Beyond Willpower: How We Actually Treat Hair Pulling and Skin Picking
Discovering that skin picking and hair pulling are driven by your nervous system—not a lack of willpower—is the first step toward true healing. This article provides evidence-based insights for residents in Alberta who want to understand how specialized treatments actually work to break the behavioural loop and finally regain control.
If you struggle with skin picking or hair pulling, you have probably heard the same frustrating advice a hundred times: "Why don't you just stop?" When you have a Body-Focused Repetitive Behaviour (BFRB) like Trichotillomania (hair pulling) or Excoriation Disorder (skin picking), hearing "just stop" feels like a punch to the gut. If it were about willpower, you would have stopped years ago.
BFRBs are not just "bad habits" or forms of self-harm. They are complex behaviours driven by the nervous system's attempt to self-soothe, manage stress, or deal with boredom. The good news is that while willpower doesn't work, evidence-based therapy does.
Here is a look at exactly how we treat BFRBs using evidence-based therapies such as Habit Reversal Training (HRT) and the Comprehensive Behavioural (ComB) model.
Why Willpower Fails
Before we talk about treatment, it is important to understand why simply trying harder doesn't work. For people with BFRBs, picking or pulling provides a brief moment of relief, physical satisfaction, or zoning out. Because your brain gets a tiny "reward" every time you do it, the behaviour becomes highly automatic.
Often, you might not even realize your hands are scanning your scalp or your skin until you have already started. You cannot use willpower to fight something your brain is doing on autopilot! That is where specialized treatment comes in.
Step 1: Habit Reversal Training (HRT)
Habit Reversal Training (HRT) is a core treatment for BFRBs. It helps you take a subconscious behaviour and make it conscious, giving you the power to interrupt the cycle. It usually involves two main steps:
Awareness Training: First, we have to wake your brain up. We work together to track exactly when and where you pull or pick. You will learn to recognize the early warning signs - like the specific feeling of tension in your hands, or the way your fingers start scanning for a "bumpy" piece of skin.
Competing Responses: Once you are aware of the urge, you learn to use a "competing response." This is an action that makes picking or pulling physically impossible. For example, if you feel the urge to pull your hair, you might immediately clench your fists or press your hands flat against your legs for one minute until the peak of the urge passes.
Step 2: The ComB Model (Becoming a Detective)
While HRT is great for interrupting the physical action, we also need to understand why the urge is happening in the first place. This is where the Comprehensive Behavioural (ComB) Model comes in.
Using ComB, we become detectives. We look at five different areas of your life (sometimes called "SCAMP") to figure out exactly what triggers your BFRB:
Sensory: Are you looking for a specific physical sensation, like the feeling of a coarse hair or a smooth patch of skin?
Cognitive: What thoughts trigger the behaviour? (e.g., "I just need to get this one perfectly, and then I'll stop.")
Affective (Emotions): Do you pick when you are anxious? Do you pull when you feel overwhelmed or angry?
Motor: Are your hands just restless? Does the behaviour happen automatically when you are watching TV or reading?
Place: Does it only happen in a specific environment, like the bathroom mirror or sitting at your desk?
Building Your Personalized Toolkit
Once we understand your unique triggers, we build a customized toolkit to address them. If you pick because you need sensory input, we might find specialized fidget tools that give you the same physical satisfaction. If you pull when you are stressed at your desk, we might change your physical environment or teach you new ways to regulate your nervous system.
You Don't Have to Fight This Alone
Struggling with a BFRB can feel incredibly isolating and shameful, but you are not broken. Your brain is just stuck in an automatic loop, and therapy can help you learn how to pause that loop and choose a different path.
Ready to get started? If you are tired of fighting your BFRB with willpower alone, dedicated support is available. Together, we can build a treatment plan that actually works for you.
Please fill out the contact form here to book your first appointment.