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Information for those interested in knowing more about behavioural therapy for BFRBs and compulsive hair-pulling. What therapy involves, and how to find a BFRB specialist therapist.

Behaviour Therapies like Cognitive Behaviour Therapy, including Habit-Reversal Therapy, and Acceptance & Commitment Therapy have been effective at relieving Trichotillomania symptoms. In studies, Behavioural Therapy fared better than common medications. Studies suggest that supportive therapies and psychoanalysis without the behaviour aspect are not effective at treating Trichotillomania or other BFRBs.

Cognitive Behaviour Therapy (CBT) is common for treating Trichotillomania and other conditions, it takes a practical, problem-solving approach to change people’s attitude and behaviour. Sometimes we base our behaviour on mistaken thoughts that we may not even be aware of. Cognitive Behaviour Therapy helps you to notice, explore and challenge false thoughts e.g. The only way this feeling will go away is with pulling, changes to: If I accept the itchy feeling and let it be, the feeling will decrease in intensity. If I continue to pull, it will only make things worse.” CBT can help you address your thoughts about yourself, your relationships with others and how you relate to the world around you. CBT may also involve behaviour aspects to help you to change the way you behave, for example to reducing hair-pulling. A type of this is habit-reversal therapy; HRT is explained more below.

Behavioural Therapy tends to be short: an hour session a week for 3 to 6 months, with homework to complete in between, e.g. keeping records, activities or problem-solving. You work with your therapist to understand your problems and develop a strategy to apply in future life. The sessions are planned and structured, and goals are set. At the start of a session usually the client and therapist will jointly decide on the topics they want to work on that week.

Your therapist may not have treated Trichotillomania before but should be experienced in using behavioural therapy to treat a range of problems and be able to adapt the techniques to hair pulling. To be realistic Cognitive Behaviour Therapy is not a miracle cure, you need to be open, persistent and it takes time and effort. It doesn’t help everybody, it may help but not to full recovery, and for some it may take extra time practising the techniques after the course has finished.

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Updated 18 January 2021, review 18 January 2022