He suggests behavioral therapy because it teaches someone to become aware of their behaviors, figure out the triggers for those behaviors, and find ways to prepare for times when they know they’ll be faced with the triggers. “[Triggers] are usually people, places, and times of day or locations,” Rieder explains. (If you’re wondering about mine, it’s driving my car alone.) “So, if you typically pick at your acne at night, when you’re looking in the mirror before bed, do something like fully cover up the mirror, to remove one of those stimuli. If it’s still happening, then, when you go to the bathroom, do something to calm down in that moment, like deep breathing.”

Another exercise Rieder suggests is adding a competing response, so if you find yourself scratching at your acne, make a fist and hold it for 30 seconds while taking deep breaths to help you calm down. “In the beginning, it’s really hard to do consistently, but eventually, they’ll become ingrained in your mind,” assures Rieder. He explains that though the work is hard, it’s extremely rewarding and will also help in the future if your acne returns because you will be more easily able to snap back into the behavioral therapy techniques you’ve already mastered.

The day after I received my diagnosis, I filled my first isotretinoin (Accutane) prescription and officially welcomed my thirties on hectic acne medication, and with a newly-minted mental health care plan and an order to get myself into therapy, stat.

The decision to go on Accutane is not one to be taken lightly, as it can come with a plethora of side effects that range from dryness of the lips, skin, and eyes to laboratory changes, including liver or cholesterol changes, or body aches, joint pains, and sun sensitivity. “Other side effects to be aware of include teratogenicity [which causes defects in a fetus], so it is important to not become pregnant while taking the medication,” cautions Garshick. “While no causal link has been established, there have also been reports related to inflammatory bowel disease as well as changes in mood and depression, so it is always important to speak with your doctor about this.”

Two years on, I’m still on an extremely low dose of Accutane and, truthfully, I wish I could just stay on it forever. My skin is phenomenal, which in itself is a huge thing for me to admit, and having clear skin appears to have helped me — as has therapy. But I’d be lying if I said I wasn’t nervous about the day I inevitably come off the medication.

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