BFRB THERAPY · TELEHEALTH FOR ADULTS IN NEW HAMPSHIRE

BFRB Therapy in New Hampshire for Hair Pulling & Skin Picking

Specialized online treatment for trichotillomania (hair pulling), excoriation disorder (skin picking), and related body-focused repetitive behaviors, for adults who are physically located in New Hampshire at the time of session. Treatment is built from your actual pattern, not from willpower.

Request a free 15-minute consultation How treatment works
Illustration of a woman at a laptop with one hand drifting toward her hair, an automatic hair pulling cue

When does a habit become a BFRB?

Most people occasionally pull, pick, or bite. A body-focused repetitive behavior is different in kind, not just in amount. These are the markers I look for in a first conversation.

  • An urge or a build-up of tension that the behavior briefly settles, followed by relief, a sense of completion, or a moment of calm.
  • Automatic episodes you only notice afterward, focused episodes where you go looking for the right hair or spot, or a mix of both.
  • The behavior is reinforced: because it works for a few seconds, it becomes more likely the next time the same cue shows up.
  • Concealment and shame: hats, makeup, long sleeves, avoiding swimming or hair salons, and not telling people who would want to help.
  • Repeated attempts to stop through rules, punishments, gloves, or promises, with the pattern returning within days or weeks.
  • Functional impact: visible hair loss or wounds, infections or scarring, lost time, avoided situations, or a running background of self-criticism.

Hair pulling and skin picking are related, but they are not the same problem

Trichotillomania and excoriation disorder share a reinforcement loop, and one person can have both. Effective treatment still needs to know which behavior it is working with, whether the episodes are automatic or focused, and what cues them.

  • Both are recognized conditions, not personality flaws or self-harm.
  • Both can shift over time: a picker may start pulling, or a scalp puller may move to eyebrows or lashes.
  • Both respond to the same family of behavioral treatment, adapted to the specific behavior.

Trichotillomania involves pulling hair from the scalp, eyebrows, eyelashes, or other body areas, often driven by the desire for a specific texture. It may also include post-pulling behaviors like examining or rolling the hair.

Excoriation disorder: picking at skin on the face, arms, cuticles, or back, usually cued by a bump, scab, or perceived imperfection, with the mirror a frequent trigger zone.

Automatic behavior: the hand is already there as you read, drive, scroll, or watch TV. You notice the pile of hair or the bleeding, not the decision.

Focused behavior: you go to the bathroom or to a mirror on purpose, hunting for coarse hair or a rough patch, often in a trance-like, absorbed state.

Sensory and environmental triggers: bright lighting, magnifying mirrors, tweezers within reach, idle hands, late evenings, and long periods at a desk.

Emotional and cognitive triggers: boredom, tension, frustration, perfectionistic thoughts about a flaw, and the pull to feel even or finished.

THE REINFORCEMENT LOOP

Why telling yourself to just stop has not worked

Every episode of pulling or picking does something in the moment: it settles tension, interrupts boredom, sharpens focus, smooths a rough edge, or produces a small hit of completion. That payoff arrives within seconds and teaches your nervous system to repeat the behavior the next time the same cue appears. Shame and willpower add pressure after the fact, but they do not change the cue, the urge, the sensory pull, or the environment, which is why the pattern keeps returning even when you badly want it gone.

A BFRB is also not a simple bad habit and not OCD. OCD is maintained by intrusive doubt and compulsions meant to neutralize uncertainty, which is why exposure and response prevention fits OCD. BFRBs are maintained by sensory, motor, emotional, and environmental reinforcement, so treatment targets that loop directly instead of treating your hands as the enemy.

How specialized BFRB treatment works

The core treatment is Habit Reversal Training, individualized through the Comprehensive Behavioral (ComB) model and supported by acceptance-based work when urges and emotions drive the loop. These components form the basis of the sessions.

Awareness training

Learning to catch the earliest part of the sequence: the hand drifting up, the scanning, the first touch. Awareness creates a choice point before the episode is already underway.

Functional assessment and trigger mapping

Recording where, when, and how episodes occur, and what they do for you in the moment, so the plan targets the sensory, emotional, cognitive, motor, and environmental cues that actually matter.

Competing responses

Practicing a planned action that is physically incompatible with pulling or picking, used at the moment of urge and held until the urge passes, then refined based on what works in your real-world settings.

Stimulus control and environmental change

Adjusting lighting, mirrors, tool access, hand occupation, and high-risk time windows to make the behavior harder to start and easier to interrupt.

ComB individualized formulation

Sorting your pattern into sensory, cognitive, affective, motor, and place domains, then choosing interventions that match your strongest drivers rather than using a generic checklist.

Acceptance-based work (ACT)

When urges feel unbearable or self-criticism keeps the cycle going, acceptance and commitment strategies help you make room for the urge without acting on it and keep treatment aligned with what matters to you.

What treatment with me looks like

I am Felix Murad, the only clinician at Murad Counseling. When you work with me on hair pulling or skin picking, you work with me directly at every session.

