How to apply values-based therapy to manage compulsive skin picking

What is values-based therapy?

There are many therapeutic interventions to help an individual focus on what is important to them. Values are those things which someone prioritizes as valuable. They can be things, ideas, people or activities and people make decisions consistent with what is important to them. Values-based therapy starts by setting up new values or reviewing existing values. This happens before discussing the problem because every step of therapy afterwards will use values as the foundation for decision making and treatment planning.

For example, someone who values family will decide on a job offer based upon that value. Maybe the job includes a prominent title, a raise, and an expense account, but requires a move to a large city. The family, however, lives in a small town where the kids have friends, are involved in school activities, and changing all of that could be developmentally harmful. Also, the spouse participates in community activities and extended family lives nearby. In a case like this, it may not be in the family’s best interest to leave. A person who values family before money and success will consider the rest of the family’s interests. On the other hand, someone who values prestige and money will make a very different decision. Of course it is not always that black and white. Sometimes our values are so intertwined and influence each other. For example if you value being a provider for your family, or higher education for your kids for example, and you are not able to live these values in the small town then you may decide to take the big city job not because it is more of a priority, but because it is a means to living your true values

You may be thinking, “I am trying to change behavior, why should I care about values?” Because values drive motivation and change.

Motivation

Motivation directly links to change. The study of motivation comes from addiction research, but can apply to any change a person wants to make. From the study of motivation came the transtheoretical model of change which outlined several stages of change that define a person’s readiness or motivation for modifying behavior. The smoker who intellectually knows the dangers of the behavior, but still does not quit, is in the contemplation stage of change. They understand the reasons why they should stop, but they don’t want to. In this case, they have no internal motivation for change, therefore they will not change no matter how much someone else wants them to change. Understanding a person’s stage of change for a problem will tell a therapist what type of intervention to use. To get someone to act who is in the preliminary stages of change, internal motivation must be discovered. One way is to figure out values and how the behavior fits in with one’s values. 

Values-based therapies begin to establish what is most important in someone’s life. This also begins the process of detaching the behavior, or problem, from the person. Let’s generalize and call excoriation disordered behaviors “the problem.” People who struggle with excoriation disorder often focus on the problem. The problem itself, engaging in the problem, thinking about the problem, hiding the problem, feeling guilt or shame about the problem, and knowing the problem needs to be fixed take up a lot of time, effort, and mental space. Loved ones focus on the problem, coworkers may notice the problem and eventually life centers around the problem. But what about the person who struggles with the problem?

How to apply values for behavioral change

A values-based therapist wants to know about the person:

• What motivates the person who struggles with the problem?
• What does that person value?
• How does the problem fit into the person’s values?

A therapist guides a client through a series of questions:

• What is important to the person?
• Why is it important?
• Where does that value originate?
• How does what is important affect goals?
• How do values impact decisions in daily life?

For example, if someone values the environment, day to day decisions will take into consideration the effect those decisions have on the environment. Do They walk to work or drive? Do they recycle or not? Do they bring bags to the grocery store or use plastic? Do they buy new things or repurpose?

The values discussion and skin picking

• What do you value?
• How does skin picking fit into those values?
• Do you value skin picking?
• Why or why not?
• Is it in conflict with a value?
• What does skin picking do for you?
• How did it start?
• How does it affect your goals?
• How does it change decisions in daily life?

The values pie chart is a way to begin discussing what your values are and which ones carry the most importance. Once your values are clear, think about how much time you spend on activities that support your values. This may lead to thinking about what activities you already do or what activities you could do to align with your values. Discuss the motivation of skin picking and how the behavior fits with your values.

Once values are figured out, daily decision making can turn into a deliberate process of aligning with values. You have a choice about how you spend your time. For those who struggle with compulsive skin picking, mindfulness training can teach you how to be present in the moment so you can make deliberate decisions about how you spend your time. For example, if you value learning and want to pursue a degree, time spent on skin picking behaviors may interfere with studying or going to class. Mindfulness and values-based therapy teaches you to slow down and think about what you want to be doing right then. Do you choose to do something you value or something that interferes with your values?

Guiding a person through a values discussion also helps figure out the reason for skin picking behavior and the purpose it serves. It may serve a mental or emotional purpose or solve a problem. Substitution or replacement behaviors that serve the same purpose or solve the same problem but are more in line with your values will help you feel more empowered to make changes.

Values drive motivation. Motivation drives change.

When what is important to you is clear, that becomes the driving force behind what will motivate you to make changes. The goals is to help you feel empowered, based on your values, to choose what to do with your time and your body.