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A Beginner’s Guide to Treating Trichotillomania

Clinical Psychologist

I often tell my colleagues that trichotillomania (hair pulling disorder) represents the wild west of psychological disorders. Unfortunately, it remains one of the least researched and most misunderstood disorders in the DSM. Additionally, there is a lot of pseudoscience, snake oil, and plain old quackery on the internet about the best way to treat it.

In this article, I will highlight what we do know about scientifically supported treatments for trichotillomania. As a disclaimer, this is only an introduction to treating trichotillomania and is not intended to formally train clinicians. Lastly, I will not be reviewing medical treatments for trichotillomania (you can learn more about those here).

Historical Treatments

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Photo by Gregory Parker

The first scientifically based treatment for trichotillomania was Habit Reversal Training (HRT) (Azrin, Nunn, & Frantz, 1980; Duke, Keeley, Geffken, & Storch, 2010). During HRT, individuals become more aware of their hair pulling behavior and practice interrupting the behavior by engaging in incompatible behaviors. For example, people who use their hands to pull from their scalp might practice reaching down towards one’s knees. While HRT has been effective in the treatment of tics and Tourette’s Disorder, it doesn’t work for everyone who has trichotillomania and also has a high rate of relapse. Why? As I described in a previous article, trichotillomania is a very heterogeneous disorder and affects each person differently. A “one size fits all” treatment just won’t work for trichotillomania.

Modern Treatments

Recently, researchers have developed more comprehensive approaches to treating trichotillomania. Dr. Charles Mansueto pioneered the Comprehensive Behavioral Model (ComB) for trichotillomania (Mansueto, Stemberger, Thomas, & Golomb, 1997). In ComB, clinicians first understand the function of hair pulling. Does it relieve stress? Does it end boredom? Does it reduce anger and frustration? Next, clinicians identify the main types of hair pulling. Some individuals pull for sensory stimulation (trying to find the hair that feels just right), others due to specific thoughts (I have to get rid of all the grey hairs), etc. Lastly, clinicians create treatments that address all aspects of trichotillomania including emotional regulation (learning more adaptive ways of dealing with stress, anger, boredom), physical habits (using HRT and objects to stop motor behavior), and environmental interventions (covering mirrors, getting rid of tweezers).

While research is underway to evaluate Mansueto’s ComB model, other researchers have found support for this approach to treating trichotillomania. In a recent pilot study, Dr. Nancy Keuthen and her colleagues found that Dialectical Behavior Therapy (DBT) was effective at reducing trichotillomania symptoms for at least 3 months (Keuthen et al., 2010). DBT is a form of cognitive behavior therapy that focuses on learning new ways of regulating one’s emotions. Additionally, in a review of all published scientific treatment studies on trichotillomania, Dr. Michael Walther and his colleagues concluded that behavior therapy (HRT), emotional regulation, and acceptance together represent the most promising treatment for trichotillomania (Walther, Ricketts, Conelea, & Woods, 2010). Furthermore, Dr. Martin Franklin and his colleagues have demonstrated that this comprehensive approach to behavior therapy not only works for adults, but it can help children as young as 7 (Franklin, Edson, & Freeman, 2010).

So what does this all mean? To the best of our scientific knowledge, effective trichotillomania treatment includes three things:

  1. An increased awareness of when, where, and why hair pulling occurs.
  2. An effort to control or change hair pulling behavior.
  3. Emotional regulation training to find alternative ways of dealing with negative feelings.

Here’s how I use these scientific findings to treat trichotillomania.

Increasing Awareness

Photo by Wim Mulder

Before creating a treatment plan, I collaborate with my clients to understand the unique patterns of their hair pulling. This usually includes a 1-2 week record of all hair pulling episodes. I ask each client to record the following information after each hair pulling episode:

  • What part of the body was the hair pulled from?
  • Where was the person when they pulled their hair?
  • What time was it when the person pulled their hair?
  • Was an instrument (e.g. tweezers) used to help pull hair?
  • What was the person doing while they pulled their hair?
  • What was the person feeling before, during, and after the hair pulling?
  • What was the person thinking before, during, and after the hair pulling?
  • Was anyone else present during the hair pulling?
  • What did the person do with their hair after they pulled it? (Sidenote: You’ll want to look out for individuals who swallow their hair, this could lead to a potentially lethal condition known as a trichobezoar and will need immediate medical attention).

Changing Hair Pulling Behavior & Emotional Regulation

Photo by Aimee Quiggle

A key component of Dr. Manysueto’s ComB model is the SCAMP Intervention. SCAMP stands for Sensory, Cognitive, Affective, Motor, and Place. Once my client and I have a firm understanding of the hair pulling behavior, I use the SCAMP Intervention to create a customized treatment plan.

Sensory: For individuals who seek sensory activation on their scalp, we might use brushes, combs, pens, massages, or ice to ease sensations. For hands, individuals can get manicures, use lotions, or file their nails. For the face, bath oils, baths, facial scrubs, or a loofah could be used.

Cognitive: Often specific thoughts can lead to hair pulling. Common thoughts include, “My hair has to look perfect”, “I need to get rid of that blemish”, “I’ll just pull a little”, “I’ve already pulled once, so why try holding back?” Here, individuals practice thinking in more realistic way (e.g. “It’s okay to be imperfect”, “The best way to fix it is to let it heal”, and “A slip-up is not a failure, any progress is helpful”).

Affective: When specific emotions lead one to pull their hair, the best way to address this problem is learn more effective ways of regulating your nervous system. To become more relaxed, individuals can use diaphragmatic (belly) breathing, progressive muscle relaxation, practice meditation, listen to white noise, use a heating pad, drink a warm beverage, take a slow relaxing walk, use an eye/face gel mask, or take a long bath. To address intensity and pain, individuals can stick their fingers in frozen ice cream, put their face in a bowl of ice water, suck on a lemon, snap a rubber band on your wrist, take a cold shower, go for a fast run, or chew a large wad of gum. To deal with boredom, individuals can learn about a topic of interest on the internet, write in a journal, draw, play a musical instrument, read a book, paint, take photographs, do a crossword puzzle, and garden.

Motor: In addition to HRT, physical barriers can often help reduce hair pulling. For example, rubber fingers, band-aids, sleep masks, head wraps, glasses, hats, gloves, thumb braces, and tape can all be used to create barriers to hair pulling. Also, changing the condition of your hair and hands can help (e.g. wetting hair, placing Vaseline on your eyelids/brows, wearing false nails, using hand lotion). Objects such as loud bracelets, elbow braces, and perfume can increase awareness of hair pulling. Fiddling toys can sometimes provide alternatives to hair pulling (e.g. koosh balls, silly putty, clay, knitting). For oral rituals, chewing gum, eating sunflower seeds, chewing raw pasta, chewing a toothpick, and eating gummy bears can help.

