Habit Reversal Therapy for Hair Pulling and Skin Picking
If you've ever caught yourself pulling out your hair, picking at your skin, biting your nails, or chewing on the inside of your cheeks without even realizing it, you're not alone. Many people struggle with these behaviors for years before seeking help. They may have tried using willpower, keeping their hands busy, or promising themselves they will stop tomorrow. Unfortunately, these strategies often only work temporarily. The good news is that there is an evidence-based treatment specifically designed to help reduce these behaviors. It is called Habit Reversal Therapy, or HRT.
What is Habit Reversal Therapy?
Habit Reversal Therapy is a form of behavioral therapy aimed at significantly reducing Body Focused Repetitive Behaviors (BFRBs), such as hair pulling and skin picking. While many people think these behaviors are simply bad habits, they are often more complicated than that.
Habit Reversal Therapy not only helps reduce the behavior itself but also addresses the underlying factors that may be contributing to it. Depending on the person, this could include stress, anxiety, boredom, perfectionism, emotional discomfort, or other triggers that increase the urge to engage in the behavior.
The goal is not simply to tell yourself to stop. Instead, we work to better understand the behavior and develop strategies that make it easier to respond differently.
What are Body Focused Repetitive Behaviors (BFRBs)?
Body Focused Repetitive Behaviors are repetitive behaviors directed toward the body that can result in physical damage or distress. Common examples include:
Hair pulling
Skin picking
Nail or cuticle biting and picking
Lip chewing
Cheek chewing
Finger sucking
Nose picking
Many people notice these behaviors happen most often during sedentary activities. For example, you may find yourself picking at your skin while scrolling on your phone, pulling your hair while watching television, or biting your nails while lying in bed. Other times, the behavior may be more intentional and occur in response to stress, anxiety, or uncomfortable emotions.
It is also very common for individuals to experience more than one type of BFRB. Someone who pulls their hair may also pick at their skin or bite their nails. There is a high level of overlap between these behaviors, which is one reason it is important to look at the bigger picture rather than focusing on a single behavior.
What Does Habit Reversal Therapy Include?
There are four main components of habit reversal therapy: monitoring the behavior to increase awareness, stimulus control, developing a competing response, and addressing the underlying triggers.
Monitoring the behavior
The first step is understanding how often the behavior is happening. This often starts with self-monitoring. You may track when the behavior occurs, where it happens, what you were doing beforehand, and how you were feeling at the time. Many clients are surprised by how often these behaviors happen without them even realizing it. Increasing awareness is an important first step because it helps identify common triggers and patterns that may otherwise go unnoticed.
Stimulus Control
Once we understand when and where the behavior is most likely to occur, we can make changes to the environment that reduce the opportunity to engage in it. This is called stimulus control.
Examples may include:
Covering mirrors if mirror checking leads to picking
Wearing bandages on fingers
Keeping tweezers or other tools out of reach
Wearing gloves during high-risk situations
Changing routines that commonly lead to pulling or picking
These strategies are not intended to eliminate urges completely. Instead, they help create barriers during situations where the behavior is most likely to occur.
Creating a Competing Response
One of the most important parts of Habit Reversal Therapy is learning a competing response. A competing response is a behavior that makes it difficult or impossible to engage in the BFRB at the same time. For example, if someone is working on reducing hair pulling, they may learn to clench their fists, squeeze a stress ball, or engage their hands in another purposeful activity when urges arise. The goal is to replace the behavior with a healthier alternative while the urge naturally decreases over time.
Addressing Underlying Triggers
For many people, BFRBs are connected to stress, anxiety, frustration, boredom, or other emotional experiences.
Because of this, treatment often includes identifying healthier ways to cope with those experiences. Depending on your needs, this may involve learning coping skills, challenging unhelpful thoughts through CBT, improving emotional awareness, or building distress tolerance skills.
When we address both the behavior and the triggers behind it, long-term success becomes much more likely.
Who Can Benefit from Habit Reversal Therapy?
Habit Reversal Therapy can benefit anyone struggling with Body Focused Repetitive Behaviors, particularly if they have been unsuccessful trying to manage these behaviors on their own.
