Therapy for Trichotillomania, Skin Picking & Other BFRBs
Specialized therapy for adults in California struggling with hair pulling, skin picking, and other body-focused repetitive behaviors (BFRBs).
Time and time again you think, “Why did I do that?”
You don’t want to keep pulling your hair, but it’s been hard to stop. Now you’re putting that hat back on to hide the patch so others won’t notice.
So, you are left keeping this a secret while feeling frustrated, hopeless, and embarrassed.
Learn about Habit Reversal Training and CLICK HERE schedule a free 15-minute consultation.
Pulling to Feel Calm, but Instead Feeling Broken
The hair pulling gradually snuck in and may have been outside your awareness at first — until it became a compulsive behavior that’s hard to stop.
You might have experienced a stressful event or noticed a coarse or ingrown hair that sparked curiosity and led to the start of the hair pulling. You may also have realized that you tend to pull your hair during idle moments — such as when you're bored, watching TV, or daydreaming.
Over time, the behavior may have continued as a way to cope, self-soothe, or groom, eventually becoming a compulsive habit.
You’re Tired of Hiding the Damage
The hair pulling has led to partial or total hair loss. If it's in areas visible to others — such as on your head — you may have tried to hide it with a hat, wig, beanie, or by styling your hair a certain way.
You’re left feeling embarrassed and ashamed, and you worry about being judged. As a result, you might avoid social situations or taking pictures — or you endure them while feeling distressed.
Therapy That Helps You Break Free from the Urge
I blend my curiosity and problem-solving skills with a nonjudgmental and empathetic stance. I help you interrupt hair pulling in three stages:
We identify and increase your awareness of triggers that occur right before hair pulling — such as specific situations, locations, thoughts, emotions, or bodily sensations.
We generate a list of competing responses that make it difficult to engage in hair pulling, and we practice them as a way to interrupt the behavior.
We explore and address the stressors, routines, and emotions that maintain the hair pulling over time.
This form of treatment is called Habit Reversal Training (HRT). HRT is one of the most effective and well-researched treatments for Body-Focused Repetitive Behaviors (BFRBs), including Trichotillomania (hair pulling).
What Are Body-Focused Repetitive Behaviors (BFRBs)?
Body-focused repetitive behaviors are repetitive actions directed toward the body, such as pulling hair, picking skin, or biting nails. For some people, these behaviors become difficult to control and cause emotional distress, physical damage, or disruption to everyday life. BFRBs can happen intentionally, automatically, or through a combination of both. You might notice a strong urge before engaging in the behavior, or you might realize only afterward that you've been pulling or picking for several minutes.
Trichotillomania (Hair-Pulling Disorder)
Trichotillomania involves recurrent hair pulling that can result in hair loss, distress, or difficulty reducing or stopping the behavior. Hair pulling may involve the scalp, eyebrows, eyelashes, or other areas of the body.
You might pull while concentrating, relaxing, feeling stressed, or searching for a particular hair texture. You may also spend time concealing thinning areas or avoiding situations where others might notice. Excoriation Disorder (Skin-Picking Disorder)
Excoriation disorder involves recurrent skin picking that can result in skin lesions, distress, or difficulty stopping the behavior. You may pick at acne, scabs, bumps, perceived imperfections, or areas of skin that feel uneven.
Skin picking may happen during periods of stress or boredom, while looking in a mirror, or when you notice a particular texture on your skin. You may feel frustrated afterward, particularly if the behavior causes wounds, scarring, or avoidance of social situations.Other Body-Focused Repetitive Behaviors
Other BFRBs can include nail biting, cheek biting, lip biting, and related repetitive behaviors. The appropriate treatment approach depends on the specific behavior, its impact, and your individual needs.
If you recognize yourself in any of these descriptions, you don't have to wait until the behavior becomes more severe to seek support. Therapy can help you better understand your patterns and explore strategies for making changes.Therapy for Trichotillomania, Skin Picking & Other BFRBs
Do you find yourself pulling your hair, picking at your skin, or engaging in repetitive behaviors that feel difficult to stop—even when you want to?
You may find yourself pulling your hair while watching television, searching your scalp for coarse hairs, picking at blemishes or perceived imperfections, or engaging in these behaviors automatically without realizing how much time has passed. You may feel temporary relief or satisfaction in the moment, only to experience frustration, shame, or regret afterward.
