Online Therapy for Trichotillomania: Does It Work?

Finding someone who understands hair pulling can be hard. Many therapists have never worked with trichotillomania (trich), and the nearest person who has may be hours away. Online therapy, also called telehealth or virtual therapy, means meeting a practitioner by video from home. It can close that gap.

This guide covers what the research says about online therapy for trichotillomania, the pros and cons, and how to find someone good.

Does online therapy work for trich?

Yes, for many people. The research is small but encouraging, and it points the same way as the much larger research on video therapy for other conditions.

The trich trials tested therapy built on Habit Reversal Training (HRT), a step-by-step approach that teaches you to notice when you’re about to pull and do something else with your hands. They added skills from acceptance and commitment therapy (ACT), which teaches you to make room for urges and uncomfortable feelings without acting on them.

• Adults: in a 2018 US trial, 22 adults were given either 10 weekly video sessions or put on a waiting list. Pulling severity fell by about 42% on average in the therapy group and rose on the waiting list. About 6 in 10 of those who finished therapy improved by a meaningful amount. Their gains held up three months later, although some pulling crept back. People rated their bond with the therapist about as highly as people usually rate in-person therapy.
• Teenagers: a 2022 pilot trial gave video therapy to 28 teenagers aged 12 to 16, with a parent involved. Pulling and distress fell by medium to large amounts and stayed lower a year later.
• Other conditions: a 2026 review pooled 12 trials comparing video and in-person therapy for conditions including OCD (obsessive-compulsive disorder), depression and PTSD (post-traumatic stress disorder). It found no clear difference in results, though the authors rated the evidence as low certainty.

Both trich trials were small and came from the same research team, so there’s more to learn. But nothing so far suggests that video makes therapy for hair pulling less effective. Read more about how the method works in our guide to Habit Reversal Training.

Online therapy is different from an online self-help programme, which you work through on your own without a practitioner. One 2023 trial of a fully automated programme with 81 adults found that about half of those given the programme improved meaningfully, compared with 15% on a waiting list. Self-help can be a good start, and you can find practical steps in our guide to how to stop pulling your hair.

What are the pros and cons of online therapy for trich?

The biggest advantage is choice. You can work with someone who knows trich well, wherever they live. The main downsides are practical: you need privacy, a steady connection, and a little extra effort to stay focused on a screen.

Shame and hiding are a big part of trich for many people. If fear of being seen has kept you from getting help, starting from your own sofa can make that first step feel smaller. In the 2018 trial, 4 in 10 people said they wouldn’t have looked for treatment at all without the video option.

Online therapy may suit you less well if you have nowhere private to talk, if you’re going through a crisis, or if you simply feel more at ease in a room with someone. Some practitioners offer both, so you can mix the two.

How do I find an online therapist for trichotillomania?

Look for someone who understands hair pulling first, then check they can work online with people where you live. Everyone in our directory has told us they understand trichotillomania and already help people who pull, in person or online. You can search the directory. Our guide to finding someone who understands trich covers what to look for in more detail.

You may also see practitioners describe themselves as online BFRB therapists. BFRB stands for body-focused repetitive behaviour, the group of conditions that includes hair pulling, skin picking and nail biting.

Before you book, ask:

1. How many people who pull their hair have you worked with?
2. What approach do you use for hair pulling, and why?
3. Can you see clients where I live?
4. Which video platform do you use, and how do you keep sessions private?
5. What happens if the connection drops, or if I need urgent help between sessions?
6. What do sessions cost, how long are they, and what’s your cancellation policy?

Rules on who can see clients across borders differ from country to country. Check the practitioner can work with people where you live, and ask which professional body they’re registered with.

A short first call is a good way to see how you feel talking to them on screen. For an overview of every treatment option and the evidence behind each, see our guide to trichotillomania treatment.

When should I get help?

Get support if pulling is causing you distress, taking up a lot of your time, or getting in the way of work, school or relationships. You don’t need to wait until it feels “bad enough”, and online therapy means you don’t need to wait for someone local, either.

If you’re a parent looking into this for your child, start with The Parent’s Guide to Trichotillomania: understanding what your child is going through.

If you’re feeling very low or hopeless, please talk to someone today.

In an emergency, call 995 or go to your nearest emergency department.

• Samaritans of Singapore (SOS) — 1767 (24h)
• IMH Mental Health Helpline — 6389 2222

Questions people ask

Sources

1. Lee, E.B., Haeger, J.A., Levin, M.E., Ong, C.W. & Twohig, M.P. (2018). Telepsychotherapy for trichotillomania: A randomized controlled trial of ACT enhanced behavior therapy. Journal of Obsessive-Compulsive and Related Disorders, 18, 106–115.
2. Petersen, J.M., Barney, J.L., Fruge, J., Lee, E.B., Levin, M.E. & Twohig, M.P. (2022). Longitudinal outcomes from a pilot randomized controlled trial of telehealth acceptance-enhanced behavior therapy for adolescents with trichotillomania. Journal of Obsessive-Compulsive and Related Disorders, 33, 100725.
3. Capel, L.K., Petersen, J.M., Becker, M.R., Levin, M.E. & Twohig, M.P. (2023). The efficacy and feasibility of a fully automated, web-based acceptance-enhanced behavioral treatment for trichotillomania in adults: A randomized waitlist-controlled trial. Journal of Obsessive-Compulsive and Related Disorders, 37, 100800.
4. Meyer-Keirath, Wallis, Kaus, Schenk, Holzhaus, Rometsch, Buntrock, Apfelbacher & Junne (2026). Comparing video-based and face-to-face psychotherapy: Systematic review and multilevel meta-analysis across mental disorders. Journal of Medical Internet Research.
5. Board of Psychology, California. Telehealth FAQ.