Place: Comprehensive interventions should also target the environment in which hair pulling takes place. Individuals can try changing light levels, covering mirrors, getting rid of tweezers (or placing them in the freezer), using sticky notes, keeping certain doors open (to decrease privacy), rearranging furniture, and sitting in different positions.

Monitoring Progress and Revising Treatment

As a client and clinician begin treatment, it’s important to keep a daily log of the hair pulling episodes and the attempted interventions. Some interventions will work right away, others will need to be fine tuned, and some will lose their effectiveness over time. The client and clinician must work together, constantly monitoring and reevaluating the treatment until a plan is developed that fits the needs of the client. This process could take weeks or months. Additionally, since trichotillomania changes as we age, treatments that worked at one phase of life may not work in another.

Advice for Treatment Seekers and Treatment Providers

As you can tell, treating trichotillomania is a complex and long process. It takes a lot of time, courage, and motivation on the part of the individual and a lot of training and experience on the part of the clinician. If you are someone who is suffering from trichotillomania, make sure that your clinician is using scientifically supported treatments. Ask them about the type of treatment they are using. If you don’t hear anything about increasing awareness, changing behaviors, or emotional regulation, their treatment may not be based on science. If they start using personal testimonials and wild theories to backup their treatment, or say their treatment cannot be evaluated by science, run away – they’re probably selling you snake oil.

I recommend using the Trichotillomania Learning Center’s list of health care providers to find individuals trained in scientifically supported treatments. If you are a health care provider wanting to learn more about these treatments, I highly recommend attending a Trichotillomania Learning Center Professional Training Institute and browsing through their clinical resources.

References:

Azrin, N. H., Nunn, R. G., & Frantz, S. E. (1980). Treatment of hair-pulling (trichotillomania): A comparative study of habit reversal and negative practice training. Journal of Behavior Therapy and Experimental Psychiatry, 11, 13-20.

Duke, D., Keeley, M., Geffken, G., & Storch, E. (2010). Trichotillomania: a current review. Clinical Psychology Review, 30, 181-193.

Franklin, M. E., Edson, A. L., & Freeman, J. B. (2010). Behavior therapy for pediatric trichotillomania: Exploring the effects of age on treatment outcome. Child and Adolescent Psychiatry and Mental Health, 4, 18.

Keuthen, N. J., Rothbaum, B. O., Welch, S. S., Taylor, C., Falkenstein, M., Heekin, M., Jordan, C. A., et al. (2010). Pilot trial of dialectical behavior therapy-enhanced habit reversal for trichotillomania. Depression and Anxiety, 27(10), 953-959.

Mansueto, C. S., Townsley-Stemberger, R. M., McCombs-Thomas, A., & Goldfinger-Golomb, R. (1997). Trichotillomania: A comprehensive behavioral model. Clinical Psychology Review, 17, 567-577.

Walther, M. R., Ricketts, E. J., Conelea, C. A., & Woods, D. W. (2010). Recent Advances in the Understanding and Treatment of Trichotillomania. Journal of Cognitive Psychotherapy, 24(1), 46-64.

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Suffering Produces Perseverance

I do not wish I never had trich or bipolar disorder. Although both come full of pain and suffering, there is another side. Working through my struggles has made me the person I am today. I don’t know if I would have have the same faith, spirit of perseverance, or compassion. I think my best traits have been developed through my pain. God did not cause my suffering, but He will use it for good.

I still hope to be pull free, but I am happy now as I am. My moods are relatively stable, and I have settled on a set of meds that works for me. I still pull, but it does not rule my life. Yes, I do spend a considerable amount of time practicing awareness and coping strategies. However, I do not feel like less of a person because I do this or because I am missing some hair. Everyone has some form of struggle in their life. Learning to use that suffering for good is the key to moving through it and finding a purpose for your pain. I read this devotional earlier today and thought that it lined up so well with the verse that has been on my heart, Romans 5:3-4.

Your Pain Often Reveals God’s Purpose for You

BY RICK WARREN — NOVEMBER 25, 2014

Your pain often reveals God’s purpose for you. God never wastes a hurt! If you’ve gone through a hurt, he wants you to help other people going through that same hurt. He wants you to share it. God can use the problems in your life to give you a ministry to others. In fact, the very thing you’re most ashamed of in your life and resent the most could become your greatest ministry in helping other people.
Who can better help somebody going through a bankruptcy than somebody who went through a bankruptcy? Who can better help somebody struggling with an addiction than somebody who’s struggled with an addiction? Who can better help parents of a special needs child than parents who raised a special needs child? Who can better help somebody who’s lost a child than somebody who lost a child?
The very thing you hate the most in your life is what God wants to use for good in your life.
The Bible says in 2 Corinthians 1, verses 4 and 6, “God comforts us in all our troubles so that we can comfort others. When we are weighed down with troubles, it is for your comfort and salvation! For when we ourselves are comforted, we will certainly comfort you. Then you can patiently endure the same things” (NLT).
This is called redemptive suffering. Redemptive suffering is when you go through a problem or a pain for the benefit of others.
This is what Jesus did. When Jesus died on the cross, he didn’t deserve to die. He went through that pain for your benefit so that you can be saved and go to Heaven.
There are many different causes for the problems, pains, and suffering in your life. Sometimes the stuff that happens you bring on yourself. When you make stupid decisions, then it causes pain in your life. If you go out and overspend and buy things you can’t afford and presume on the future, and then you go deeply in debt and lose your house, you can’t say, “God, why did you let me lose my house?” You can’t blame God for your bad choices.
But in some of your problems, you’re innocent. You’ve been hurt by the pain, stupidity, and sins of other people. And some of the pain in your life is for redemptive suffering. God often allows us to go through a problem so that we can then help others.

Conflict in Relationships

img_5156Any type of stress, anxiety, anger, or conflict makes my pulling worse. It is a self-soothing behavior that helps me calm down and often dissociate from my feelings. Over the past few years, I have been working to use helpful strategies that help me relax without pulling my hair (which only leaves me feeling worse in the end).
As a high stress person, I have suffered with anxiety for most of my life. It still plagues me at times, but I have learned strategies to calm my mind and body. Taking a quick break from the situation, praying, practicing deep breathing, and trying to find a more positive outlook are some simple tools that have helped me.