  • Felix Murad, M.Ed., CMHC (New Hampshire), LPC-S (Texas), LMHC (Washington), NCC.
  • Individual telehealth treatment for adults who are physically located in New Hampshire at the time of session.
  • Treatment informed by Habit Reversal Training, the ComB model, and ACT, matched to your specific behavior and pattern rather than a fixed protocol.
  • Progress tracked with your own account of episodes alongside validated measures such as the MGH Hairpulling Scale or the Skin Picking Scale-Revised.
  • Between-session practice is part of the work, because the behavior happens in your kitchen, car, and bathroom, not in a therapy hour.
  • A free 15-minute consultation comes first, to check fit before you commit to anything.
WHAT WE MAY TRACK

Targets that tell us whether treatment is working

Awareness of episodes

How early you notice an episode starting, and how often you catch it before the first pull or pick rather than afterward.

Antecedents and time windows

The situations, moods, and times of day that reliably come before the behavior, mapped over several weeks rather than guessed.

Environmental cues

Mirrors, lighting, tools, seating, and screens that make the sequence easier to start, and which changes actually reduce episodes.

Urge patterns

How intense urges get, how long they last, and whether they peak and pass when you use a competing response instead of acting.

Competing response use

Which planned responses you actually use in real settings, how long you hold them, and where they need to be adjusted.

Concealment and interference

Time spent covering, checking, or avoiding, and the activities you have started to reclaim, from haircuts to swimming to sleeves you can push up.

NEW HAMPSHIRE TELEHEALTH

Online BFRB therapy for adults across New Hampshire

I hold a Clinical Mental Health Counselor (CMHC) license in New Hampshire, which allows me to provide telehealth therapy to adults who are physically located in the state during each session, whether you are in Manchester, Nashua, Concord, the Seacoast, the Lakes Region, or a small town with no BFRB specialist within driving distance. This practice does not have a physical office in New Hampshire.

Telehealth suits BFRB work unusually well: the behavior happens at your desk, in your bathroom, and on your couch, and video sessions let us look at those real settings, test environmental changes where they will actually be used, and review your between-session records together. Sessions are private pay; current fees and the limited insurance options are listed on the pricing page.

RELATED RESOURCES

Go deeper on the specific behavior

This page is the starting point for New Hampshire adults. The pages below cover each behavior and method in depth.

Frequently Asked Questions

No. Trichotillomania sits near OCD in diagnostic manuals, and some people have both, but the maintaining loop is usually different. OCD runs on intrusive doubt and compulsions that try to neutralize uncertainty. Hair pulling is more often driven by sensory, motor, emotional, and environmental reinforcement. That is why the first-line behavioral treatment for pulling is Habit Reversal Training rather than exposure and response prevention, and why assessment matters before choosing a method.

Excoriation disorder is classified as an obsessive-compulsive and related disorder, not an anxiety disorder, although anxiety, boredom, tension, and perfectionistic thoughts can all trigger episodes. Some people pick mostly when stressed; others mostly when calm and absorbed. Treatment identifies your specific triggers rather than assuming anxiety is the whole story.

Habit Reversal Training (HRT) is a structured behavioral treatment with a strong evidence base for BFRBs. Its core components are awareness training, identifying the cues and functions of the behavior, practicing a competing response incompatible with pulling or picking, and modifying the environment to make the behavior harder to initiate. It is practical and repeatable, and it is not a willpower contest.

Yes. I am licensed as a Clinical Mental Health Counselor in New Hampshire and provide video sessions to adults who are physically located in the state at the time of the appointment. Telehealth works well for this work because the behavior occurs at home, allowing us to address your real environment directly. Severe wounds, infections, or medical concerns are coordinated with your physician or dermatologist.

That is automatic behavior, and it is common. It does not mean you cannot change it. Treatment starts by building awareness of the earliest links in the chain, such as hand position, posture, or the settings where episodes cluster, and by using environmental changes that interrupt the sequence before awareness is required. Awareness usually improves with structured practice.

The Comprehensive Behavioral (ComB) model is a way to individualize HRT. It categorizes what drives your behavior into sensory, cognitive, affective, motor, and place domains, then matches interventions to the domains that matter most to you. Two people with the same diagnosis can end up with quite different plans.

No. Demanding immediate, total abstinence tends to increase shame and obscure the data we need. Early sessions focus on understanding the pattern and identifying episodes earlier. Reductions in frequency, duration, and damage are tracked over time, and setbacks are treated as information about triggers rather than as failures.

If you have tried to stop through rules, gloves, promises, or general talk therapy and the pattern keeps returning, if episodes are causing visible damage, lost time, or avoidance, or if a previous therapist treated the behavior as a stress habit without a specific plan, a consultation is worth considering. The free 15-minute call is designed to answer that question honestly, including when a different kind of help would be a better fit.

Ready to work on hair pulling, skin picking, or another BFRB from anywhere in New Hampshire?

A free 15-minute consultation is the first step. No pressure to commit, and no judgment about how long this has been going on.

Request a free 15-minute consultation
Illustration of the same person in two settings, working at a desk and resting on a couch, both common contexts for pulling or picking