Trichotillomania can be effectively treated with cognitive behavioral therapy. Sessions are generally kept short, one hour a week.

Trichotillomania is a body-focused repetitive behavior (BRFB) that results in hair pulling, usually on the head, but can also include eyelashes, beard hair, and other body parts. The condition often co-occurs with a related behavior called trichophagia, which is the chewing or swallowing of hair.

Acceptance and Commitment Therapy (ACT)

ACT focuses on overcoming anxiety by accepting the reality of your situation and taking action to move forward meaningfully. It is one of the most effective treatments for trichotillomania to date. It can help you overcome the fear, shame, guilt, embarrassment, and other negative emotions accompanying hair pulling.


In ACT therapy, your therapist will work with you to learn techniques like cognitive defusion (reducing the tendency to reify thoughts, images, feelings, sensations, urges, memories, and other internal experiences), acceptance of unwanted private experiences, accessing and observing self, and committed action.

Your therapist will also teach you to let core values and life goals, rather than aversive internal experiences, guide your behavior. Metaphors, in-class activities, talks, exercises, and homework assignments are used to explore these topics. It is essential to find a therapist with the right skills and training to offer trichotillomania therapy.

Cognitive Behavioral Therapy (CBT)

For those suffering from trichotillomania, cognitive behavioral therapy is a very successful treatment choice. It has also effectively treated other Body-Focused Repetitive Behaviors (BFRBs, which include skin picking, nail-biting, and tics).

One component of CBT for trichotillomania is habit reversal training, whereby a person learns to recognize trigger situations and use substitute behaviors to combat the urge to pull. It might involve clenching your fists or staring into space. It can also involve finding sensory substitutes to satiate the urge to pull and changing environments and situations so that they are less conducive to the behavior.

CBT can be used alone or in combination with psychotherapy techniques. For example, Dialectical Behavior Therapy (DBT) is often combined with habit reversal training to provide clients with the emotion regulation skills they need to address any feelings that make trichotillomania worse. It can help prevent relapse, as feelings of shame and embarrassment are often associated with compulsive hair-pulling.

Family Therapy

The key to effective treatment of trichotillomania and other body-focused repetitive behaviors (BFRBs) is to work with a therapist who understands underlying emotional issues. The therapist should also be experienced in treating BFRBs and understand how to address them.

Behavioral therapy, including habit reversal training and other techniques from Dialectical Behavioral Therapy and Acceptance and Commitment Therapy, is typically the primary psychotherapy for trichotillomania.

Research has shown that these treatments are more effective than other psychotherapy methods, such as hypnotherapy and psychodynamic psychotherapy.

Family therapy is a type of group psychotherapy that involves a therapist and one or more families. The therapist works with the family to help them understand how their interactions and communication patterns contribute to the hair-pulling problem.


It may include exploring ego defenses that are used by members of the family and interpreting these dynamics. This approach can last a few sessions or may go on for many months and is most effective in a psychologically sophisticated family.

Mindfulness-Based CBT

Often, people with trichotillomania can overcome their hair-pulling habit through behavioral therapy. A therapist will teach them how to identify their triggers and replace the negative behaviors with healthy ones.

Typically, they will also address the underlying emotional concerns.

Mindfulness-based cognitive therapy (MBCT) combines training in mindfulness meditation practices with principles of cognitive therapy. Learning to both familiarize oneself with and develop a new relationship with the thought patterns that often accompany mood disorders is the main objective of this treatment.

For example, if normal sadness is a major trigger for depression, the client will learn to accept it and change their negative associations with it. It is done through mindfulness meditation exercises and activities, such as a body scan.

These activities rebalance neural networks, allowing clients to shift away from automatic negative responses and toward understanding that their thoughts are just thoughts.


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