If I catch myself being negative or getting stressed out, I try to take a step back and look at the situation objectively. In the past, I would catastrophize my situation. Now, I can identify those feelings and look for the truth.

  • Are my concerns based on truth?
  • Can I do anything about this?
  • Is there a more positive outlook I can strive for?
  •  If the worst case senario does play out, is it really that bad?

Beyond my stress and anxiety is anger that can cause relationship problems. The following article presents 3 ways to create conflict (and therein, 3 ways to avoid it). I know I am guilty of these and am making it a priority to avoid them. Reducing conflicts in our relationships, greatly increases our overall well-being.

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Three Sure Ways to Create Conflict

By Rick Warren

“Any fool can start arguments; the honorable thing is to stay out of them” (Proverbs 20:3 TEV).

Wise people are peacemakers, not troublemakers. Wise people don’t carry a chip on their shoulder. They’re not always looking for a fight, and they don’t intentionally antagonize other people.

The fact is, if you’re around anybody for any length of time, you’ll figure out what that person does that irritates you, and you file that information in the back of your mind as a tool to use when you get in an argument. It becomes a personal “weapon of mass destruction”! When you get in an argument, and that person says something that hurts, offends, or slights you in any way, then you pull out the big gun. You push the hot button. And it works every time!

You know what the Bible calls that? Foolishness! You’re not getting any closer to the resolution. You’re not helping the relationship. In fact, you’re hurting it. It is not wise.

Proverbs 20:3 says, “Any fool can start arguments; the honorable thing is to stay out of them” (TEV).


We all use tools, tricks of the trade, and skills in relationships that are actually counter productive. They’re hurtful, they’re harmful, and they don’t get you what you want out of relationships. In fact, they get you the exact opposite behavior. But when we lack wisdom, we use them anyway.

There are many of these tools, but here are just a few:

1. Comparing. Never compare your wife, your husband, your kids, your boss, or anybody else, because everybody’s unique. Comparing antagonizes anger.

2. Condemning. When you start laying on the guilt in a relationship, all you’re going to do is get the exact opposite of what you expect. It doesn’t work. It’s foolish.

3. Contradicting. William James, the famous psychologist said, “Wisdom is the art of knowing what to overlook.” There’s some stuff you just need to overlook.


The Bible says in Proverbs 14:29, “A wise man controls his temper. He knows that anger causes mistakes” (TLB). Have you ever said or done anything stupid out of anger? Yes? Because when you get angry, your intelligence goes out the window. When you get angry, you say and do foolish things that are actually self-defeating.

Did you ever think about the fact that there is only one letter difference between “anger” and “danger”? When you get angry, you are in dangerous territory. You are about to hurt others — and yourself — with your own anger.

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Inositol

Studies show that Inositol helps many Trichotillomania suffers. I find that it reduces the urge to pull, which helps with my focused pulling. The Inositol also increases my awareness, which decreases my unfocused pulling.

Leading Trichotillomania specialist Dr. Penzel’s wrote, Inositol and OCD. He recommends the following regimen to begin Inositol: 

(1 teaspoon=2 grams, and be sure to use a measuring spoon) for an adult:

Week 1 – 1 teaspoon/2x per day
Week 2 – 1 teaspoon/3x per day
Week 3 – 1.5 teaspoons/3x per day
Week 4 – 2 teaspoons/3x per day
Week 5 – 2.5 teaspoons/3x per day
Week 6 – 3 teaspoons/3x per day

Following this regimen, I worked my way up and now take 18g each day. I do this by mixing 3 teaspoons (1 tablespoon) of inositol in water 3 times a day. I have found the Jarrow brand powder (shown above) to dissolve well. It is available on amazon for reasonable price. I mix it with warm water as it dissolves better that way. You can add it to fruit juice or other sweetened drink. I simply mix the powder with ~3oz of warm water and drink plain as it has a mild sweet taste that I actually like. In addition to Inositol, l I take 1800mg of  NAC, which I started several months before the Inositol. I did not see much progress with that alone, therefore I added the Inositol. If you are considering both supplements, choose one to start with, otherwise you will not know which is helping and or causing side effects.

I have taken Inositol on and off for 2 years. When I first started the recommended regimen over 6 weeks, I noticed many GI side effects. When I unexpectedly became pregnant a couple months later, I had to lower my dose because it increased my nausea. That did not help so I discontinued the Inositol until my morning sickness passed. Reassured by my OB that Inositol is safe while pregnant and breastfeeding, I slowly reintroduced the Inositol. I only took 1-2 because it aggravated epigastric pain I had while pregnant. The lower dose helped a bit, but not nearly as well as the recommended 3 TBSP. Now that I am back to 3 TBSP per day (which I take in one large dose at night to help my insomnia), I am definitely feeling the benefits. It decreases my urges and makes me more aware of pulling.

Here’s more details information I copied from the article about Inositol use for trich sufferers, written by trich specialist Fred Penzel:

“Obviously, before you run out and try anything new, you should always consult your physician. If your physician recommends trying this, you might also want to mention the following information to him or her:

  1. It cannot be taken together with Lithium, as it seems to block its action.
  2. The chief side effects of inositol are gas and diarrhea. Some people get this for the first few days and then it clears up. Many of those taking it never have this side effect, and some only get it when they take more than a particular amount.
  3. I have heard reports that caffeine lowers inositol levels in the body, so if you are a heavy coffee drinker, you might consider cutting down or eliminating this from your diet. Actually, stimulants such as caffeine can sometimes contribute to anxiety, jitteriness, etc.
  4. It should be purchased in powdered form, and taken dissolved in water or fruit juice. It has a sweet taste, and is chemically related to sugar. If it is allowed to stand for about 10 minutes after mixing it, it seems to dissolve better. Vigorous mixing for a few minutes also helps. If it still doesn’t dissolve well (not all brands do), stir it up and drink it quickly before it settles. The use of powder is recommended, as the larger doses required could require taking as many as 36, 500 mg. capsules per day.
  5. Inositol is a water-soluble vitamin, so although the doses appear to be large, it will not build up to toxic levels in the body. Whatever the body doesn’t use is excreted. The average person normally takes in about 1 gram of inositol each day via the food they eat. There are no reports of any harm associated with the long-term use of inositol. Some of our patients have been taking it as long as eight years now, with no problems.6. It can be built up according to the following schedule (1 teaspoon=2 grams, and be

sure to use a measuring spoon) for an adult:

  • Week 1 – 1 teaspoon/2x per day
  • Week 2 – 1 teaspoon/3x per day
  • Week 3 – 1.5 teaspoons/3x per day
  • Week 4 – 2 teaspoons/3x per day
  • Week 5 – 2.5 teaspoons/3x per day
  • Week 6 – 3 teaspoons/3x per day

A child can be built up to 3 teaspoons per day over the same six-week period. Dosages for adolescents can be adjusted according to weight. In either case, it is best to allow side effects to be the guide. If they begin to occur, it is not considered wise to increase the dosage unless they subside.

