Presented by Suzanne Mouton-Odum, Ph.D. For the Austin Trich Support Group Austin, Texas

1. Readiness for Change Presented by Suzanne Mouton-Odum, Ph.D. For the Austin Trich Support Group Austin, Texas February, 2014

2. Motivation vs Readiness Ambivalence: Raise your hand if you want to stop pulling/picking? It is not the pulling/picking that you want to stop, it is the consequences of the pulling and picking that are unpleasant. Which comes first, motivation or action? Can you have motivation without readiness? Can you increase readiness? YES!!!!!

3. Are You Ready? Behavior change is a process, not an all or nothing event. It involves a shift in motivation or readiness to change. Your decision to change is like a weight scale; the balance shifts depending on how you view the pro’s and con’s of changing.

4. The Pro’s and Con’s of Change Con’s Pro’s • Less worry about bald spots/scabs/scars. • Less time getting ready and more time for fun. • Less family conflict. • I will be happier. • More money for me! • It is hard! It will take a lot of time and energy. • I will miss it. • I will have to find other ways to feel good. • I will have to allow things to exist that are uncomfortable.

5. The 6 Stages of Change • Pre-contemplation: • Not even considering changing your behavior. • Maybe you think it will go away on its own or maybe you don’t even really acknowledge to yourself that you do it or that it is a problem. • Resistant to ideas of change. • Has no intention to take action within the next 6 months Prochaska and DiClemente

6. The 6 Stages of Change 2. Contemplation: • Maybe you have looked it up on the internet. • Maybe you have done some reading. • You still have not told anyone except maybe spouse or very close family members. • You want it gone, but not sure you want to do anything about it. (Tumor analogy) • Intends to take action within the next 6 months. Prochaska and DiClemente

7. The 6 Stages of Change Prochaska and DiClemente 3. Preparation: • Maybe you have called a therapist. • You are at this workshop voluntarily. • You are possibly planning to make some changes. • Interested in hearing about what change would involve. • Intends to take action within the next 30 days and has taken some behavioral steps in this direction.

8. The 6 Stages of Change Prochaska and DiClemente 4. Action: • You have started behavioral therapy. • You have begun monitoring behavior. • You have started to make changes in lifestyle to support a non-pulling/picking existence. • You have accepted that this is a part of you and that you, like someone with diabetes, will have to manage it to be successful. • Has changed overt behavior for less than 6 months

9. The 6 Stages of Change Prochaska and DiClemente 5. Maintenance: You still may experience slips, but these are rare. You have changed overt behavior for more than 6 months. Slips occur, but are well managed and not frequent. 6. Termination: You can look back and think about “when I used to pull” and not have any urges, slips or setbacks. Overt behavior is unlikely to return, and there is complete confidence that you can cope without fear of relapse.

10. Elements of Readiness Acceptance: (Pre-contemplation, Contemplation and Preparation) Are you dealing with the shame surrounding your BFRB? Are you in denial about your BFRB? Do you think it will just“go away?” Understanding how BFRBs affect your life, both positively and negatively. Can you talk about it? Do you love yourself despite your BFRB? Who have you told? Can you educate others about BFRBs? Have you abandoned the search for the magic bullet? Do you understand that improving your BFRB involves changing many aspects of your life? Is that OK with you? i.e., no TV Have you made a plan?

11. Elements of Readiness 2. Taking Responsibility: (Action, Maintenance and Termination) Are you active in your recovery? Do you work your plan each day? Do you acknowledge your BFRB and/or recovery each day? Use markers? You are the only one who can effect change in your behavior. Are you relying on others to help you make changes? Are you making changes because they are what YOU want, not to please others? Are you making sure your needs are getting met in all areas of your life? Are you being proactive? Are you rewarding your successes? Are you learning from your failures? Can you visualize yourself BFRB free or in recovery?

12. Visualize Readiness Visualize yourself as a person who is attending to his/her needs daily, that is thinking ahead, predicting hard times, and using strategies accordingly. Visualize yourself as a person who is OK with his/her BFRB, not angry at it or in denial. Visualize yourself accepting that your BFRB just “is” and that this is not a terminal illness or a death sentence. Visualize yourself as a person in recovery. What would that look like? How would that feel? What is recovery for you? Visualize yourself as a person who is actively dealing with slips and relapse, who can predict and anticipate hard times.

13. Readiness Plan: What Can I Do? • Acceptance: • Exercise self-compassion. Be your own best friend. • Get social support (TLC, support groups, friends/family). • Forgive yourself for not being perfect. • Accept that this is a process, not a light switch. • Taking Responsibility: • Turn anger/self-pity into action. • See each minute, hour, day as an opportunity to do better. • Get excited about the possibilities. • Walk out of here with a plan, even if it is just to be kinder to yourself.

14. Remember… “You are not responsible for the fact that you [or your child] have a BFRB, but you are responsible for how you approach it. You can either choose to be a victim, or learn to walk with grace.” Christina Pearson, Founder TLC