Competing Response Strategy That Works

A competing response, also known as a competing behavior, an incompatible behavior or a competing habit, is a strategy used in behavioral therapies such as habit reversal treatment to replace or counteract an unwanted or problematic behavior. Using a competing response involves teaching a person to engage in an alternative behavior that is incompatible with the target behavior, making it difficult for both behaviors to occur simultaneously. In other words, a competing response is everything you do that prevents you from picking/pulling while you’re doing it.

Competing responses are a staple of BFRB treatment, very frequently the first concrete set of techniques that a person implements, before moving on to more advanced ones. They are also commonly used in the treatment of compulsions but also simply any habit you wish to get rid of and replace.

The goal is to reduce or eliminate the frequency or intensity of the problem behavior by actively engaging in a different behavior that serves as an alternative or substitute. Read this again: the goal is to reduce or eliminate the frequency or intensity of the problem behavior and not to find something that feels the same.

For example, in the treatment of trichotillomania, you may learn to recognize the triggers and urges that precede hair pulling. That’s always the first step, because without awareness of urges or pulling you won’t even know that you need to use a competing response. Common sense, therefore, not some sophisticated psychological thinking. When a person experiences a trigger or an urge, they can be trained to perform a competing response, such as clenching their fists, squeezing a stress ball, or engaging in another activity that requires the use of their hands, which makes it physically difficult to engage in hair pulling.

Before we dive in deeper into the exploration of competing responses, let’s outline the process itself:

1.      Developing awareness

2.      Selecting a competing response

3.      Testing a competing response

4.      Evaulating

5.      Contuning practice and awareness development

I won’t discuss the awareness development process in detail in this article. This was addressed in some previous articles and if you want, I will write one that systematically deals with different ways to develop awareness of your BFRB. For those of you in the VIP Lounge, there’s a simple self-monitoring worksheet that you can download to start working on this aspect, and you’re free to share it with me if you need feedback.

How to select your competing response?

It's important to note that the selection of a competing response should be tailored to the individual's specific needs and circumstances. While it’s nice to see what other people use, just because something may work for 90% of the people, it doesn’t mean it will work for you. Shop around for ideas, but don’t accept them uncritically.

The alternative to picking or pulling should be:

·        Acceptable, which means that you’re actually willing to do it.

·        Effective in counteracting picking/pulling.

·        Your competing response should be as simple as possible.

Another thing to remember: your competing response is just one aspect of the whole healing process. It is not meant to be the only thing. To give an example: when you struggle with stress headaches, Tylenol can help, but ultimately you have to work on whatever is causing your stress. Absolutely the same thing applies to body-focused repetitive behaviors.

Setting the right expectations

In my experience, the most common cause of failure with competing responses is setting unreasonable expectations. Let’s bust some myths.

·        Your competing response will not feel as good as picking/pulling and this is not its function.

·        Less is more applies to fashion but also to competing responses. Trying more than 1 at a time makes it very likely that you will fail.

·        When you use a competing response, its goal is to make it difficult or ideally impossible to pick or to pull while you’re using it. No more and no less.

·        It will take a long time for your competing response to become as natural as picking/pulling feels, because natural is just another word for habitual. It will feel forced in the beginning and this is OK.

·        Don’t expect to find what works immediately. You may be among the lucky few, but most people have to go through a period (or even periods) of looking for the right combination.

·        You won’t do anything perfectly.

Selecting an appropriate competing response

Based on your self-monitoring experience or the awareness of your BFRB overall, consider the following: where do you typically pick/pull, who is with you or are you alone, what triggers the urge to pick/pull.

Write these down on a piece of paper and then consider one or two competing responses, but not more than that. There are two requirements to consider:

1.      You can use them with relative ease in at least 80% of instances when you need to.

2.      You are willing to use it.

Don’t be afraid of failing or choosing the wrong response. You most certainly will because you are human and the way we change is experimental and messy. Even when you work with a therapist, change isn’t a straightforward path to success. Choosing a wrong competing response can also be useful information: perhaps there are some aspects of your BFRB that you need to observe more and learn about, maybe you’ve made a methodological error and you need to reconsider the type of response, perhaps look inward and reflect on your willingness or even resistance. Every scientist will tell you that there’s no scientific progress without failure and pretty much the same goes for our personal lives.

Testing the chosen competing response

People often ask why I insist on only one competing response at a time being tested and to explain it, let’s keep rolling with the scientific analogies. Can you test 7 different hypotheses in one experiment? You can’t. Well, you can try, but good luck interpreting the results!

If you try 3 or 4 competing responses at a time, you are essentially committing to establishing 3 or 4 new habits. Habits are hard to form and hard to get rid of even when you do it one by one. Trying to do 4 at a time is all but a guarantee to fail. Another reason is that you won’t be able to assess the effectiveness of each of these responses. Even if you experience improvement, how do you know if it’s because all of them helped a little or because just one helped a lot? Do you then continue to use all of them, when you could possibly go on with just one? Or do you change some and keep the others, if so – how do you make the selection?

To make things simple, here’s how to do it:

1.      Select one competing response.

2.      Give yourself a week or two to implement it.

3.      Use it regularly (more on this below).

4.      Keep notes daily on how effective it is and track your willingness to use it.

5.      Assess at the end of the week.

Practice!

Think of a competing response as a new habit. Your picking and pulling also obviously have a habitual aspect to them, but that didn’t form when you did it once or twice. There are many things in life (good and bad ones) that we do occasionally, yet they don’t become habits. For something to become a habit, it needs to be repeated over and over again, and for something to become so automatic that it unfolds unconsciously, even more repetition and validation!

When you find a competing response that works, in order to keep reaping the benefits, you have to practice. Practicing doesn’t mean using it only when you need it but using it often in those specific contexts where you pick or pull.

·        Schedule practicing in important situations or places daily.

·        Use the competing response when you anticipate that you may be triggered.

·        Be very mindful of your resistance to practice and use, and discuss this with your therapist or in the Club. Resistance is something to understand and work through, it’s bound to occur.

If you have a competing response that works, there is no need to add more of them.

Move beyond

While competing responses are useful and effective, in my experience, too many people end up fixated on the behavioral aspect of BFRBs and neglect what I think of as core issues: emotional regulation, self-soothing and all the other psychological needs and intricacies.

While having a functional competing response is an important part of the process, it’s not where the story ends. A competing response is not a miracle cure. It’s merely a useful tool that will allow you to reduce the damage you do to your skin and your hair, but it’s not going to be the final solution for your BFRB.

Once you find a competing response that works, practice it and use it often. But continue to explore other aspects of your picking and pulling, those that pertain to emotional regulation, experiential avoidance, relationship to your skin, perhaps issues such as perfectionism, self-worth, etc.

To conclude…

·        Be strategic.

·        Don’t rush. Try them one by one and evaluate each response separately.

·        When you find what works in most situations – keep it and practice it.

·        Practice. Did I say you need to practice?

·        Make notes, keep records, do our accountability prompts to follow your progress.

·        Remember that you have to fail to succeed.