Once a person has reached either the maximum dosage, or the greatest amount they are able to tolerate, it is best to try staying six weeks at that level to see if there is any noticeable improvement. If there is none by the end of that time, it should probably be discontinued. As with any treatment, those who are absolutely positive that it will help are only setting themselves up, and may wind up more than disappointed. Everything works for someone, but nothing works for everyone.”

Trich Thinking Vs. Recovery Thinking

This is a post that I read on the UK Trichotillomania Support Site which originated at a site called Daily Strength and I have to emphasise is not my own, but it is a great thing to refer to:

Trichotillomania Way of Thinking vs. Recovery Way of Thinking

1. T: I have to pull out my hair. R: I can do some thing else that is positive.

2. T: Pulling out my hair is fun. R: What is fun about being bald?

3. T: The white/kinky/thick/whatever hairs must go. R: All hairs are good hairs. I need them all for a healthy head of hair, etc.

4. T: I’ll just pull out one hair. R: This is a lie trich tells me. I can rarely just stop at one hair.

5. T: When I get that itchy or “trich sensation”, I have to pull my hair. R: I can wash my hair or scratch my head instead.

6. T: It’s ok to use the mirror to find good hairs to pull. R: Why would I want to pull out my hair and create more bald spots? I will stay away from the mirror and temptation.

7. T: It’s ok to use tweezers to get those small hairs. R: Again, why would I want to pull out new growth and create more bald spots? I will use my tweezers for the unwanted hairs only, then put them away.

8. T: When I’m stressed I need to pull out my hair. R: I can take deep breaths, meditate or go for a walk to relax my body, or I can destress with a nice bubble bath. I can do so many other healthy things to relax my body instead of pulling. Pulling really doesn’t help me to feel less stressed any way, because I know that by pulling I will be creating new bald spots. Everyone has stress in life. I must learn to be with my stress with out pulling out my hair.

9. T: When I’m bored I need to pull out my hair. R: Can’t I think of some thing more fun to do than pull out my hair when I’m bored? Why not do a hobby, a sport, a puzzle, a craft…any thing but pulling!

10. T: When I’m tired I need to pull out my hair. R: I can go to sleep instead. How many times do I stay up way past when my body tells me that I am tired, only to start pulling out my hair? I must go to bed!

11. T: When I’m depressed I need to pull out my hair. R: I can get help for my depression from a psychiatrist and/or therapist. Pulling out my hair will only increase my depression, because I feel sad when I have bald spots.

12. T: I have to make both brows look the same. R: Symmetry is not important. New growth is! In time, once my brows have had a chance to come back, both brows will look the same. By trying to make both brows even, I risk pulling more than I want to.

13. T: Now that my hair is filling in, I can lose a few hairs with out any noticeable damage. R: No I can’t! Once I start pulling, I have a hard time stopping. A few hairs a day over time will still lead to bald spots. Small or large amounts of pulling are both dangerous behaviors.

14. T: I’ll quit pulling tomorrow. R: You know what they say…”Tomorrow never comes!” I will make today the day that I stop pulling.

15. T: I can play with my hair this time with out pulling. R: Touching my hair leads to playing with my hair, playing with my hair leads to pulling. I will keep my hands down!

16. T: I love to play with the hairs after I pull them. R: Playing with the hairs only reinforces my trichotillomania, so I must not do this. I must break the trich rituals in order to be free of trichotillomania.

17. T: Some day my trich will go away, until
then I will continue to pull. R: Trich is for life. It will not magically go away. I have to work at my recovery in order to break free of this disorder.

18. T: I can learn to live with this longer hair, even if I am pulling right now. R: When I am pulling, it is hard to stop. I must cut my hair short so that I can get a break from the pulling. I have no urges when my hair is really short. I won’t risk more damage to my hair, which will take longer to grow back.

19. T: My hair will grow back, so I can pull out my hair today. R: Just because my hair will grow back doesn’t mean that I can keep pulling. Why would I want to postpone my regrowth and my recovery?

20: T: I’ll keep on pulling until I see significant damage in the mirror. R: It’s not ok to keep pulling! Any damage means that it will take longer before I get all my hair back. Trich makes excuses so that I keep pulling! This is one I have told myself often.

21. T: I have to check the mirror to see if my hair is regrowing. R: This is obsessive and obsessiveness leads to pulling. I take pictures of my hair now once a month and stay away from the mirror and obsessing.

22. T: Concentrating on individual hairs makes it fun to pull and keeps me in the trich way of thinking. R: I concentrate on thinking of my hair as a whole unit. I need all those hairs to make a full head of hair, a set of brows or a set of lashes.

23. T: I need to pull out my hair when I procrastinate. It bothers me that I am not doing what I need to do, which creates a stressful mood and then I want to pull. R: I can get up and do 5 minutes of what I need to do. I can do some thing for 5 minutes! Then once I am started, it will probably be easier to keep going and I will get what I need done and feel good about myself. Even if I quit after 5 minutes today, if I work 5 minutes on what needs doing each day, soon it will be done, therefore eliminating my stress and helping me to feel better about myself.

24. T: My hair will never grow back, so what is the point in trying to stop pulling! R: It takes 2 to 6 years for hair to grow back for some one who has pulled for 20 years or more, but the good news is it will come back, which is great!

25. T: I can’t tell any one about my hair pulling, because then they will think I’m crazy and stop liking me. R: By telling others about my trich, I will lose my shame and guilt associated with it. It is not my fault that I got trich or have a hard time dealing with it. By telling others, I see that having trich is no big deal. Every one has something! And most people are very understanding and supportive once they find out more about this disorder. This was the big surprise for me when I “came out”. Also in letting others know about my trich and have them accept me any way, helps me to accept and love myself.

26. T: My hands have to go to my head and pull! R: No they don’t! I can keep my hands busy with trich toys such as a koosh ball, silly putty, stress ball, grabbing both hands, holding any thing or doing some thing to keep my hands busy in a positive way instead of pulling, such as rug hooking or other crafts and hobbies.

27. T: Every thing that I do must be perfect, if it is not, then I get stressed out and want to pull out my hair. R: Every thing that I do does not have to be perfect! No one else is perfect and I don’t expect them to be, so why should I expect perfection from myself? I can lighten up and enjoy life!

