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Trichotillomania, also known as hair-pulling disorder, is a Body-Focused Repetitive Behavior (BFRB) that can be deeply distressing and difficult to manage. If you’re wondering, “What therapy is best for trichotillomania?”, you’re not alone. Fortunately, there are evidence-based treatments that can help you take back control—and yes, recovery is possible.
The Gold Standard: Habit Reversal Training (HRT)
Habit Reversal Training (HRT) is widely considered the most effective therapy for trichotillomania. It's a form of Cognitive Behavioral Therapy (CBT) that targets both the awareness of hair-pulling urges and the development of new, healthier behaviors to replace them.
Here’s a breakdown of what HRT involves:
1. Awareness Training
The first step in HRT is becoming aware of when and why you pull. This involves identifying your personal triggers—whether emotional, environmental, or sensory. Many people don’t even realize they’re pulling until it’s already happened. Awareness is key.
2. Competing Response Training
Once awareness is in place, the next step is learning to replace the hair-pulling urge with a behavior that’s incompatible with pulling—like squeezing a stress ball, clenching fists, sitting on your hands, or using wearable tools.
One innovative tool that supports this part of therapy is HabitAware Keen2, a smart bracelet that helps individuals with trichotillomania by gently vibrating when it detects a hair-pulling motion. This real-time alert builds awareness and empowers users to choose a different response before the pulling happens. HabitAware is based on the principles of HRT and is clinically studied and recommended by therapists worldwide.
💡 Want to build awareness and gain back control? Try using HabitAware alongside HRT to supercharge your recovery journey.
3. Motivational Strategies
Finally, HRT includes motivation-building techniques. These help individuals stay committed to change and reduce feelings of shame or ambivalence about seeking help.
Other CBT-Based Therapies for Trichotillomania
While HRT is the foundation, other CBT-based approaches may be helpful for different individuals:
✨ Acceptance and Commitment Therapy (ACT)
ACT focuses on accepting difficult thoughts and emotions without trying to suppress them. For people with trichotillomania, this approach helps reduce the inner struggle with urges, creating more space for values-based action.
🌊 Dialectical Behavior Therapy (DBT)
DBT teaches emotional regulation, distress tolerance, and mindfulness skills, which can be essential for individuals whose hair pulling is triggered by strong emotions or stress.
Group Therapy and Peer Support
Community is a powerful part of recovery. Support groups—whether in-person or online—can provide a space to feel seen and understood. Hearing others' experiences and sharing your own can reduce isolation and increase accountability.
💬 Looking for support? Check out peer-led communities like the BFRB Changemakers Facebook Group or HabitAware’s online recovery community.
Are Medications Effective for Trichotillomania?
While therapy is the primary treatment, medication may help manage co-occurring conditions like anxiety, OCD, or depression. Selective serotonin reuptake inhibitors (SSRIs) are sometimes prescribed, but they are not considered a stand-alone treatment for hair pulling.
Additional Strategies That Help
📒 Self-Monitoring
Keeping a journal or log of hair-pulling episodes can help identify patterns—such as time of day, location, emotions, or activities.
🧢 Environmental Modifications
Simple changes like wearing gloves, fidget rings, hats, or cutting hair shorter can reduce the opportunity or urge to pull.
💆 Stimulate Your Senses (Sensory Substitution)
Engage your senses in healthy ways:
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Brush your lips with string if you rub hairs there
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Massage your scalp instead of pulling
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Wash or brush your hair as a soothing ritual
Final Thoughts: There’s No One-Size-Fits-All, But Help Is Available
If you're living with trichotillomania, know this: you’re not broken. The best therapy for trichotillomania is the one that meets your unique needs—and often, it’s a multi-faceted approach combining Habit Reversal Training, peer support, and tools like HabitAware to build awareness and resilience.
Whether you’re just starting your recovery journey or looking for new strategies to maintain progress, don’t hesitate to reach out to a mental health professional trained in CBT for BFRBs.
