Habit reversal training in trichotillomania: guide for the clinician

Abstract

Trichotillomania (hair-pulling disorder) involves repetitive hair pulling that can cause significant distress and impairment in functioning. Both children and adults suffer from the disorder. Habit reversal training (HRT) is the trichotillomania treatment with the most empirical support. HRT begins with developing an in-depth understanding of the client’s unique pulling behaviors. The major components of HRT can then be carried out in a way that targets the client’s specific needs. These include awareness training and self-monitoring, stimulus control and competing response procedures. Within each of these components the client learns to recognize his or her pulling urges, avoid situations in which pulling is more likely and adopt behaviors that can be used instead of pulling. Future work will involve evaluating the efficacy of adding therapy models such as mindfulness meditation in order to further enhance the effectiveness of HRT, and studying the long-term efficacy of HRT for children and adults.

Keywords::

• awareness training
• cognitive behavioral therapy
• competing response hair pulling
• excoriation
• habit reversal training
• self-monitoring
• skin picking
• stimulus control
• trichotillomania

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Trichotillomania (TTM) involves pulling of hair from the scalp, eyebrows, eyelashes, pubic region or body.

• • TTM can cause significant distress or impairment to patients.

• • Habit reversal therapy (HRT) is the treatment with the most empirical support.

• • An in-depth functional analysis of the patient’s hair pulling is essential in effectively using HRT to treat TTM.

• • The main components of HRT are awareness training and self-monitoring, stimulus control (SC) and competing response procedures.

• • Adding therapeutic approaches to HRT such as acceptance and commitment therapy, dialectical behavior therapy and mindfulness meditation are being tested and may enhance HRT’s effectiveness further.