28. T: If I stop pulling, who am I? R: I am still a person who has trich, only I am in recovery.

29. T: If I stop pulling, will I do some thing else that is equally destructive? R: I won’t replace my trich with another bad habit, if I realize that this is possible. I will work at replacing my trich with good behaviors and habits.

30. T: When I am on the phone I have to pull. R: I don’t have to stay on the phone with a person that is stressing me out. I can end the conversation and therefore end my need to pull. I can also play with the cord instead of pulling, when I have to be in this stressful situation and continue talking to this person.

31. T: I am a compulsive hair puller. R: I am so much more than a person that pulls out their hair. I am some one who enjoys hobbies, sports, leisure, relaxation, work and fun! I can choose what will define me and hair pulling is not what I want to be known for.

32. T: If I pull out my hair, I’m not worthy of love. R: Yes I am! I am worthy of love whether I pull out my hair or not. Hair pulling is not all that I am. I am worthy of love from others and from myself!

33. T: What is the point of trying to quit, when I will just start again? R: I know that everything takes time to learn and I will learn to not pull out my hair. I may have setbacks, but with each successful attempt at not pulling, I get closer to quitting pulling forever!

34. T: Trich is bad! R: Trich is good. When my hand goes to my hair, I know that some thing is not right with in me. I am either bored, tired, stressed, have dirty hair, am procrastinating, am depressed, etc. and I need to do some thing about it. Trich the is first to know, long before I know these things consciously.

35. T: I have an urge to pull, therefore I must pull! R: The urge to pull will pass if I do nothing at all. I will not die from this urge. It’s ok to get urges, but I don’t have to act on them. I can take a deep breath and relax.

36. T: I’ll never be able to stop pulling! I hate myself! R: I can learn to stop pulling by learning all that I can about trich and how it affects me. I can learn what my triggers are and what to do when I get them. I can learn that beating myself up for pulling and hating myself because of my pulling only makes my pulling worse. I can learn to use positive self-talk to help decrease the urge to pull. I can learn to love myself even if I continue to pull out my hair. I am worthwhile for who I am, not for how much hair I have.

37. T: I often pull with out realizing it and zone for a long time before I am aware of my pulling. How can I help myself if I don’t know I’m pulling? R: Awareness takes time and practice. In time, I will become aware of where my hands are and stop them before they start pulling. I will give myself the time and patience to learn the new behavior of awareness.

38. T: I’m the only one that does this. R: Nope. Millions of people pull out their hair, some where between 2 and 5% of the population pulls their hair. This covers all walks of life.

39. T: Slips are bad. R: Slips are a way of learning. I ask myself why I was pulling and then try to do something different next time to either avoid that situation or to change my response to that trigger, one that is positive and not negative like pulling.

40. T: Quitting pulling is too hard. R: Quitting pulling is not too hard if I take it in small steps, have patience with my recovery and give my recovery the time that it needs to succeed.

Sources: http://www.pallister.co.uk/uk-ttm-mb/messages/37/458.html?1203158711

http://dailystrength.org/c/Trichotillomania-Hair-Pulling/recs/1927-trichotillomania-way-thinking-vs

Please visit the site for more information, or for support if you think you have any form of Trichotillomania. This can be pulling from any area, large or small amounts, which I will post more about soon.

Small Victories

I made it 10 days without pulling my hair!

image

We are often hardest on ourselves so after pulling a few hairs, I’m giving myself the same advice I would offer another trichsters who stopped pulling for any length of time and then pull again.

Don’t stop celebrating that victory just because you slipped up.

image

Although it seems like all that work was for nothing, it’s not in vain. Every time you resisted the urge to pull was a small victory, another step closer to recovery. You are building strength and training yourself not to pull.

It’s a long hard process, but you’ve already done a lot of the work. You are learning ways to be aware and self-sooth without pulling. It didn’t start overnight so it will also take time to fully stop. Next time it will be that much easier. 💜

 

Persistence not Perfection

Trichy Insights

Let’s strengthen those weak muscles!  

Just persist until you are successful!

My solace tonight as I persist in my journey to recovery from trich comes from comments of some of the people on the Fairlight Bulletin Board posted on Amanda’s Trichotillomania Guide.

Definition of Success

I just wanted to add another observation to all that has been said about making a commitment to not pulling. Think of it as exercise. When I started walking a couple of months ago, I thought a mile was forever. Now that I’ve been walking regularly, my stamina has increased, and a mile goes by quickly. I can’t run a marathon (yet!), but I am stronger. In the same way, as we practice not pulling, we’re building “muscles” that make it easier not to pull. The first couple of weeks are horrible, but then it gets easier–if you persist. I’ve slipped a couple of times…

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Treating the Whole Person: Part 2

Treating the Whole Person: A Personal User’s Guide, Part Two

Renae M. Reinardy, PsyD.,LP
Lakeside Center for Behavioral Change, PC
Fargo, ND

Reprinted from InTouch Issue 64, Winter 2012
© The TLC Foundation for Body-Focused Repetitive Behaviors. 2016. All Rights Reserved

As we bring in the New Year many people have the goal of making a significant change in their life. If you struggle with a body focused repetitive behavior (BFRB), that goal might be increased control over picking or pulling. In Part One of the Personal User’s Guide, we discussed how building a healthy foundation through nutrition, exercise and sleep are important to good health and decreased urges. We also looked at the balance of how we live our life in comparison to how we would like to spend our time and energy. Spirituality was also briefly discussed as a tool to improve our experience. Any one of these areas could be the focus for changes in the coming year. Do not overwhelm yourself, narrow your goals to what makes sense to you. The purpose of the Personal User’s Guide is to serve as a self-guiding compass. It is not a final destination, but a process of change.

Here are some other things to consider in planning your route in your personal change process. And, please pull out your notes from Part One.

My Mind

We are all actors in our internal soap operas. Our thoughts are incredibly powerful, yet we tend to just accept our internal script without much editing. Cognitive behavioral therapists encourage the process of cognitive restructuring. This involves identifying, challenging and replacing thoughts that are not true or helpful to us. It is good to look inside of your mind to make any helpful editorial changes to your internal script about BFRBs. Thoughts can involve perceptions of self control, permission-giving thoughts, perfectionism, and/or social judgments to name a few. Just like a soap opera, there tends to be many areas of dialog that can use some editing to more accurately reflect reality.

Identify: What is a thought that often comes up about your picking or pulling? How much do you believe it?
  • Is this thought true?
  • Is it helpful?
  • Is there another way of thinking about it that would be p helpful?Edited thought: What is my new self-care script about picking or pulling that is more positive, realistic, or takes a problem solving approach?