Many people seek treatment after years of frustration. They may know they want to stop but feel like the behavior happens automatically or returns whenever they are stressed.
If you find yourself repeatedly pulling your hair, picking your skin, or engaging in other BFRBs despite your best efforts to stop, Habit Reversal Therapy may be worth exploring.
Can I Do Habit Reversal Therapy on My Own?
While there is a significant amount of work that happens between sessions, Habit Reversal Therapy is generally most effective when guided by a trained mental health professional.
One reason for this is that it can be difficult to accurately identify the function of your behavior on your own. A therapist can help you recognize patterns, increase awareness, identify triggers, and develop competing responses that fit your specific needs. Your therapist can also help you address the emotional factors contributing to the behavior and teach more effective coping strategies.
Finally, treatment should include a plan for maintaining progress after therapy ends. As you prepare for discharge, your therapist can help you develop a relapse prevention plan so you know what to do if symptoms begin to increase again in the future.
When Should I Reach Out for Help?
Many people wait until they feel embarrassed, frustrated, or discouraged before seeking treatment. The reality is that you do not have to wait until the behavior becomes severe to benefit from support.
If you struggle with hair pulling, skin picking, nail biting, or other Body Focused Repetitive Behaviors and are unsure whether therapy is right for you, we encourage you to reach out for a free consultation. We would be happy to discuss your symptoms, answer your questions, and help you explore whether Habit Reversal Therapy may be a good fit for your needs.
These behaviors can feel overwhelming, but effective treatment is available. With the right support and tools, many people are able to significantly reduce their symptoms and improve their quality of life.
Start Habit Reversal Therapy in Missouri, North Carolina, or Illinois
If you've been pulling your hair, picking your skin, or biting your nails for years, you've probably already tried to stop on your own. And it makes sense that it hasn't stuck. These behaviors are more complicated than willpower, which is exactly why the right kind of treatment matters.
Here's something most people don't know: a lot of therapists try to treat hair pulling and skin picking without specific training in Habit Reversal Therapy. We think that's a problem. HRT works best when it's delivered the way the research supports, and that takes real training.
At Aspire Counseling, Mikayla is one of our therapists currently trained in Habit Reversal Therapy, and she's also one of our therapists who most often uses ERP for OCD. When you work with her, you're not getting a generalist taking a guess. You're getting someone trained specifically in this approach.
And because we offer this online, you don't have to live near Columbia or Lee's Summit to get help. Mikayla can see clients located anywhere in Missouri or North Carolina, and our Senior Clinical Team Lead, Kristi Sveum, is also able to see clients using HRT in Illinois.
You don't have to wait until it feels unbearable to reach out. If you're curious whether Habit Reversal Therapy might be a good fit, we'd be happy to talk it through.
Call us at 573-328-2288 or fill out our contact form to set up a free consultation. We'll answer your questions and help you figure out the next step.
About the author
Written by Mikayla Wichern, MSW, LCSW. Mikayla is a licensed clinical social worker at Aspire Counseling and one of the practice's most active providers of Exposure and Response Prevention (ERP) for OCD. She is also one of only two therapists at Aspire currently trained in Habit Reversal Therapy for body-focused repetitive behaviors like hair pulling and skin picking.
Mikayla earned both her Bachelor of Social Work and her Master of Social Work from the University of Missouri. During graduate school, she provided therapy, including Cognitive Processing Therapy, at a pro bono clinic in Columbia under the supervision of an LCSW. She completed her final MSW internship at an acute inpatient psychiatric hospital, delivering evidence-based interventions rooted in Cognitive Behavioral Therapy, and later worked in a high-security inpatient facility providing evidence-based treatment for individuals with serious mental illness. Today, she provides online therapy for anxiety, OCD, trauma and PTSD, depression, repetitive body focused behaviors (such as nail biting, skin picking and hair pulling) and the stressors of everyday life.
Mikayla sees clients online throughout Missouri and North Carolina. She's known for being direct, down-to-earth, and unafraid to use a little humor in session. Learn more about Mikayla here.
