When You Can’t Feel It, You Pull It: The Link Between Experiential Avoidance and Trichotillomania

Just why someone develops trichotillomania, commonly known as hair pulling or trich, is not fully understood. It is thought that certain behavioral and cognitive factors play a role in its development and perpetuation. A number of negative affective states including boredom, anxiety, stress, and sensory sensitivity have been mentioned as possible triggers to hair pulling. The act of hair pulling is thought to act as a sort of buffer against dealing with unpleasant, negative feelings or sensations. If you don’t want to feel it, you pull it. 

Research suggests that this experiential avoidance plays a substantial role in hair pulling, shaping both the severity of hair pulling urges and how individuals respond to them. Understanding how this process works can help explain why hair pulling is sometimes so resistant and how targeted treatment can help.

Experiential Avoidance Explained

Experiential avoidance happens when a person tries to avoid or suppress unwanted thoughts, feelings, or sensations, even if the relief is short-lived or it creates more problems later. It’s a pattern seen in lots of other mental health conditions, including anxiety disorders, depression, and body-focused repetitive behaviors (BFRBs) like trich.

Rather than dealing with emotional distress, avoidance might look like: 

• Distracting yourself to avoid thinking about something painful.
• Pushing away distressing feelings like sadness, anxiety, or anger.
• Numbing sensations you don’t like through repetitive behaviors.

The problem with avoidance is the underlying issues remain. Avoidance feels good in the moment, but relief is fleeting. Over time, it can perpetuate the very cycle it was meant to break. 

How Experiential Avoidance Connects to Hair Pulling

Research has shown a link between experiential avoidance and the severity of trich. People who engage in more efforts to avoid internal distress tend to experience more intense and frequent urges to pull. Hair pulling is often used as way to cope with distressing feelings like boredom, stress, or anxiety.

When difficult feelings arise, they can trigger the urge to pull, temporarily alleviating the distress. Over time, this response becomes entrenched and actually strengthens to association between the distressing event and the avoidance, creating a negative feedback loop that is very difficult to break. It looks something like this:  

• Distressing thoughts or feelings trigger an urge to pull
• The pulling brings relief or distraction
• Distressing feelings like shame or embarrassment arise after pulling that reinforce the need to avoid future distress and cope by pulling. 

The very strategy that is meant to stop or avoid difficult feelings, causes more distress, and subsequently more pulling. 

Experiential Avoidance and Treatment of Trichotillomania

Experiential avoidance doesn’t just intensify hair pulling. It can actually impede treatment efforts. Both research and anecdotal evidence shows that people who are highly avoidant are more likely to experience shame and isolation, are less like to seek or benefit from therapy, and more likely to feel helpless about their ability to change. 

Given the role of avoidance, research suggests that acceptance-based approaches to therapy like Acceptance and Commitment Therapy (ACT) may help to address avoidance. ACT aims to help people learn how to accept rather than avoid uncomfortable internal experiences like urges or distressing feelings. Instead, they learn to practice acceptance and how to choose responses that align with their values and goals rather than simply avoid distress. This approach fosters psychological flexibility and can reduce the need to rely on avoidance. 

Addressing avoidance is one piece of the treatment plan. Treatment should also address the behavioral and cognitive factors that drive hair pulling. Integrated approaches combine aspects of different treatments to create a treatment plan that is tailored to meet the person’s needs.  

Moving Toward Recovery

With compassionate support, evidence-based therapy, and a focus on both thoughts and experiential avoidance, recovery from trichotillomania is possible. 

If you or a loved one is living with trich, there is help. Trichstop has a team of experienced therapists ready to work with you to find a treatment approach that is tailored to your needs and can get you on the road to recovery. And online therapy makes getting help easier than ever. Recovery is possible and Trichstop is here when you’re ready to take the next step.  

References

1. Franklin, M. E., Zagrabbe, K., & Benavides, K. L. (2011). Trichotillomania and its treatment: a review and recommendations. Expert Review of Neurotherapeutics, 11(8), 1165–1174. https://www.tandfonline.com/doi/full/10.1586/ern.11.93

2. Norberg, M. M., Wetterneck, C. T., Woods, D. W., & Conelea, C. A. (2007). Experiential avoidance as a mediator of relationships between cognitions and hair-pulling severity. Behavior Modification, 31(4), 367-381. https://www.researchgate.net/publication/6287162_Experiential_Avoidance_as_a_Mediator_of_Relationships_Between_Cognitions_and_Hair-Pulling_Severity

3. Wetterneck, C., Singh, R. S., & Woods, D. W. (2020). Hair pulling antecedents in trichotillomania: Their relationship with experiential avoidance. Bulletin of the Menninger Clinic, 84(1), 35–52. https://doi.org/10.1521/bumc_2020_84_01

4. Lee, E. B., Homan, K. J., Morrison, K. L., Ong, C. W., Levin, M. E., & Twohig, M. P. (2018). Acceptance and commitment therapy for trichotillomania: A randomized controlled trial of adults and adolescents. Behavior Modification, 44(1), 70-91. doi:10.1177/0145445518794366