The script that we rehearse is the life that we choose to live. In addition to identifying, challenging and replacing toxic thoughts, it is also good to practice mindfulness. Mindfulness involves awareness of ourselves and how our mind functions. It is turning off autopilot. There is quite a bit of information out there on the benefits of mindfulness training. I would encourage you to practice a mindfulness activity daily. One thing at a time, being aware of ourselves and our activity in that moment. This also helps to improve awareness of BFRBs and can be a good substitute if your picking or pulling puts you into a “trance-like” state.

My Emotional Triggers

Emotional triggers are very common in picking and pulling behavior. It is good to understand what emotions your BFRBs are trying to regulate. Do you pull when you are bored? Tired? Frustrated? Unsure? Angry? Excited? Intolerant of less than perfect skin or hair?

Most common emotional triggers:

  • What sparks your emotions?
  • What do you do to cope with emotions?
  • What can you do to cope with emotions?

Once you are aware of your emotional triggers, you can start to learn and practice some adaptive emotional coping skills. For example, if you notice strong picking or pulling urges when you are frustrated, it may be helpful to learn a relaxation exercise such as controlled breathing or progressive muscle relaxation. Most cognitive behavioral therapists can help you identify which skills would be best for you to regulate trigger emotions.

Other Triggers

This article has already discussed some of the cognitive (thought-related) and emotional triggers of BFRBs, but it is important to look at other factors that may also influence your behavior. It is common for people to have certain locations that become conditioned as situational triggers (i.e., pulling in the car, picking when washing your face before bed, etc.). Sensory triggers are the fascinating experiences that people have when they pick or pull. It can be a tpingly scalp, the coarse feeling of a hair, a bump on the skin, or the pop of a blemish. There can be much satisfaction in these sensory cues, so it is important to understand if they are a factor for you, and what substitutes can be used to satisfy these sensory experiences.

Situational triggers:

Sensory triggers:

Other triggers:

My Strategies

In this section, take a few minutes to focus on one or two strategies/goals in each area. If it is overwhelming, break it down and focus on one area at a time. Once that becomes more of a habit add another to your daily routine. Remember to be flexible; there are often twists and turns in any journey.
There are a number of strategies that can be used; it may be helpful to review some of the resources on the “Resource Library” tab on The TLC Foundation for Body-Focused Repetitive Behaviors’ website,www.bfrb.org, for some additional inspiration.

My Body: Diet, Exercise, Sleep

How will you meet physical needs to promote overall well-being?
Example: Decrease soda consumption to 2 cans per week

My Life:

How will you create a better match between the “ideal” and the “real?”
Example: Check work email no more than 2x per week at home

My Spirit:

What steps will you take to connect to something outside of yourself?
Example: Practice walking meditation twice per week

My Mind:

How will you edit your internal script?
Example: Challenge permission-giving thoughts like, “I will start tomorrow” with “Trich is getting restless, now is the time to use a strategy before I even start pulling”

My Emotions:

What are some different ways you can cope with emotions
Example: Practice breathing exercise when mind is racing before bed

My Other Triggers: Sensory, Situational, Habits

Example: Meet sensory needs by using fiddle toy while on computer

Example: Modify situation trigger by practicing quick in and out of bathroom without lingering

Example: Make picking or pulling more difficult by wearing a rubber fingertip

As you practice these new patterns you will find that they will become stronger and the BFRBs will decrease in the frequency and intensity of urges. It is important to remember that it is still a part of you, but it can go into “hibernation.” Monitor how you are doing and evaluate which strategies work best for you in getting and keeping your picking or pulling under control by giving your body and mind what it needs in other ways.

My Story
What is the direction you have decided to take on this journey?

 

 

Many good wishes on your path.

Dr. Renae Reinardy is the founder of the Lakeside Center for Behavioral Change in Fargo, ND. Prior to opening her own practice, Dr. Reinardy worked as a psychologist at the Behavior Therapy Center of Greater Washington in Silver Spring, Maryland. Dr. Reinardy specializes in the treatment of hair pulling and skin picking disorders, obsessive compulsive disorder, compulsive hoarding, and related conditions. She has been an adjunct professor at the doctoral level and has presented numerous times at national conferences and at local meetings and trainings, including The TLC Foundation for Body-Focused Repetitive Behaviors’ Annual Conferences and Retreats. Dr. Reinardy has been interviewed on Good Morning America, the Joy Behar Show, Dateline NBC, and A&E’s Hoarders. For more information, visit www.lakesidecenter.org.

 

 

 

 

 

 

Treating the Whole Person

imageTreating the Whole Person:

A Personal User’s Guide

By Renae M. Reinardy, PsyD., LP

There are many different ways for us to understand our experiences in life. I have not found it helpful for clients to be overly harsh or punishing in their efforts to produce the changes they want to make. Rather, it is good practice to take a comprehensive, wise and compassionate approach toward getting unstuck on the path to change. Everyone’s path is different, so I want to offer a few tips that might help you to write your own Personal User’s Guide. This includes taking care of your mind, body and spirit in a comprehensive manner, which I will briefly outline in this article. Please have a pen and paper handy for taking notes as we go along.

Before reading on, take a few minutes to write down what your pulling or picking means to you. Questions to help you start include: How did this journey start, what directions has it taken you in, what have you gained and what do you feel like you have lost, what works, what doesn’t, when did the behavior start, and what function does it serve?

The way that I conceptualize BFRBs is that they are like a friend who is trying really hard to make a person feel better, but they do not offer the best advice. Pulling and picking are often ways for one’s body to sort out sensory, emotional, cognitive, spiritual, and physical deregulation. This friend may offer some quick relief or distraction from these experiences, but often there are no lasting gains. Rather, it can lead to a vicious cycle of behavior which can feel out of control.

Somewhere along the way, many people lose track of what they need and have stopped listening to their inner core. Instead, they tried to quiet it with distracting and impermanent forms of relief or pleasure. Let’s look at a few components of the Personal User’s Guide to see if it is helpful in hearing one’s self better.

One of the first things that I work on with my clients is the “pillars of health”. This is learning how to take care of one’s body through proper nutrition, sleep, exercise and general self-care. Again, if a person has any deregulation in their body, there is a good chance that the BFRBs will pick up on that imbalance and try to fix the problem. Let’s try in a new way, by looking at what might be contributing to the problem in the first place. Please ask yourself to honestly answer the following questions:
Nutrition: What do I eat?

List some typical items you consume on a daily basis for the following meals:
Breakfast
Lunch
Dinner
Snacks
Caffeine
Vitamins:
Exercise: How and when do you exercise?

