Habit Reversal

Habit Reversal

5 Sessions

Body-focused repetitive behaviors (BFRBs) develop when everyday grooming or soothing habits—like nail biting, hair twirling, or skin picking—turn into repetitive patterns that are hard to stop and cause emotional distress or physical harm. Over time, these behaviors can become part of a cycle: something in your environment or emotional state triggers an urge, the soothing behavior brings temporary relief, and feeling that relief reinforces the behavior, despite its long-term consequences.

Our Habit Reversal plan combines Habit Reversal Training (HRT) and the Comprehensive Behavioral (ComB) model to target the specific emotional, sensory, cognitive, and environmental factors that sustain these habits. This structured, five-session approach helps you build awareness of your triggers, develop alternative behaviors, and gradually break the cycle.

For children, the plan includes age-appropriate strategies and parent involvement. For older teens and adults, the focus shifts to independent skills and practical strategies for real-life situations.

Sessions are delivered primarily through our secure virtual platform, with limited in-office options available.

The chains of habit are too weak to be felt until they are too strong to be broken. - Samuel Johnson

Body-focused repetitive behaviors affect about 1–5% of the population and can range from minor habits to more serious conditions that cause noticeable distress, physical damage, or social anxiety.

You might notice yourself pulling at your hair while working, picking your skin during moments of stress, or biting your nails to the point of pain—even when you want to stop. These behaviors may feel automatic or difficult to control, and attempts to hide them can lead to isolation or shame.

Common indicators for this plan include:

  • Hair pulling from the scalp, eyebrows, eyelashes, or other body areas
  • Skin picking or scratching that causes damage or scarring
  • Nail biting beyond normal grooming
  • Cheek or lip biting that causes pain or tissue damage
  • Cuticle picking or hangnail removal that becomes excessive
  • Scab picking that interferes with healing
  • Feelings of shame, embarrassment, or distress related to these behaviors
  • Attempts to hide damage with makeup, clothing, or avoidance
  • Significant time spent engaging in these behaviors
  • Physical consequences such as bald spots, skin infections, or damaged nail beds
  • Social or occupational impairment due to these behaviors
Why you might choose this plan
What to expect

BFRBs can look different in children and teens than they do in adults. Younger children may not recognize when or why the behavior is happening, and they may not be able to explain what they're feeling before or after it occurs. In teens, visible effects like hair loss or scarring can contribute to shame, self-consciousness, and isolation at a time when peer relationships are vitally important.

For younger patients, these behaviors are often misunderstood as intentional or defiant when they’re actually rooted in neurobiological and emotional processes. If you’ve noticed increased school avoidance, slipping grades, or a withdrawal from social or extracurricular activities, BFRBs may be playing a role.

In-person, telehealth or both
How long does therapy take?

HRT and ComB interventions represent significant advancements in the treatment of BFRBs. Research shows that these methods can reduce the frequency of behaviors by 60–80% for those who complete treatment.

Your therapist will begin with a thorough assessment to understand your unique behavior patterns—what triggers them, what purpose they serve, and where and when they tend to occur. From there, you'll learn strategies for increasing self-awareness, including simple tools for tracking behaviors and identifying urges in real time. You'll also create “competing responses,” which are intentional, alternative actions to use when you notice the urge arising.

Along the way, you'll build tools for managing the emotions and environments that tend to trigger these behaviors. For children, the plan includes parent training to help reinforce skills and provide support at home, whereas therapy for teens and adults focuses on applying techniques independently across school, work, and social settings.

Therapy Lab clinicians hold advanced degrees in clinical psychology or related science-based clinical practices, with specialized training in BFRB-specific protocols. They create a supportive, non-judgmental environment where these often sensitive issues can be addressed without shame. To learn more about evidence-based treatments for BFRBs, please see the resources below.

About Therapy Lab therapists
  • Lee, E. B., Haeger, J. A., Levin, M. E., Ong, C. W., & Twohig, M. P. (2018). Telepsychotherapy for the treatment of trichotillomania: A randomized controlled trial of ACT enhanced behavior therapy. Journal of Obsessive-Compulsive and Related Disorders, 18, 106-115.

  • Mansueto, C. S., Golomb, R. G., Thomas, A. M., & Stemberger, R. M. T. (1999). A comprehensive model for behavioral treatment of trichotillomania. Cognitive and Behavioral Practice, 6(1), 23-43.
  • Skurya J, Jafferany M, Everett GJ. Habit reversal therapy in the management of body focused repetitive behavior disorders. Dermatol Ther. 2020 Nov;33(6):e13811. doi: 10.1111/dth.13811. Epub 2020 Jul 7. PMID: 32542916.