These experiences can be associated with body-focused repetitive behaviors (BFRBs), a group of repetitive behaviors that involve the hair, skin, nails, or other parts of the body. Common BFRBs include trichotillomania (hair-pulling disorder) and excoriation disorder (skin-picking disorder).
BFRBs are not simply bad habits or a lack of willpower. They can be influenced by sensory experiences, emotions, stress, boredom, environmental cues, and learned behavioral patterns. Even when you genuinely want to stop, changing these behaviors can be challenging.
As a therapist specializing in trichotillomania and BFRBs, I provide practical, individualized therapy to help adults understand their pulling or picking patterns, recognize triggers, and develop strategies for changing behaviors that interfere with their lives.
BFRB Therapy: Habit Reversal Training (HRT)
Changing hair pulling or skin picking can be difficult, especially when the behavior has become an automatic response to certain situations, sensations, or emotions. Habit Reversal Training (HRT) is a behavioral treatment approach commonly used to help people change repetitive behaviors, including trichotillomania and other BFRBs.
In therapy, we'll work together to understand what happens before, during, and after the behavior. Rather than relying on willpower alone, we'll identify specific patterns and develop strategies tailored to your experience.
Depending on your needs, our work may include:
Increasing awareness & identifying triggers: Recognizing when pulling or picking occurs, including situations in which you may not notice the behavior until afterward. Exploring whether the behavior is associated with sensory stimulation, tension, boredom, stress, or other experiences. Exploring the settings, emotions, thoughts, physical sensations, and environmental cues associated with pulling or picking.
Practicing competing responses & hanging environmental patterns: Developing alternative responses that make it more difficult to engage in the target behavior when you notice an urge or the beginning of a behavioral sequence. Identifying practical adjustments that can reduce opportunities for automatic pulling or picking.
Building a plan for setbacks: Learning how to respond constructively when pulling or picking happens, rather than becoming stuck in shame or self-criticism.
Treatment is individualized. The strategies that help with hair pulling may differ from those that help with skin picking, and we'll adapt our work to the behavior you're experiencing and the situations in which it occurs. The goal is to help you develop greater awareness, increase your ability to respond differently, and reduce the impact these behaviors have on your daily life.
Does this sound like you?
I work best with adults who are ready to better understand their body-focused repetitive behaviors and explore practical ways to change them.
You may be a good fit for BFRB therapy if:
✔️ You've tried to stop pulling or picking but keep returning to the behavior.
✔️ You engage in the behavior automatically. You might notice hair pulling while working, reading, watching television, or using your phone—or realize you've been picking at your skin without consciously deciding to do so.
✔️ You feel frustrated or ashamed afterward. You may hide hair loss, avoid mirrors or photographs, cover your skin, or worry about what others will think.
✔️ You want to understand your triggers. You're interested in identifying the situations, sensations, and emotions that make pulling or picking more likely.
✔️ You want a practical approach to treatment. You're looking for more than general support and want to develop specific strategies you can practice between sessions.
You don't have to know exactly why the behavior happens or have a perfect record of when it occurs. We can begin by understanding your experience and identifying a manageable place to start.
If you're looking for a therapist in California who works with trichotillomania, skin picking, or other BFRBs, a free 15-minute consultation is an opportunity to discuss your concerns and determine whether my approach may be a good fit.
Ready to Work on Hair Pulling or Skin Picking?
You don't have to keep struggling with hair pulling, skin picking, or other body-focused repetitive behaviors on your own.
Therapy can help you understand the patterns behind these behaviors and develop practical strategies for responding differently. If you're looking for specialized BFRB therapy in California, let's talk about what you're experiencing and whether working together may be a good fit.
Schedule a free 15-minute consultation to discuss your concerns and ask questions about the therapy process.
How to Get Started
1
Complete the Phone Consultation
Schedule a free 15-minute phone call consultation. Robyn will call you at the time you select. If it is a good fit, you will be scheduled for your first appointment.
2
Complete Forms Online
Complete intake forms on the secure client portal no later than 24-hours before your first appointment.
3
Start Therapy
You will have your first comprehensive intake assessment appointment ($250). Then weekly 50-minute therapy sessions ($225).
“I blend my curiosity and problem-solving ability with a non-judgmental and empathetic stance to help you interrupt the hair pulling behavior. ”
— ROBYN TAMANAHA, LMFT
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