Various components of Cognitive Behavioral Therapy (CBT) are the most widely recognized and efficacious treatments for Trichotillomania. These are some of the techniques that have been shown to be effective in reducing hair pulling symptoms for adults with Trichotillomania.
Habit Reversal Therapy (HRT) is relatively well established in the treatment of Trichotillomania, with large effect size versus control conditions. HRT is a first-line treatment and focuses on awareness training (encouraging awareness of situations that can precede pulling episodes); relaxation training (since anxiety and stress are commonly reported triggers for hair pulling episodes); competing response training (encouraging unwanted pulling behaviors to be replaced with a less conspicuous action—e.g., clenching fists or squeezing a stress ball antagonistic to the pulling action); motivation procedures (designed to improve how acceptable HRT is to patients and their families); and generalization training (rehearsing trigger situations and the sequence of starting the pulling episode, quelling it, and undertaking a competing response). There is evidence that a short course of HRT can be as effective as a more protracted course of therapy and that the benefits extend beyond the end of the treatment.
Stress reduction training, in conjunction with habit reversal techniques, is also beneficial in helping patients to reduce pulling and deal with emotion regulation difficulties. Depending on the triggers of the patient, learning how to reduce stress may alleviate some of the intensity of pulling urges and behavior. For example, if the patient reports that high levels of work stress generally trigger a pulling episode in the car on the way home from the office, the clinician can suggest ideas to manage the stress without pulling (such as going for a vigorous walk immediately after work prior to getting in the car).