ACT Guide for Trichotillomania

What’s ACT Guide for Trichotillomania?

  • ACT Guide for Trichotillomania is an online mental health program designed by psychologists at Utah State University.
  • The development and testing of this program were financially supported by the Huntsman Foundation.
  • This program is designed for people who have difficulties with hair pulling. You’ll learn skills to help manage your pulling, more effectively respond to your urges to pull, and reengage with areas of life that you have been avoiding.

How does it work?

  • The “ACT” in ACT Guide stands for Acceptance and Commitment Therapy. ACT targets psychological flexibility, or the ability to engage in meaningful activities while uncomfortable thoughts or sensations are present (e.g., urges). ACT Guide for Trichotillomania also incorporates Habit Reversal Training (HRT), which helps build awareness around hair pulling urges and teaches new behavioral strategies. HRT has been widely studied as a treatment for hair pulling.
  • Dr. Michael Twohig has conducted research on treating Trichotillomania for over 20 years, with several studies demonstrating ACT is helpful in reducing hairpulling. ACT Guide for Trichotillomania is designed to teach these same skills taught in therapy, but now in a self-guided format to learn at your own pace.
  • ACT-Enhanced behavior therapy has been shown to be effective for trichotillomania in over 15 studies including
    • Face to face psychotherapy
      • Twohig, M. P., & Woods, D. W. (2004). A Preliminary investigation of acceptance and commitment therapy and habit reversal as a treatment for trichotillomania. Behavior Therapy, 35, 803-820
      • Woods, D. W., Ely, l. J., Bauer, C. C., Twohig, M. P., Saunders, S., Compton, S. N., Espil, F. M., Neal-Barnett, A., Alexander, J., Walther, M. R., Cahill, S. P., Deckersbach, T., & Franklin, M. E. (2022). Acceptance-Enhanced Behavior Therapy for Trichotillomania in Adults: A Randomized Controlled Trial. Behaviour Research and Therapy, 158, 104487
    • ACT-Enhanced behavior therapy delivered over Zoom
      • Lee, E. B., Haeger, J. A., Levin, M. E., Ong, C. W., & Twohig, M. P. (2018). Telepsychotherapy for trichotillomania: A randomized controlled trial of ACT enhanced behavior therapy. Journal of Obsessive-Compulsive and Related Disorders18, 106-115.
      • Twohig, M. P., Petersen, J. M., Fruge, J., Ong, C. W., Barney, J. L., Krafft, J., ... & Levin, M. E. (2021). A pilot randomized controlled trial of online-delivered ACT-enhanced behavior therapy for trichotillomania in adolescents. Cognitive and Behavioral Practice28(4), 653-668.
  • ACT Guide for Trichotillomania was found effective in a clinical trial with 81 adults with Trichotillomania. Most participants saw a decrease in hair pulling and distress, and improvement in their well-being and quality of life. Participants said that the stories and examples in the website were relevant to them and their experience of pulling and said that this helped them feel better understood and more motivated to use the treatment.
    • Capel, L. K., Petersen, J. M., Becker, M. R., Levin, M. E., & Twohig, M. P. (2023). The efficacy and feasibility of a fully automated, web-based acceptance-enhanced behavioral treatment for trichotillomania in adults: A randomized waitlist-controlled trial. Journal of Obsessive-Compulsive and Related Disorders, 37, 100800.

What to expect?

  • ACT Guide for Trichotillomania is completed entirely online and has eight self-guided modules that you can work through at your own pace. This course will teach you to regulate your pulling, new ways to interact with your urges to pull, and help you do what matters most to you.
  • You can expect to spend around 30 minutes per module with the program. Most people complete one new lesson each week, so the whole program around two months, but you can personalize the pace to your needs – it’s all about what works for you.
  • Read the Privacy Notice and the Terms of Use.

Who created the ACT Guide?

  • We’re a group of researchers at Utah State University who spend our time helping others with their mental health. We have spent the past 20 years researching how best to help people with Trichotillomania reduce their hair pulling. We made ACT Guide for Trichotillomania so that the evidence-based resources we’ve developed are widely available to those who might benefit. You can learn more about us by visiting the Utah State University ACT Research Group.

How do I sign up?

  • The program costs $25, and you’ll have access to ACT Guide for Trichotillomania for six months. During that time, you can work through the program at your own pace.
  • All money we make directly supports program maintenance and future program development. Payments are processed securely via PayPal.

Who can I contact if I have questions?

  • We'd love to hear from you! If you have any questions about ACT Guide, please email us at