Trichotillomania Treatment
San Diego

Trichotillomania is more than a habit. It’s a body-focused repetitive behavior (BFRB) where you repeatedly pull out hair despite wanting to stop. If pulling feels compulsive, creates shame, or interferes with daily life, it may be Trichotillomania.

If previous therapy was unsuccessful, I would encourage you to try again with someone who has specific knowledge, understanding, and training related to BFRBs. The modalities I specialize in—HRT, and the ComB model of therapy—have all been shown effective for the treatment of trichotillomania and other BFRBs³. Additionally, I am a member of the TLC Foundation, a leading institution for research and training in BFRBs. Not only have I trained with TLC in their professional institute, but I am also listed as a verified provider on their website. 

It varies for each person. Some notice improvements in a few months, while others benefit from longer-term support. What matters most is consistency and practicing the strategies between sessions.

Through HRT, you will learn awareness training and skills to practice waiting out urges or replacing BFRBs with other, nonharmful behaviors. ComB is based on the belief that people pull or pick because it meets a need. The action may either soothe you or, conversely, stimulate you when you are bored. This therapy uses elements of HRT but it adds more depth to the treatment by looking at the whole picture. 

Rather than using a cookie-cutter approach, ComB first examines the unique factors that underlie why you pull or pick. We will assess the following:

• Cognitive – how do your thoughts affect picking or pulling?

• Mood – for example, does your BFRB occur when you’re anxious, bored, or frustrated?

• Physical – are there certain postures that make you more prone to pull or pick, such as when your hand is close to your face?

• Environment - where and when does the pulling or picking occur?

• Sensory cues – for example, is your trichotillomania triggered when it feels as though your scalp is itchy or tight and you’re attempting to relieve that sensation through pulling or picking?

After evaluating each factor, we will decide together which ones to address to help you with the picking or pulling. From there, I will help you to better understand the urges, recognize when they occur, and teach you skills that will help you resist acting on them.

Therapy offers hope that your trichotillomania will eventually become manageable.  Although BFRBs usually never go away completely, I will teach you skills to help redirect the strong urges. With a commitment to the process, the urges will diminish over time. 

Our team at Resilience Counseling is trained in treatment specifically for trichotillomania and other body-focused repetitive behaviors. These approaches give us a clear framework for understanding why pulling or picking happens and how to interrupt the cycle. Together, we will at the situations, emotions, and urges that drive the behavior.

Once we have a better understanding of you and your patterns, we will teach you practical tools and coping strategies. You will learn new ways to manage urges, reduce stress, and build healthier habits. We know that change takes time, so we walk alongside you through each step of the process.

You do not need to go through this journey alone. With the right support and guidance, lasting recovery is possible.

It can often feel satisfying to pick or pull. In fact, studies have shown there is a dopamine response in the brain during a picking or pulling episode. And although it may feel good in the short term to succumb to the urge, in the long term you will often experience guilt, shame, and discouragement that you have no control to stop. In therapy, we will work together to break these negative patterns and work towards healthier coping mechanisms. 

There is a way forward. Even if it feels like you have tried everything, recovery is possible. With the right support, many people have found freedom from the cycle of pulling and picking. Healing happens gradually, and every small step forward matters. You do not have to do this alone. We are here to help!