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Hair Pulling/Skin Picking

I successfully help clients with all kinds of habits and body focused repetitive disorders (BFRB). My most common are hair pulling (Trichotillomania), skin picking, and nail biting.

Cognitive-Behavioral Therapy (CBT) works on changing behavior by identifying the specific factors that trigger hair pulling and learning skills to interrupt and redirect responses to those triggers. According to the TLC foundation for body-focused repetitive disorders at www.bfrb.org, CBT is based on learning theory which has shown that as we practice new behaviors and thoughts in response to familiar emotions or situations, our brain's physical structure actually changes, too. We develop new neural pathways and, with repetition, the new behavior becomes an automatic response.

The TLC foundation for body-focused repetitive disorders also recommends that the CBT should be performed by a therapist trained in this method and well versed in treatment of these behaviors-something that may be easier said than done as there is not an abundance of therapists with this specialty. The therapist will encourage hair pullers to develop an increased awareness of the times of day, emotional states, and other factors that promote hair pulling as an important precursor to being able to control the behavior. Some hair pullers have had success with simple behavioral devices such as putting bandages on their fingers to interfere with pulling and, keeping records of their hair pulling, or changing environmental cues that can trigger pulling. The CBT therapy used for hair pullers is similar to the therapy used for skin pickers and other body focused repetitive behaviors.

The methods of cognitive-behavior therapy I use, such as Habit-Reversal Training and the Comprehensive Model for Behavioral Treatment of Trichotillomania, have shown to be the most successful treatments for trichotillomania known today.