your face on your hands in a certain chair, actively try to adjust to a new position where you don’t rest your face on your hands. 
  • For individuals with longer hair, you may notice that you have the urge to touch your face when adjusting your hair. Putting your hair back or up can help decrease this frequency.

When I’m writing, like right now, I’ve started using a new website designed to increase awareness while working on a computer. Donottouchyourface.com created an algorithm to increase your awareness, and can be programmed to send you a notification when you start touching your face while working on a computer. Fingers crossed that it helps with my habit! 

Increase awareness 

Mindfulness practice in general is a great skill for coping with anxiety and the uncertainty during situations like this.  With mindfulness, you can become much more aware of physical sensations, urges, and behaviors. How aware are you, really, of the process of face touching? What does the itch of your skin feel like? What about the sensation of the pull from your hand towards your face? What thoughts are you having before and after? 

Many folks who come in for HRT will tell me in our first sessions, “Nothing happens before I pull! I don’t think of anything!” I imagine any of you reading this would also say similarly, “It’s just a habit, I don’t think anything.” 

When something has been habitual for a long time, the behavior in response to the physical sensation of discomfort can become so automatic we become unaware that there is a preceding thought. But commonly, when we start to work on awareness training, the thoughts related to the habit surface. The most common thoughts include “Just do it!” or “You’ll feel better after!” or “Just this one time, and then you’ll stop!” Or most commonly, “This feeling won’t go away until you do it.” The mind basically becomes an advertising slogan factory for the habit.

I challenge you to take 30 seconds right now and start to notice your face. Notice any spots of itchiness or where you need to adjust your hair. Maybe you have an eyelash out of place. What is your mind telling you about that feeling? Not for all, but for many, the mind begins to tell you that you have to do something to get rid of that discomfort, that itch, or that twinge. By becoming aware of these advertisements, we can start to have agency over which of these ads we want to listen to. Even if your mind is screaming “you have to do this or it won’t feel better ever,” you’ll start to learn that this too shall pass. 

I often play a game with clients working on these habits called “Catch the Urge.” In the game, we talk about something unrelated for a few minutes. If I notice their hands go up to their face or hair, I put my finger up and I get a point. But, if they notice themselves having an urge or starting the behavior before I do, they put their finger up and get a point. Why do we do this silly game? To practice the habit of noticing and to become more observant of your behavior and urges. This practice is transportable. In this age of telehealth, I can practice this virtually with any clients anywhere through video calls. Even better, it can be more realistic while immersed in the settings where they struggle with the behavior. And you can practice with a friend for a few minutes to increase your own awareness of your face touching urges. 

Competing response

Competing responses refer to behavior that is physically incompatible with the undesired behavior. We introduce competing responses as a means of breaking the cycle of relying on the habit to relieve the discomfort of an urge. Most commonly, it’s doing something else with your hands for one complete minute or until the urge goes away, whichever is longer. For face touching, most commonly, I recommend making a tight fist at your waist with both hands. You can also do this by sitting on your hands or holding your fingers and hands flat against a surface. The important thing is to try and do it for the full sixty seconds or until the urge goes away. This becomes a new learning experience for the mind: that we don’t have to listen to those advertisements in our brains that tell us these habits bring relief.

It’s important to know that bringing awareness to these habits can temporarily increase them. With the media’s constant reminders to not touch our face, we are more aware of the fact that we do, in fact, touch our faces often. It’s important to know what’s normative and what may need help from a professional. 

Most people have a habit of touching their face consistently throughout the day. If you are noticing that your face touching feels beyond your control and has turned into picking, or if the increased awareness has brought your attention to habits of skin picking or hair pulling, it may be time to seek help from a professional. 

The TLC Foundation has a directory of therapists who specialize in evidenced-based treatment for body focused repetitive behaviors. We also treat this at Brooklyn Minds, offering video sessions as needed. In this time of social distancing, this type of therapy translates easily into a telepsych format, so we can all do our part to flatten the curve while taking better care of ourselves and seeking professional care.