Sleep: What time do you wrap up your day?

How long does it take to fall asleep?
Do you wake up at night?
What time do I wake up in the morning?
Well, how does it look?

If you are like most of us, at least some improvement can be made in how we care for our bodies. Perhaps there are one or two things from the lists above you’ve always wanted to change, or believe if you COULD change, it would help with your BFRB management. Can you identify one small difference you could make to begin?

Over the past few years, there has been more research to support the role of nutrition in BFRBs, including sugar intake, and dietary supplements. Some people have had great success with the supplements N-acetylcysteine (NAC) and/orInositol (B- vitamin) decreasing urges to pick or pull. Work with your healthcare provider to determine if these might be appropriate for you. I have also found that my clients experience great benefit when sugar intake is reduced.

In our typical diet, we are often starving for good nutrients. Our diet must contain 5 essential items to be truly healthy: carbohydrates, proteins (1/5 of our calories), fats, water and minerals. Amino acids are the building blocks of protein which plays a role in every cellular function of the body. Out of 20 amino acids present in the body, 9 are essential, meaning that they must come from diet. Clinical nutritionists have found that deficiencies in B1, B2, B6, folate, B12, C, magnesium and zinc are related to a number of mental health conditions. Since many people do not get what they need from their diet, vitamin supplements are often needed in addition to dietary changes. Be sure to get a good natural vitamin that your doctor approves.

The “E” word. Research has proven the mental health benefits of exercise. It is believed that exercise stimulates the production of endorphins—the feel good hormone. Serotonin, dopamine, and norepinephrine are also released during exercise. (Do these sound familiar? Yep, these are same chemicals that are targeted with many psychotropic medications.) Other benefits of exercise include improved blood flow, increased brain function, increased oxygen, and removal of toxins through breathing and sweat. Time to dust off those shoes with the laces. Start gradually and set realistic goals. For example, if you’d like to exercise more, maybe start with just ten minutes of exercise every day. Ten minutes of walking at a faster pace, ten minutes of jogging, ten minutes on the treadmill or the elliptical….then when that gets easy, add five more minutes. Before you know it, you are exercising for an hour. Talk to your doctor if you have any medical conditions that would restrict exercise.

Sleep is another thing we all know is important, yet is one of the first things to go in our busy schedules. The average adult needs 7-9 hours of sleep each night. Research suggests that people who do not get adequate sleep tend to live shorter lives than those who do. Chronic sleep deprivation also leads to increased risk of obesity, diabetes and heart disease. When we sleep, we produce extra protein molecules to help us fight off infection, stress and toxins by helping the immune system mend our bodies. Take good care of your body and your body will take good care of you. Again, remember that picking and pulling serve a function. If any of these areas are out of whack, you may notice urges on the rise in attempts to self regulate.

Take the time to evaluate your pillars of health. When we rush things, they tend not to be effective. In working with my clients, I’ve found that focusing on the pillars of health can be a big factor in getting someone unstuck when a traditional behavioral and cognitive plan are not enough.
How I Live My Life

Another piece of the Personal User’s Guide that I want to cover in Part One is how we live our life. So many times people plow through the day, just to work toward another goal—the weekend, a long-awaited vacation, or milestones such as graduation, retirement, etc. Yikes! There is often quite a bit of time spent waiting for something good to happen!

Draw two circles in your notebook. Label one circle “real Life” and the other circle “Ideal Life.” In each circle complete a pie chart: one on how you spend your typical day and the other on how you would like to spend your day.

How do they compare? Is there anything that you can take from your ideal and build into your everyday/real life? It is important to take time now to spoil yourself a bit—listen to music, get and receive hugs, sing, pet an animal, smile, pray, make good wishes for others, take a nap, get a massage, acknowledge yourself and your accomplishments, or try to find a quiet place to rejuvenate. We often cannot live every moment in the ideal, but it is good to not get stuck in long patterns of unfulfillment.

Can you think of a few ways you can incorporate goals from your ideal life into your real life? Write them in your notebook.

Okay, one more thing to think about in Part One of your Personal User’s Guide: Spirituality.

Pretty big topic and I am not talking about religion, although that can fall into this category. Focusing on one’s spirituality involves developing an inner life to experience greater connectedness through practices such as prayer, meditation and contemplation. These practices help us to experience a more comprehensive sense of self and the interrelatedness to others, nature and/or religious experiences. Recent research has shown the medical and emotional benefits of these practices including a more complex range of brain activity, stress relief, decreased heart rate, improved lung capacity, and decreased anxiety, to name a few. Please take a few moments and think of how you might summarize your spiritual life.
My Spirit: Take some notes on the following questions

What gives me inner strength and connectedness to things outside of myself ?
How can I build on this?

In Part Two of the Personal User’s Guide, we will discuss emotions, thoughts, and behavioral strategies that can help give your body what it needs. By learning and listening to ourselves it is possible to improve one’s overall well-being and decrease undesirable behaviors and patterns. In the meantime, best wishes in reinforcing or changing any experiences that you may have realized in completing.

This is part 1 of a two-part article. Read part 2, here >>

Dr. Renae Reinardy is the founder of the Lakeside Center for Behavioral Change in Fargo, ND. Prior to opening her own practice, Dr. Reinardy worked as a psychologist at the Behavior Therapy Center of Greater Washington in Silver Spring, Maryland. Dr. Reinardy specializes in the treatment of hair pulling and skin picking disorders, obsessive compulsive disorder, compulsive hoarding, and related conditions. She has been an adjunct professor at the doctoral level and has presented numerous times at national conferences and at local meetings and trainings, including The TLC Foundation for Body-Focused Repetitive Behaviors’ Annual Conferences and Retreats. Dr. Reinardy has been interviewed on Good Morning America, the Joy Behar Show, Dateline NBC, and A&E’s Hoarders. For more information, visit http://www.lakesidecenter.org.

 

 

How Long Does it Take to Break a Habit?

image.jpegYes Trich is more than a ‘bad habit’. However, it is an unwanted behavior that I believe can be unlearned or changed.

My goal is to break this ‘habit’. I have been working at this since beginning this blog 2 years ago. Yes, I tried to stop pulling before that, but my mindset changed. I was willing to do everything I could, including changing my mindset.

Before a bad habit or unwanted behavior can be changed or stopped, I believe you need to change your thinking. Your thinking rules everything you do. This is why cognitive therapy is effective. The fist step of changing your thinking is to accept that you have a real disorder that causes you to pull your hair. It is not a lack of will power or discipline that keeps you in the cycle of hair pulling and self-loathing that often directly follows pulling. Click here for more information about Commitment and Acceptance Therapy.

