Habit reversal training in trichotillomania: guide for the clinician

Trichotillomania (hair-pulling disorder) involves repetitive hair pulling that can cause significant distress and impairment in functioning. Both children and adults suffer from the disorder. Habit reversal training (HRT) is the trichotillomania treatment with the most empirical support. HRT begins with developing an in-depth understanding of the client's unique pulling behaviors. The major components of HRT can then be carried out in a way that targets the client's specific needs. These include awareness training and self-monitoring, stimulus control and competing response procedures. Within each of these components the client learns to recognize his or her pulling urges, avoid situations in which pulling is more likely and adopt behaviors that can be used instead of pulling. Future work will involve evaluating the efficacy of adding therapy models such as mindfulness meditation in order to further enhance the effectiveness of HRT, and studying the long-term efficacy of HRT for children and adults.