Trichotillomania & BFRB Therapy in Pennsylvania

If you've been pulling — and hiding it, and hating it, and swearing this is the last time — please take a breath. This is not a character flaw. It's not a lack of willpower. Trichotillomania is a recognized body-focused repetitive behavior (BFRB), and there are treatments built specifically for what your brain and body are doing. You do not have to figure this out alone.

We work with adults and teens across Pennsylvania who are ready to actually address the pulling, not just white-knuckle their way past it. Sessions happen over secure video, so wherever you are in the state, care is one appointment away.

Book your free 15-minute consult →

What trichotillomania actually is

Trichotillomania, sometimes called trich or TTM, is the recurrent pulling out of one's own hair — from the scalp, eyebrows, eyelashes, beard, pubic area, arms, or anywhere else — resulting in noticeable hair loss and distress. It's classified alongside OCD and related disorders, and it usually starts in adolescence, though it can begin at any age.

Pulling can look very different from person to person. For some people, it's focused: you notice you're doing it, you feel some kind of pull toward it, and there's a full ritual — searching for a specific kind of hair, examining the root, sometimes chewing or swallowing. For other people, it's automatic: you look up and realize you've been pulling for twenty minutes without noticing, usually while doing something else like reading, driving, or scrolling. Most people do some of both.

The emotional aftermath is often the hardest part. Shame, secrecy, the ritual of covering the spot, avoiding certain lighting, avoiding certain relationships, avoiding the hair salon. The pulling is one thing. The hidden life that gets built around it is another.

None of that is your fault. It also isn't something you have to keep living with.

Why habit reversal training (HRT) works

Habit Reversal Training is the frontline behavioral treatment for trichotillomania, with the strongest research base of any single intervention for BFRBs. In practice, it has four moving parts:

Awareness training. Before you can change the behavior, we have to slow it down enough to see it. Together we track when pulling happens, where on the body, in what settings, at what emotional temperature, with what preceding sensations. Most clients are surprised by what shows up in the log. Patterns that felt random turn out to be predictable.

Competing response. For each pulling situation, we build a physical response that is incompatible with pulling — something you can do instead, in the moment, that occupies the same hand for the same duration. This is not "just do a fidget toy." A competing response is a specific, engineered movement matched to the pulling pattern, and it's held long enough to let the urge pass.

Stimulus control. We change the environment so that pulling becomes harder and the competing response becomes easier. This might mean bandages on fingertips during your highest-risk window, blue light on in the bathroom, gloves in the car, a hat during studying. These are not permanent. They're scaffolding while the new response gets automatic.

Social support. Someone in your life — partner, parent, roommate, close friend — becomes part of the plan in a specific, structured way. Not a policeman. A support.

HRT alone helps a lot of people. For many, though, it's the beginning of a fuller approach called ComB.

The ComB approach — treating the full picture

ComB stands for Comprehensive Behavioral Treatment. Developed by Mansueto, Golomb, and colleagues, it recognizes that pulling is almost never just one thing. It's driven by a mix of sensory input, cognitive patterns, affective states, motor habits, and situational triggers. HRT alone addresses the motor and situational pieces well. ComB addresses all five.

In a ComB-informed course of treatment, we work through each of the five domains:

• Sensory — the specific sensations that drive or accompany pulling. We identify sensory substitutes that satisfy the same input in a non-damaging way.
• Cognitive — the thoughts and beliefs that give pulling permission ("just one more," "I'll fix this tomorrow"). We work with the thoughts directly.
• Affective — the emotional states that make pulling feel necessary (anxiety, boredom, understimulation, overwhelm). We build a different toolkit for each.
• Motor — the habit itself, addressed with HRT.
• Place — the environments and situations where pulling is most likely, addressed with stimulus control.

The strength of ComB is that it's individualized. Two people with trichotillomania can have completely different profiles, and the treatment plan reflects that.

Teletherapy across Pennsylvania

We're licensed in Pennsylvania, which means we can see you whether you're in Philadelphia, Pittsburgh, Erie, Scranton, State College, Bethlehem, Lancaster, King of Prussia, or a small town most people can't find on a map. All sessions are secure video, HIPAA-compliant, and end-to-end encrypted. All you need is a device with a camera and a private space.

For trich work specifically, teletherapy has a real advantage. Pulling happens at home. When treatment happens at home too, we can practice competing responses in the exact chair, the exact lighting, the exact time of day where the behavior actually lives.

If you're a provider looking to refer

Trichotillomania is often missed or misclassified in primary care and general mental health settings. If you're a physician, dermatologist, psychiatrist, pediatrician, or generalist therapist with a patient who might benefit from specialty BFRB care, we make the referral pathway simple. Send them the consult link. We handle the intake, and we'll keep you looped in with the patient's written consent.

Recommended reading

For clients and family members who want to read alongside treatment, the Comprehensive Behavioral Treatment (ComB) Workbook by Mansueto, Golomb, and colleagues is the gold-standard workbook and closely mirrors the approach used in sessions. (Affiliate link placeholder — insert amazon.com/trichotillomania-comb-workbook URL when finalized.)

About us

Onward Healing Therapy is a private-pay practice focused specifically on OCD, OCD-spectrum conditions, and body-focused repetitive behaviors including trichotillomania, skin picking, and nail biting. Nina Eberly, PhD, LCSW founded the practice after seeing too many clients with BFRBs receive shame-based interventions or well-intentioned but ineffective general therapy. Every client on the caseload is here for specialty work.

Ready to talk?

The first step is a free 15-minute video consult. We'll talk about what pulling has been like for you, what you've tried, and what a course of HRT and ComB-informed treatment might look like. If it isn't the right fit, we'll help you think about next steps.

Book your free 15-minute consult →

FAQ

How long does treatment usually take? Most clients see meaningful reduction within the first three to four months of weekly sessions. Full course varies. Some clients continue on a maintenance cadence — every other week, then monthly — to protect the gains.

Do you take insurance? We're a private-pay practice and do not bill insurance directly. We can provide a superbill for possible out-of-network reimbursement if your plan includes that benefit.

What if I've tried treatment for trich before and it didn't work? That's a very common starting point. Often what people have tried was generic CBT or talk therapy without HRT or ComB. Specialty treatment done specifically for trichotillomania looks different, and it's worth a fresh conversation.

Can I do this if my pulling is mostly automatic and I don't notice it? Yes. Awareness training is the first phase of treatment for exactly that reason. Automatic pulling can be brought into awareness, and then addressed.

Do you work with kids? We work with teens (roughly 14 and up). For younger children with trichotillomania, we're happy to refer to specialists in child-specific care.