Trichotillomania Treatment: Every Option and the Evidence

If you’re looking into trichotillomania treatment, you’ve probably already tried to stop on your own. You may have been told to “just leave it alone”, or seen a doctor who hadn’t heard of it. That’s common, and it isn’t a sign that nothing will help. Trichotillomania (trich) affects about 1 in 50 people, and researchers have been testing treatments for it for more than 40 years.

This guide covers every main option: talking therapies, medication and supplements, self-help, and other approaches such as hypnotherapy and coaching. For each, we explain what it involves and what the research actually shows, including where the evidence is strong and where it’s thin. We also cover treatment for children, how long it takes, and how to find someone who understands hair pulling.

What treatments exist for trichotillomania?

The main treatments for trichotillomania are behavioural therapies, medication and supplements, structured self-help, and a group of other approaches such as hypnotherapy and coaching. Behavioural therapy is where most of the research sits. The others are sometimes used on their own, and often alongside therapy.

Here’s a summary of each option and how much research supports it for hair pulling.

Most people don’t use just one of these. A common pattern is behavioural therapy as the core, with self-help tools between sessions, and sometimes a supplement or medicine discussed with a doctor.

Where to read more about each option:

• Our guide to Habit Reversal Training walks through each step.
• Our guide to the ComB model explains its five areas in plain English.
• Our guide to CBT for trichotillomania explains how it relates to habit reversal.
• Our guide to ACT and DBT for hair pulling covers the skills for urges and feelings.
• Our guide to NAC for trichotillomania looks at every trial in detail.
• Our guide to medication for trichotillomania covers prescription options and side effects.
• Our guide to hypnotherapy for trichotillomania explains what a session involves.
• Our guide to EFT, NLP and coaching explains what to expect from each.

Which treatments have the most research behind them?

Behavioural therapy built around Habit Reversal Training has the most research behind it. It has been tested in more trials than any other approach for trich, in both adults and children, and it has consistently done better than no treatment or general support.

The evidence in brief:

• A 2014 review of 11 trials found behavioural therapy had a large effect on hair pulling. Trials with more therapy time had bigger effects, and so did those that added work on mood and feelings.
• A 2019 review found eight trials of habit reversal for trich, and every one favoured it over the comparison group. The same review pointed out real weaknesses: the trials were small, measured things in different ways, and rarely followed people up for long.
• A June 2026 review of around 30 trials found that therapies including habit reversal did better than those without it. It ranked behavioural therapy with habit reversal, ACT-enhanced habit reversal and NAC as the best-supported options.

So the evidence points the same way from several directions, but it isn’t perfect. Most trials are small, and we need more long-term studies.

Habit Reversal Training (HRT)

Habit Reversal Training (HRT) is a behavioural therapy that helps you catch pulling as it starts and replace it with something your hands can do instead. It was developed in the 1970s and is the backbone of most trich therapy today. The UK’s National Health Service (NHS) describes it as a form of cognitive behavioural therapy (CBT) and recommends it for trich.

HRT has three main parts:

1. Awareness training. You learn exactly what your pulling looks like: the places, times, feelings and hand movements that come before it. Many people pull without noticing, so this step alone often makes a difference.
2. A competing response. You practise an action you can’t do while pulling, such as clenching your fists gently or pressing your palms on your thighs, and use it whenever you notice an urge or your hand moving up. You hold it until the urge passes, often about a minute.
3. Support. Someone you trust encourages you and praises progress. They don’t police you or point out every pull.

Therapists usually add stimulus control too. That means changing your surroundings to make pulling harder, such as wearing a hat at home, keeping tweezers out of reach, or covering a mirror you tend to pull at.

ACT and DBT added to habit reversal

Acceptance and commitment therapy (ACT) is a talking therapy that teaches you to make room for urges and uncomfortable feelings without acting on them, and to focus on what matters to you. Dialectical behaviour therapy (DBT) teaches skills for managing strong emotions and distress. Both are often added to HRT, because many people pull to cope with feelings, not just out of habit.

Trials that combined ACT with habit reversal found it did better than a waiting list, and a trial that added DBT skills found improvements that lasted at least six months. The 2026 review ranked ACT-enhanced habit reversal among the best-supported treatments.

The ComB model

The Comprehensive Behavioural (ComB) model is an approach that looks at everything that drives your pulling and matches a strategy to each part. It was developed by two clinicians, Charles Mansueto and Ruth Golomb, and builds on HRT by adding more tools.

