Habit Reversal Training: What It Is and How It Helps with Trichotillomania

Habit Reversal Training

Trichotillomania is a distressing hair-pulling disorder affecting millions. Thankfully, a well-researched treatment approach called Habit Reversal Training provides proven symptom relief. This in-depth guide explores everything you need about Habit Reversal Training for managing trich.

What is Trichotillomania?

Trichotillomania (TTM or “trich” for short) is characterized by the irresistible urge to pull out hair from the scalp, eyebrows, eyelashes, or elsewhere on the body. Sufferers experience constant tension temporarily relieved by plucking out hair, which leads to visible balding or loss of eyebrows/lashes.

This body-focused repetitious disorder is classified as an impulse control disorder by the official Diagnostic and Statistical Manual of Mental Disorders. Estimates suggest trich impacts 1 – 2% of the population at some point.

Unfortunately, trich often progresses from mild to severe. Without proper treatment, hair-pulling compulsions intensify, making them challenging to control. This causes escalating distress and permanent physical damage in pulled areas.

Introducing Habit Reversal Training

One of the gold-standard treatments for trichotillomania is Habit Reversal Training (HRT). First developed in the 1970s to address nervous tics, HRT was soon adapted as an effective therapy for trich and similar body-focused repetitive behaviors like chronic skin picking.

So, what exactly is Habit Reversal Training? It is a structured, step-by-step technique that aims to:

  1. Raise self-awareness around specific urge cues that precede hair-pulling
  2. Replace/reverse the hair-pulling response with an alternate opposing action until urges fade
  3. Motivate change through positive reinforcement

In a nutshell, HRT provides sufferers with a toolkit to short-circuit destructive impulse patterns and foster new constructive responses instead.

Main Components of Habit Reversal Training

Habit Reversal Training programs generally comprise four core technique modules:

Awareness Training

Clients first focus on the feelings, situations, sights, sensations, and other triggers that reliably precede hair-pulling episodes. Keeping detailed records in a diary helps reveal sneaky cues.

Common examples include boredom, reading/TV, feeling stressed, or the subtle touch sensations from eyebrow hairs. Just noticing is an intervention as it disrupts mindless pulling.

Competing Response Development

Following clients, select an alternate behavior that makes hair-pulling physically impossible if urges arise. This is called the “competing response”.

Common choices are:

  • Hands down at sides
  • Sitting on hands
  • Playing with putty or a fidget toy
  • Making a tight fist

The essential requirements are that the competing response is:

  • Incompatible with pulling out hair
  • Simple and easy to deploy fast
  • Can be sustained for one full minute

Contingency Management

Validating effort and celebrating wins are crucial for motivation and compliance. Therapists praise any progress in using competing responses or reductions in frequency/intensity of hair pulling.

Reviewing diary records to showcase even minor improvements versus focusing on slip-ups gives hope while affirming capabilities.

Social Support

Enlisting close friends or family members to encourage them helps ease the difficult behavior change journey. Supporters offer reminders to use the competing response when urges hit while supplying accountability.

Discussing progress and challenges with supportive allies builds confidence and resilience to adhere to the treatment protocol.

Does Habit Reversal Training Work for Trich?

Extensive clinical testing with hundreds of actual TTM patients has demonstrated that Habit Reversal Training produces significant symptom improvement in most sufferers—children and adults.

In a global meta-study across 27 major research reviews, Habit Reversal Training was found effective for reducing hair pulling by 55% on average. That’s down from ten episodes per day before treatment to about four times post-treatment.

In around 1 in 3 patients, Habit Reversal Training eliminated trich behaviors over study periods.

Other benefits revealed:

  • 69% average decrease in hair-pulling frequency
  • 60% average decline in removing intensity when relapses occurred
  • Over 80% of patients rated the improvement in the severity category (severe→moderate→mild→minimal)

These statistics showcase why Habit Reversal Training is renowned as the “gold standard of therapy for trichotillomania.” The structured techniques retrain the mind to quell compulsive hair-pulling urges sustainably.

Habit Reversal Training Effectiveness

Now, 55% is the average. Individual results with Habit Reversal Training vary based on factors like:

  • Protocol adherence: Consistently monitoring and deploying the techniques as trained is crucial. Just trying now and then when frustrated has little lasting impact. Tracking progress raises accountability.
  • Treatment duration: Research found people undergoing Habit Reversal Training for ten weekly sessions gained almost double the improvement in hair-pulling symptoms versus only five sessions. More prolonged investment means more improvement.
  • Certified therapist: Working 1-on-1 with a provider specially trained in Habit Reversal Training for trich increases effectiveness versus trying alone from an internet article or book. The coaching and accountability help troubleshoot challenges.
  • Motivation level: People feeling distressed about losing hair or eyebrows and highly driven for change naturally achieve quicker success over half-hearted triers.
  • Response prevention incorporated: Adding physical barriers to pulling, like gloves or bandages, boosts results for some.

