A 2023 study published by
Cognitive Therapy and Research Journal evaluated the level of treatment knowledge that current mental health practitioners have in working with people who struggle with hair pulling or skin picking.
The researchers were inspired by a previous study published in 2006, where a team of scientists assessed healthcare providers’ knowledge of trichotillomania and its treatment. In the original study, they found a general lack of knowledge of trichotillomania and limited experience in providing treatment.
Due to the current rate of growth in knowledge of and treatments for trichotillomania, the researchers in this effort aimed to replicate the 2006 study. They also broadened the evaluation to include skin picking.
Study Methods
In this study, all licensed mental health providers (e.g., social workers, psychologists;) in Utah were contacted via email to complete an online survey. The survey assessed the therapist's knowledge and treatment of trichotillomania and skin picking.
A total of 329 mental health providers were surveyed. The results were shocking, but not if you've tried to find a therapist who has successfully helped people heal from hair pulling.
Many had largely outdated or inaccurate knowledge of diagnostic criteria for trichotillomania and skin picking, and inaccurately identified evidence-based treatments (e.g., 30% noted psychoanalysis and 25% noted hypnosis as effective.)
Even worse, participating therapists reported feeling that their training had not prepared them to treat either medical condition. The good news is that most expressed interest in additional education to help them better understand and treat hair pulling and skin picking.
Researchers in this study determined that mental health provider knowledge of trichotillomania and skin picking remains limited, and
a need for enhanced education and training on these medical conditions exists. Therapist indicated interest in training opportunities (e.g., workshops on diagnosis and evidence-based treatments). In the full study, implications of these findings and future directions are discussed.
VIEW STUDYMany people find that their most successful therapeutic approach for trichotillomania relies on Habit Reversal Training (HRT), a specialized type of cognitive-behavioral therapy. The HRT technique was formulated during the 1970s to address recurrent behaviors like hair-pulling, skin-picking, nail-biting, and various tics.
HRT views hair-pulling as an ingrained reaction to particular situations or events. This type of therapy aims to aid individuals in stopping the reaction.
HRT Awareness Training:
During awareness training, individuals are educated to identify the triggers that provoke their hair-pulling behavior. Therapists often encourage them to document the specific conditions in which they indulge in hair pulling.
This could involve recording locations, times, emotional statuses, among other factors. These records allow both the therapist and the individual to discern patterns in the behavior.
An individual could, for instance, notice that they invariably pull their hair while watching television, based on their journal entries.
Competing response training is the subsequent step. When faced with a recognized trigger, individuals are guided to perform a "competing response," such as fist-clenching, which physically impedes them from engaging in hair-pulling. This alternate behavior is practiced whenever they feel the impulse to pull their hair.
HRT therapy & social support:
Finally, social support plays a crucial role. Loved ones can help individuals with their competing response training by reminding them to engage in the alternative behavior during trigger situations, as well as providing motivation when they manage to resist the urge to pull hair.
Various other therapeutic methods may augment HRT, depending on your unique circumstances and personal history:
Acceptance and Commitment Therapy (ACT): This technique assists individuals in enduring hair-pulling urges, enabling them to observe these compulsions without actively resisting them.
Dialectical Behavior Therapy (DBT): This method enhances mindfulness and emotional regulation.
Group Therapy: This technique proves beneficial for individuals feeling isolated or embarrassed about their condition by providing emotional solace and social reinforcement.
Medication: While medications generally don't effectively treat trichotillomania, they may be prescribed in cases of concurrent anxiety or depression, with antidepressants being a common choice.
However, it's important to note that no specific medication for treating hair-pulling has received FDA approval to date. This means there is not one specific medication that works for everyone who has TTM, although many people find success by trying different medications, supplements and lifestyle changes, depending on their individual needs.
Finding a therapist who understands trichotillomania (TTM) and its complexities is a vital step toward healing.
At Healing from Hair Pulling (HFHP), we know firsthand how difficult it can be to locate the right support. That’s why we aim to empower women like you with the tools and resources needed to connect with professionals who truly "get it."
Start by looking for therapists with experience in treating body-focused repetitive behaviors (BFRBs), such as hair pulling. These professionals are more likely to understand the emotional and physical challenges that come with TTM.
When searching online, use directories like the Behavioral and Emotional Health Alliance (BEHA) which offers curated lists of licensed, knowledgeable providers. You can also ask about their experience with evidence-based approaches like Cognitive Behavioral Therapy (CBT), Habit Reversal Training (HRT), or Acceptance and Commitment Therapy (ACT). These therapies have shown success in helping women manage their triggers and reduce flare-ups.
If there aren’t any trich-informed therapists near you, don’t be discouraged! Many therapy services offer virtual sessions that can be just as effective as in-person visits.
You might also consider taking our self-help course called UnTrick YourselfTM that offers affordable, online health education designed for women living with TTM.
The UnTrick Yourself™ program can complement therapy by helping you build a holistic, personalized care plan that works alongside treatment. This includes identifying physical and emotional triggers, learning daily self-care actions, and finding a supportive community to uplift your journey.
You deserve a therapist who listens, understands, and partners with you to find solutions that fit your unique needs. Therapy combined with educational resources like ours ensures you’re addressing TTM from every angle.
At HFHP, we’re here to guide you every step of the way, helping you connect with the support you need to reclaim your confidence and reduce your symptoms.
Healing from Hair Pulling offers health education and customized support programs for women who have trichotillomania. We understand how chronic hair pulling makes you feel because many of our team members have TTM too!
Our easy-to-understand guides teach women like us how to better understand their medical condition, plus ways to lessen internal triggers in their bodies that may be making it worse.
HFHP’s evidence-based, peer-led educational program called UnTrick Yourself™ incorporates personalized support plans and a friendly private community—all designed to help you better manage your symptoms while uplifting how you feel—physically, emotionally, and in spirit.
Our affordable, holistic education gets to the root of the issue, as we explain TTM causes and triggers, diet changes that can reduce flare-ups, daily self-care actions, and ways to create a caring support team who helps you heal, alongside therapy and medication.
Join us at
healingfromhairpulling.com and take the first step on your journey toward healing.
Together, let’s find what works best for you!Capel, L.K., Petersen, J.M., Woods, D.W. et al. Mental Health Providers’ Knowledge of Trichotillomania and Skin Picking Disorder, and Their Treatment. Cogn Ther Res 48, 30–38 (2024). https://doi.org/10.1007/s10608-023-10381-w