ComB looks at five areas, often remembered as SCAMP:

• Sensory: physical feelings, such as a hair that feels coarse or an itchy scalp
• Cognitive: thoughts, such as “just one more” or “I need to even this up”
• Affective: emotions, such as stress, boredom or sadness
• Motor: movements and habits, such as resting your hand on your head
• Place: where you are, such as in bed, at a desk or in the bathroom

A small 2016 study of 16 people found large improvements in pulling and daily life after ComB treatment, and the gains held at follow-up. It was a treatment development study without a comparison group, so it can’t tell us yet how ComB compares with standard HRT. Larger trials are the next step. Many practitioners use ComB in their work, and people often like how personal it feels.

CBT

Cognitive behavioural therapy (CBT) is a talking therapy that works on the link between your thoughts, feelings and actions. For trich, CBT almost always means HRT plus some work on unhelpful thoughts, such as all-or-nothing thinking after a slip. When people talk about “CBT for trich”, this combination is usually what they mean. CBT that doesn’t include habit reversal has much less evidence for hair pulling.

How long does treatment take?

Behavioural therapy for trich is usually a short course rather than open-ended. The 2011 children’s trial below used 8 weekly sessions, and many practitioners work in blocks of about 8 to 12 weekly sessions, with practice between sessions. Some people need longer, especially if they have other conditions such as anxiety or low mood, or have pulled for many years.

What to expect over time:

A few things make a difference to how quickly treatment helps:

• Time spent in therapy. The 2014 review found trials with more therapy hours had larger effects.
• Practice between sessions. The skills work because you use them in everyday life, not just in the therapy room.
• Tracking. In a large 2025 study of an online self-help programme, people who logged their pulling more often tended to improve more.

Progress usually looks like pulling less often and catching it sooner, rather than stopping overnight. Some pulling after treatment is common, and the 2019 review noted that some people’s symptoms crept back up after therapy ended, even though they stayed better than before treatment. Booster sessions can help.

To see what a first appointment is like, read our guide to what happens in trichotillomania therapy.

Is medication used for trichotillomania?

Sometimes, but no medication is approved specifically for trichotillomania, and the evidence for medicines is much weaker than for behavioural therapy. A 2021 Cochrane review, which pools the best-quality trials, found 12 small trials and concluded there wasn’t enough evidence to confirm or rule out any one medicine or type of medicine. Doctors may still suggest a medicine “off-label”, which means using a licensed medicine for a condition it isn’t officially approved for.

Here’s what has been studied. Many of these trials compare a treatment with a placebo, a dummy treatment with no active ingredient, so researchers can tell whether the real treatment does better than simply expecting to improve.

A few points to keep in mind:

• NAC has the longest track record of the non-prescription options, and the 2026 review ranked it among the best-supported treatments overall. But it didn’t help children in the one trial in young people, and supplement quality varies.
• SSRIs are often assumed to help because trich sits in the same family as obsessive-compulsive disorder (OCD). In practice, they don’t reduce pulling much for most people. The NHS says antidepressants aren’t usually prescribed to treat trich itself.
• Memantine and olanzapine each rest on a single trial. Those results are encouraging, but they need repeating before anyone can be confident.

Medication and therapy can be combined. Many people use both, and the skills from therapy stay useful whatever else you try.

What about treatment for children and teenagers?

For school-age children and teenagers, behavioural therapy adapted for young people is the main treatment, and it has good results in trials. For very young children and toddlers, pulling often stops on its own, and gentle support at home is usually the place to start.

What the research shows for young people:

• In a 2011 trial of 24 young people aged 7 to 17, 75% of those who had 8 weekly sessions of behavioural therapy responded to treatment, compared with none in the group who didn’t get it. The gains held during a follow-up phase.
• In a 2017 trial reported in the 2019 review, 76% of children and teenagers who had habit reversal responded, compared with 21% who had usual care. The authors suggested some young people may need booster sessions.
• NAC did no better than placebo in the one trial in 8 to 17 year olds. The researchers recommended behavioural therapy as the first thing to try.

How therapy differs for children:

• Parents are usually involved. You may learn how to encourage your child, set up barriers at home and praise progress.
• It’s made age-appropriate. Younger children may use games, rewards for practising skills, and simpler words.
• Punishment and nagging make things worse. Telling a child off or pointing out every pull adds shame, and shame feeds pulling. Therapists will help you find calmer ways to support them.

Our guide to toddler hair pulling explains why pulling in very young children often fades. Our guide for parents of children with trichotillomania covers what to say and what helps at home.

If you’re a parent, The Parent’s Guide to Trichotillomania covers understanding what your child is going through.

What about hypnotherapy, EFT, NLP and coaching?

Hypnotherapy, EFT, NLP and coaching are used by many practitioners who work with people who pull, and some people find them helpful. Research on them for hair pulling is limited, so we can’t say how well they work compared with behavioural therapy.

