treatment for TrichotillomaniaIt is important that therapists who work with children & adolescents with Trichotillomania – a type of Body-Focused Repetitive Behavior (BRFB) otherwise known as “hair pulling disorder” – understand the potential causes as well as treatment for Trichotillomania.

Approximately 2 in 50 people experience Trichotillomania and it generally occurs in late childhood/ early puberty. Potential causes include genetics, trauma, anxiety, the child’s temperament, environment, age of onset, and family and social stress factors.


In my two hour recorded online CE training called A Play Therapy Approach for Treating Trichotillomania, you will find a detailed explanation of the different types of treatment along with many valuable interventions gathered from many years of my own experience working with children with BRFBs. This training provides APT and NBCC continuing education hours.

In this article, I will give you a sneak peek into what you will learn in that workshop, some mindfulness-based play therapy techniques, a video to share with parents, as well as book recommendations to use with children and families.

8 Types of Cognitive Behavioral Therapy Treatment for Trichotillomania:

1) Habit Reversal Training (HRT)

HRT states that all habits have 3 components: 1) A trigger, 2) habitual response behavior, and 3) reward. It involves awareness training, development of a competing response, building motivation, and generalization of skills.

2) Dialectical Behavioral Therapy (DBT)

“Dialectical” means synthesis or integration of opposites. DBT has 4 stages: 1) Helping the client becoming aware and take responsibility for their behaviors that are causing harm; 2) Helping the client move towards experiencing emotions authentically without harm to self or others; 3) Helping the client be more self-reliant and learn how to live more productively; and 4) Examining how the client can experience greater life fulfillment through the process of finding meaning in experiences.

3) Functional Analytic Therapy

Through the relationship between the client and therapist, FAP focuses on the function of a client’s behavior instead of the form.

4) Compassion Focused Psychotherapy (CFP)

CFP refers to specific activities designed to develop compassionate attributes and skills, particularly those that influence affect regulation. It helps clients develop a felt sense of compassion for self, for body, and for mind that can be key in motivating the client to employ tools and strategies.

5) Mindfulness Based Cognitive Therapy (MBCT)

MBCT combines cognitive therapy with meditative practices. It helps clients learn specific skills for tuning in, noticing, paying attention as well as the element of self soothing in alternate, healthier forms in lieu of hair pulling.

6) Comprehensive Behavioral Model (ComB)

This form of therapy aims to understand the function of the behavior (i.e. Does hair pulling relieve stress? End boredom? Reduce anger and frustration?) Treatment and data collection address all aspects of trichotillomania including emotional regulation, physical habits, and environmental interventions.

7) Acceptance & Commitment Therapy (ACT)

Stands for Accept your reactions and be present, Choose a valued direction, and Take action. Over the course of approximately 8 weeks, clients learn to be aware of their pulling and warning signals, use self-management strategies for stopping and preventing pulling, stop fighting against their pulling-related urges and thoughts, and work towards increasing their quality of life.

8) CBT Play Therapy (CBPT)

CBPT is a type of play therapy that merges the traditional and effective Cognitive Behavioral Therapy with Play Therapy (Susan Knell, Ph.D.). It is structured, short-term, goal-oriented, play based, and psychoeducational. CBPT is facilitated by the therapist and involves collaboration with parents and teachers.

How to use mindfulness-based play therapy techniques as treatment for Trichotillomania:

Mindfulness means paying attention in a particular way (i.e. really noticing what we’re thinking and feeling) without judging what we notice. Here is a sneak peek at some of the interventions I share in A Play Therapy Approach for Treating Trichotillomania.

  • Mindful listening game. The therapist tells the child, “We are going to sit here and be really quiet and listen for all the sounds we can hear. When we’re done, we’ll share with each other what we heard.”
  • Closed eye meditation. The therapist says, “Let’s feel the floor underneath us. Do we hear any sounds? Notice anything in our body? Just breathe, and notice.”
  • Open eye meditation. The therapist encourages the child to focus on an object while sitting and being quiet (i.e. crystal, stone, or flower) and says “We’re going to gaze at this (object). Breathe, and sit with yourself in stillness.”

You can learn even more about incorporating mindfulness into play therapy in my recorded webinar called Mindfulness Techniques and Play Therapy with Children.

This video by the TLC Foundation is a great resource to share with parents who have a child with Trichotillomania:


Here are some additional resources for working with children with Trichotillomania:

(There are affiliate links in this article which will share a small commission with me if any purchase is made through those links)

Check out my training here to learn more about treatment for Trichotillomania.

Need consultation or coaching on how to work with a child with Trichotillomania? I offer both contact and non-contact play therapy training as well as consultation for therapists and coaching for parents. Contact me here to schedule a consultation.