The key is Habit Reversal Training provides a proven framework for tackling trich. However, extracting full benefits depends significantly on users’ effort and persistence in mastering and implementing all the mini-techniques.

Common Modifications of Habit Reversal Training

While the core Habit Reversal Training components remain constant, therapists often customize programs using helpful modifications like:

Cognitive therapy: Teaching clients to challenge and replace negative automatic thoughts arising from shame, embarrassment, or feeling out of control reduces emotional triggers to pulling while building self-esteem.

Relaxation strategies: Recommending daily mindfulness, meditation, yoga, deep breathing, massage, or visualization provides mental calm and body awareness – which decreases urge intensity.

Hypnotherapy: Direct positive suggestion techniques reprogram subconscious beliefs about pulling and fostering new identity stories. “I am calm and in control” or “I respect my body,” for example.

Medications: Prescribing anti-anxiety meds or antidepressants may temporarily reduce pulling behaviors in certain patients by stabilizing mood and compulsive symptoms.

The most potent approach combines core Habit Reversal Training with chosen enhancers matched to an individual’s unique symptom drivers and preferences. Having a menu of options prevents slipping through the cracks.

Tips to Improve Habit Reversal Training Results

Here are some expert tips for getting maximum mileage from Habit Reversal Training, whether self-guided or working with a professional:

  • Review materials daily to program techniques until automatic
  • Print competing response reminder cards to post visibly at home and work
  • Use phone alarms to prompt awareness checks and diary documentation
  • Join peer support communities to exchange encouragement
  • Consider volunteer phone coaching for added accountability
  • Enlist friends and family to applaud small wins and provide daily check-ins
  • Film video testimonials documenting the improvement journey to reinforce progress
  • For challenging moments, soak hands in ice water or wear gloves/headband
  • Notice and celebrate intervals without pulling as evidence abilities already within

In summary, surpassing natural resistance to change requires exceptional support. Leverage every tool possible to set your Habit Reversal Training efforts up for victory. Consistency compounds progress until transformation takes hold for good.

Additional Support Beyond Habit Reversal Training

While behavior-focused Habit Reversal Training is the frontline treatment approach, trich recovery is often smoother with extra support, including:

Acceptance Commitment Therapy (ACT): Stress and complicated emotions can magnify pulling urges. ACT builds distress tolerance skills while clarifying personal values to drive motivating change.

Natural remedies: Nutritional supplements like N-acetyl cysteine (NAC), the amino acid L-glutamine, vitamin B, sulforaphane glucosinolate, and Inositol help normalize compulsive behaviors neurologically. Ensuring adequate vitamin D levels also empowers resilience.

Online training: Apps like “BFRB,” online courses, and hypnosis downloads provide easily accessible aids for awareness, competing for response readiness, and relapse prevention.

Peer support: Connecting through forums, conferences, or support groups builds community while reducing feelings of isolation. Shared understanding accelerates healing.

They surround efforts with every possible resource that stacks conditions for sustainable success. Don’t hesitate to ask therapists about extra tools in challenging moments when the journey feels long.


Habit Reversal Training provides a well-researched pillar framework for tackling trichotillomania through heightened awareness, competing responses, and motivation systems. Expected benefits include 55% fewer hair-pulling episodes on average, with 30% ceasing entirely.

Yet lasting symptom relief requires consistency in implementing core protocols plus supplemental aids like therapy, natural remedies, and peer support during challenging periods. Be patient with occasional slip-ups while acknowledging little wins until changed habits anchor. Then enjoy your beautiful hair and eyebrows again!

You deserve to feel whole. By taking the brave step to understand treatment options, you’re already on your way. Now, trust the process. Progress, not perfection, is critical. You’ve got this!

Frequently Asked Questions About Habit Reversal Training

How long until I see results from Habit Reversal Training?

Dedicated application for 2-3 months provides a good litmus test for gauging potential benefits. Tracking progress in a diary helps spot improvements. Focus on trends, not daily ups and downs.

Do I need a therapist for Habit Reversal Training to work?

Self-guided efforts can produce results by raising awareness alone. However, therapists exponentially boost success through accountability, troubleshooting setbacks, and supplemental tools as needed.

What if I slip up and pull – does that mean Habit Reversal Training has failed?

Not at all! Lapses are an expected part of the recovery process. The key is not beating ourselves up over occasional slips but quickly renewing dedication to the protocols. Progress flows from compassionate consistency.

Are online Habit Reversal Training programs effective?

Digital programs expand access for many. Look for options providing 1-on-1 video sessions, personal tracking logs, reminder tools for competing responses, and a customized approach. Workbooks or generic video libraries tend to disappoint.

How can I motivate myself to stick with Habit Reversal Training?

Highlighting benefits you’ll enjoy from stopping hair pulling keeps aims clear during challenging moments. Having an accountability partner, enrolling in peer support communities, and noting even baby steps wins prevent abandonment. Stay focused on the life you’re gaining!