Trichotillomania Habit Reversal Training: How HRT Helps Stop Hair Pulling

Have you ever suddenly caught yourself pulling your hair out, realized that you don’t know how long you’ve been doing it, and then asked yourself, “Why can’t I just stop?”

That’s exactly the sort of negative experience that trichotillomania habit reversal training is designed to help prevent.

It doesn’t use shame, punishment, or any of those empty and ultimately unhelpful grindset-type platitudes like “just try harder” or “just get over it.”

Instead, HRT is intended to teach you how to identify your urges as you’re experiencing them and then learn how to interrupt them before you pull your hair.

The idea is to gradually break the habit by doing this over and over again until it’s drilled into you and becomes automatic. 

But what exactly does that look like in practice?

Why “Just Stop” Hasn’t Been Working

Compulsive hair pulling is not just a bad habit; it’s a conditioned response to stress that has been learned through consistent repetition.

Over a long period of time, you unconsciously learn to associate the act and sensation of pulling with a temporary feeling of relief from whatever emotional pain/distress you’re in.

Due to this association, attempting to stop pulling hair through sheer willpower typically results in the urge becoming psychologically overwhelming.

And that, unsurprisingly, tends to lead to relapsing.

The thing is that willpower is a finite resource.

Like anyone else, you will simply have a bad day or be particularly exhausted at some point.

And you don’t want financial strain or a period of sleep loss to be all it takes to make you relapse into a self-destructive habit.

Luckily, trichotillomania habit reversal training is very frequently successful precisely because it focuses on breaking the habit loop rather than attempting to stop the behavior “cold turkey.”

But What Is Trichotillomania Habit Reversal Training?

Trichotillomania Habit Reversal Training (HRT) is a structured behavioral therapy that was developed specifically to treat habitual or repetitive behaviors.

And trich falls firmly under that umbrella, as do compulsive skin-picking (dermatillomania) and nail-biting (onychophagia).

Trichotillomania habit reversal training is based on the development of three core skills:

1. Awareness
2. “Competing responses” (more on this in a bit)
3. Environmental support

Collectively, these skills, once sufficiently honed, enable you to identify when you experience the urge to pull your hair early enough for you to be able to respond to it in a healthy way.

Let’s break it down into simple terms.

👉Don’t forget to reach out to your therapist.

Step 1: Become More Aware

When you pull your hair, you probably don’t even think about it or notice it until you’ve already created a bald spot.

That’s why we call trich a “compulsive” disorder.

So, the primary objective of trichotillomania habit reversal training, at least in the very beginning, is to increase your awareness of when hair-pulling occurs.

At this stage in the healing process, you’ll learn to start paying more attention to:

• When you pull your hair
• Where you’re physically located when you do it
• What you’re experiencing emotionally when you do it
• What you’re doing with your hands just before you start pulling your hair

Remember that awareness is not about being critical of yourself; it’s about being curious and mindful.

If there’s one thing that someone with trich doesn’t need, it’s more self-criticism.

When you get to the point where you can say something like, “I normally get the urge to pull my hair when I’m tired and doomscrolling online,” you will have already regained some control just by understanding more.

Step 2: Develop a Competing Response

Do you remember us mentioning this earlier?

A competing response is a physical action that uses the same muscle groups as hair pulling, is socially acceptable, and eliminates hair pulling when performed. 

Examples of competing responses can include things like:

• Clenching your fists for 30-60 seconds
• Squeezing a stress ball as hard as you can
• Sitting on your hands while you take a few slow, deep breaths
• Messing around with a “fidget toy” (e.g., a fidget spinner, dice, putty, etc.)

This stage is all about timing.

You’ll learn to use your competing response immediately as soon as you recognize that you’re beginning to experience the urge to pull your hair, and before you actually start doing it. 

As you perform the competing response regularly, your brain will get used to this new conditioned response to the urge, and it will become your default. 

urge → competing response → relief

Step 3: Change Your Environment

In addition to developing awareness and a competing response, habit reversal training will also teach you to be more aware of your environment.

Even if you work out and eat healthy every day, you’ll still be at risk of developing respiratory issues if you live in Delhi, Lahore, or Cairo.

Your environment has a huge impact on you. 

So, as you’re going through this step in the process, you’ll learn to start modifying both your external environment and your relationship to it to be healthier for you.

Small environmental modifications can lead to significant reductions in hair-pulling:

• Remove mirrors and reflective surfaces because they often trigger the urge
• Have fidget toys readily available and placed in locations where you often pull
• Join a support group and actively participate in it
• Wear gloves or bandages on your fingers when you are feeling at risk of pulling
• Keep your hair tied back or cover it entirely

This step is not about hiding from society and becoming a recluse.

It’s about crafting and cultivating an environment that supports you while you develop healthy new behaviors.

And it’s also about reducing the amount of additional negative pressure your environment exerts on you.

Keep in mind what we said about everyone inevitably getting exhausted or having a bad day at some point. 

You want your external environment and the choices you’ve already made to modify it to help keep you from relapsing, even during those particularly hard times when your willpower alone might not be enough.

It Could Be One of the Best Decisions You Make

If you’re struggling with hair-pulling, know that you are not alone, and you are not beyond help or healing.

Trichotillomania habit reversal training is a highly effective treatment that provides a practical and compassionate approach to finally breaking the cycle of hair pulling and regaining control over your life.

And, if you decide to go for it, having the opportunity to get all that in a non-judgmental, supportive way can make a profound change in your life.