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Beating Trichotillomania with Habit reversal

Updated: Nov 16, 2022

All our life so far as it has definite form is but a mass of habits.*

Life is a mass of habits; we often do the same thing, eat the same food, get up at the same time, go to the same places, drive the same route, … Many of our habits are ones we want to keep, they serve us well. We don’t particularly think about them, they simply happen. They provide a certain ritual and comfortable, safe routine in our lives.

Habits aren’t always good and wholesome though. Some are downright nasty. And as anyone knows who has tried to stop an annoying habit - nail biting, smoking, cheek chewing, skin picking, hair pulling - it can be difficult!

I work with many clients who pull out their hair (trichotillomania). This compulsive body-focused repetitive habit distracts the sufferer from unpleasant feelings and thoughts, and gives a certain pleasure or release. At the same time, the resulting hair loss or thinness(eyebrows, eyelashes, hair) leads to embarrassment, shame, and a feeling of being out of control.

A permanent cycle

👉 internal or environmental triggers that lead to pulling👉 pulling out hair 👉 feeling a certain release/satisfaction/pleasure 👉 feeling disgust and shame at having pulled

Every habit and capability is confirmed and grows in its corresponding actions, walking by walking and running by running … therefore if you want to do something make a habit of it, if you don’t want to do that, don’t, but make a habit of something else instead’ **

Easier said than done with a BFRD (body-focused repetitive disorder).

You WANT to stop, but at the same time, you feel COMPELLED to pull or pick. You just can’t seem to get out of the cycle.

the 4-step habit reversal protocol

Cognitive behavioural hypnotherapy and a client’s strong belief that she is worthy and capable of overcoming her compulsive habit can help her either stop or effectively manage what used to be out-of-hand.

One of the tools central to cognitive behavioural therapy for trichotillomania is habit reversal.

In essence, as Epictetus suggested all those centuries ago, one habit is replaced by another counter habit using this 4 step process

Step 1

You gain clarity and awareness, about when, where, and how you pull and build precise knowledge concerning the feelings, thoughts, and behaviours associated with hairpulling before, during, and afterwards.

Awareness is the key word here. You discover more and more about your particular habit as together with the therapist you bring all of its quirks and rituals out to the light of day.

You often discover that this annoying habit is fed by many other rituals and routines. Sometimes just by changing these routines, your habit lessens as it is disrupted.

Step 2

You learn and practice Destress Exercises which bring you calm and increase your ability to self-regulate your emotions. You discover that by breathing, using mindfulness, relaxation, and self-hypnosis techniques you can distract your mind and body from urges and the ‘need’ to pull.

Repetition is the key word here. If you do an exercise once in a while it won’t work. If you consistently and consciously dedicate time to them, guess what: you create a new habit.

Step 3

You are now ready to put in place a strong counter habit which includes consciously changing your muscle movement and breathing pattern, and switching your thoughts as you repeat a dedicated coping statement. This brings your attention back to what you want. You remember the reason WHY you have decided to stop hair-pulling each and every time you use your protocol

This is super effective. It works.

Step 4

Practice, practice, practice. As the days and weeks go by this new habit becomes more automatic, more ‘normal’. It strengthens your self-belief and Trich dwindles from an urge that is compelling and intense to a distant irritation .

The key word, you’ve guessed it: Practice

When you reinforce the 4 step Habit Reversal with hypnosis, you deepen its impact and tap into your creative, powerful imagination and all of its resources to help and guide you.

Trich takes a back seat

Trich never ‘goes away’ completely, however using these effective strategies means you never ‘let it back in’ to your life.

It means you know how to stop yourself from pulling if that urge comes

It means that even if you pull one hair you can use your strategies to stop right there.

It means it no longer has a hold over your life and actions

You can gain control and BE in control


*William James in 1892, quoted by Charles Duhigg in his fascinating book The Power of Habit (2012) Penguin

**Epictetus Discourses quoted by Ryan Holiday and Stephen Hanselman in The Daily Stoic (2016) Profile Books

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