• Hypnotherapy uses guided, focused relaxation and suggestions to help you change how you respond to urges. Published evidence for trich is mostly case reports: descriptions of small numbers of people, such as three teenagers in one report. A 2008 review of hypnotherapy for children’s mental health found the evidence overall was mainly case reports and called for proper studies. Some hypnotherapists combine their work with habit reversal techniques.
• EFT (emotional freedom techniques), sometimes called tapping, involves tapping on points on the face and body while focusing on a feeling or urge. There’s very little published research on EFT for hair pulling.
• NLP (neuro-linguistic programming) uses language and visualisation techniques to change patterns of thinking and behaviour. We didn’t find published trials of NLP for hair pulling.
• Coaching for body-focused repetitive behaviours is one-to-one support, often from someone with lived experience of trich. Coaches frequently teach behavioural tools such as tracking, barriers and competing responses.

Lack of research doesn’t mean an approach doesn’t work. It means we don’t yet have good studies to tell us. If you choose one of these, it’s worth asking how the practitioner works with hair pulling specifically, what training they have, and whether they include practical skills such as noticing and replacing pulling.

Can I treat trichotillomania myself?

Yes, many people make real progress with structured self-help, and it’s a good place to start. Self-help means using the same skills a therapist would teach, from a book, website, app or guide, on your own.

What the research shows:

• In a 2025 study of an online self-help programme with more than 2,000 people, about 4 in 10 of those who finished it cut the severity of their pulling by more than a third. People who tracked their pulling more often did better.
• On average, self-help helps less than working with a trained practitioner. The 2014 review found that more therapist contact went with bigger effects.

Self-help works best when you track your pulling, choose a few techniques and practise them every day, rather than reading lots of tips. Useful tools include barriers such as hats and gloves, fidget toys that feel similar to pulling, changes to the places you pull most, and apps or wearables that help you notice.

If you’ve tried steadily for a few months and you’re stuck, that’s a good sign it’s time to get help from someone who understands trich. It isn’t a failure.

Our step-by-step guide on how to stop pulling your hair shows how to put self-help together.

Our guide to pulling at night covers bedtime and sleepy pulling.

Our guide to fidget toys and tools matches tools to the feelings pulling gives you.

Our guide to apps and wearables looks at devices that help you notice pulling.

Our hair-pulling tracker gives you a simple log to start with.

What if treatment works and then pulling comes back?

Pulling coming back after a good stretch is common, and it doesn’t mean treatment failed. Stress, big life changes, tiredness and illness can all bring urges back, sometimes years later. The skills you learned still work.

What helps:

• Go back to basics. Restart tracking, bring back your barriers and practise your competing response.
• Look at what’s changed. A new job, a move or a hard few weeks often explain a rise in pulling.
• Book a top-up session. Many practitioners offer short booster courses.
• Be kind to yourself. Self-criticism is one of the strongest triggers for more pulling.

Our guide to handling a relapse covers the difference between a slip and a relapse, and how to get back on track.

How do I find someone who can help?

Look for a practitioner who already works with people who pull, not just someone who treats anxiety or OCD in general. Many doctors and therapists have never met someone with trich, and feeling understood makes a real difference. Everyone in our directory has told us they understand trichotillomania and already help people who pull, in person or online.

You can search our directory.

Questions worth asking on a first call:

• How many people with hair pulling have you worked with?
• What approach do you use, and does it include habit reversal or similar practical skills?
• How many sessions do people usually have?
• Do you work with children and parents, if that applies?
• Can we meet online, and what does a session cost?

You can also start with your family doctor. They can check for other causes of hair loss, talk through medication if you’re considering it, and may be able to refer you to a psychologist or therapist. What’s available and covered varies by country and by health plan, so it’s worth asking what support you can access.

Our guide to finding a therapist who understands trichotillomania goes through what training to look for and where to search.

Our guide to online therapy for trichotillomania covers what to expect from video sessions.

Our guide to the cost of trichotillomania therapy explains typical fees and funding.

When should I get help?

Get help if pulling is causing you distress, taking up a lot of your time, affecting your work, school or relationships, or if you’ve tried self-help for a few months without much change. You don’t need to wait until it’s “bad enough”.

It’s also worth seeing a doctor to rule out other causes of hair loss, especially if the pattern doesn’t match where you pull. Our complete guide to trichotillomania explains how it’s diagnosed. For more detail on the talking therapies, see the therapy section of our complete guide. If you’re wondering about regrowth, the hair regrowth section of our complete guide explains typical timelines.

Our guide to eating hair explains the warning signs in more detail.

Trich often comes with low mood or anxiety, and living with it can feel lonely. If you’re feeling very low or hopeless, please talk to someone today.

In an emergency, call your local emergency number or go to your nearest emergency department.

• Find a helpline (international directory) (findahelpline.com)

Questions people ask

Sources

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