Once you have changed your thinking, you can focus more on the unwanted behavior (hair pulling or any behavior). Cognitive Behavioral Therapy follows this approach (CBT).

According to The OCD Center of Los Angeles:

“The most effective treatment for Trichotillomania is a combination of various types of Cognitive-Behavioral Therapy (CBT). Perhaps the most important of these is called Habit Reversal Training (HRT). HRT is based on the principle that hair pulling is a conditioned response to specific situations and events, and that the individual with Trichotillomania is frequently unaware of these triggers. HRT challenges Trichotillomania in a two-fold process. First, the individual with Trichotillomania learns how to become more consciously aware of situations and events that trigger hair-pulling episodes. Second, the individual learns to utilize alternative behaviors in response to these situations and events.

Other Cognitive-Behavior Therapy techniques can be used as adjuncts to HRT in the treatment of Trichotillomania. Among these are Stimulus Control techniques and Cognitive Restructuring. Stimulus Control techniques involve utilizing specific physical items as “habit blockers” to restrict the ability to pull hair, while Cognitive Restructuring helps an individual with Trichotillomania learn to think differently in response to the urge to pull their hair.
Skin Picking and Hair Pulling – Reflections

One of the most effective CBT developments for the treatment of Trichotillomania is Mindfulness Based Cognitive Behavioral Therapy. The primary goal of Mindfulness-Based CBT is to learn to non-judgmentally accept uncomfortable psychological experiences. From a mindfulness perspective, much of our psychological distress is the result of trying to control and eliminate the discomfort of unwanted thoughts, feelings, sensations, and urges. In other words, our discomfort is not the problem – our attempt to control and eliminate our discomfort is the problem. For those with Trichotillomania, the ultimate goal of mindfulness is to develop the ability to more willingly experience their uncomfortable thoughts, feelings, sensations, and urges, without pulling their hair. To learn more about Mindfulness Based CBT for the treatment of Trichotillomania, click here.

Here’s how long it takes to break a habit, according to science
*You’re gonna need more than will power.
SIGNE DEAN 24 SEP 2015

From daily tooth-brushing to the 11am coffee, we all have dozens of habits that get us through our daily routine. Some are great – weekly gym visits are often encouraged – others not so much, like smoking a pack a day, or dialling the number of the pizza place way too often. Because we recognise our habits as useful or detrimental behaviours, we often strive to shape them accordingly.

There’s no shortage of apps out there designed to help you form a habit, and many of those are built on the assumption that all you need is 21 days. This number comes from a widely popular 1960 book called Psycho-Cybernetics by Maxwell Maltz, a plastic surgeon who noticed his patients seemed to take about 21 days to get used to their new faces.
However, according to a 2009 study, the time it takes to form a habit really isn’t that clear-cut. Researchers from University College London examined the new habits of 96 people over the space of 12 weeks, and found that the average time it takes for a new habit to stick is actually 66 days; furthermore, individual times varied from 18 to a whopping 254 days.

The take-away message here is that if you want to develop a new behaviour, it will take at least two months, and you shouldn’t despair if three weeks doesn’t do the trick – for most people that’s simply not enough. Stick with it for longer, and you’ll end up with a habit you can keep without thinking.

But what about trying to break an unwanted habit?

It turns out the two – habit forming and breaking – can be quite closely linked. As psychologist Timothy Pychyl explains to Alison Nastasi at Hopes and Fears, they’re two sides of the same coin: “Breaking a habit really means establishing a new habit, a new pre-potent response. The old habit or pattern of responding is still there (a pattern of neuron responses in the brain), but it is less dominant (less potent).”

From daily tooth-brushing to the 11am coffee, we all have dozens of habits that get us through our daily routine. Some are great – weekly gym visits are often encouraged – others not so much, like smoking a pack a day, or dialling the number of the pizza place way too often. Because we recognise our habits as useful or detrimental behaviours, we often strive to shape them accordingly.

There’s no shortage of apps out there designed to help you form a habit, and many of those are built on the assumption that all you need is 21 days. This number comes from a widely popular 1960 book called Psycho-Cybernetics by Maxwell Maltz, a plastic surgeon who noticed his patients seemed to take about 21 days to get used to their new faces.
However, according to a 2009 study, the time it takes to form a habit really isn’t that clear-cut. Researchers from University College London examined the new habits of 96 people over the space of 12 weeks, and found that the average time it takes for a new habit to stick is actually 66 days; furthermore, individual times varied from 18 to a whopping 254 days.

The take-away message here is that if you want to develop a new behaviour, it will take at least two months, and you shouldn’t despair if three weeks doesn’t do the trick – for most people that’s simply not enough. Stick with it for longer, and you’ll end up with a habit you can keep without thinking.

But what about trying to break an unwanted habit?

It turns out the two – habit forming and breaking – can be quite closely linked. As psychologist Timothy Pychyl explains to Alison Nastasi at Hopes and Fears, they’re two sides of the same coin: “Breaking a habit really means establishing a new habit, a new pre-potent response. The old habit or pattern of responding is still there (a pattern of neuron responses in the brain), but it is less dominant (less potent).”

“It’s much easier to start doing something new than to stop doing something habitual without a replacement behaviour,” says neuroscientist Elliot Berkman. “That’s one reason why smoking cessation aids such as nicotine gum or inhalers tend to be more effective than the nicotine patch.”

Experts agree that there’s no typical time frame for breaking a habit, and the right recipe is going to be a mix of personality, motivation, circumstances, and the habit in question. “People who want to kick their habit for reasons that are aligned with their personal values will change their behaviour faster than people who are doing it for external reasons such as pressure from others,” says Berkman.

According to psychology professor Susan Krauss Whitbourne, sometimes a habit can be broken quickly: “In extreme cases, the habit can be broken instantly, such as if you happen to become violently ill when you inhale cigarette smoke or nearly get hit by a bus when texting and walking.” But in most cases it’s going to take longer than that, and you should probably allow for at least two months.

To successfully break a habit, you need to think of your strongest motivation, which will drive you along. Think of a ‘replacement behaviour’ for the habit, but make sure it’s a positive one – replacing smoking with snacking is a common trap, for example. And be patient. The longer you’ve had a habit, the longer it will take to get rid of it.

“Longtime habits are literally entrenched at the neural level, so they are powerful determinants of behavior,” explains Berkman. “The good news is that people are nearly always capable of doing something else when they’re made aware of the habit and are sufficiently motivated to change.”

So stay strong, you can do it.