Prices, eligibility rules and program status verified July 2026 against Open Path Psychotherapy Collective, HRSA, the US Office of Personnel Management, the TLC Foundation for BFRBs, the International OCD Foundation, NHS England and published university clinic fee schedules.
There are four price tiers for BFRB help, and most people never hear about the first one.
Tier zero costs nothing and has randomized trials behind it. Tier one runs $10 to $40 a session at a university clinic. Tier two is $40 to $70 through a sliding-scale network. Tier three is what you already priced and closed the tab on.
Almost every affordable-therapy guide starts at tier one and never mentions that for picking and pulling specifically, the free option has better published evidence than a random low-cost generalist does. That's where this starts.
Most of what follows is US-specific. Non-US routes are gathered near the end.
Free, Starting Today
The Free from BFRB manual and website
Who it's for: anyone with picking, pulling, biting or cheek chewing, anywhere in the world.
Cost: nothing. No account, no email, no upsell.
What it is: a self-help program built with Prof. Steffen Moritz's research group at University Medical Center Hamburg-Eppendorf. It teaches self-guided habit reversal training, decoupling, and decoupling in-sensu, through a video, a text version, and a downloadable manual. The site states its purpose plainly: to "provide affected people with scientifically based self-help techniques free of charge." It carries no advertising and links to no paid program of its own.
The catch: the same review found that how often you use it predicts whether it works, and that therapist-guided versions of these techniques probably outperform doing it alone. Free self-help is a real treatment, not a placeholder, but it puts all of the structure and all of the follow-through on you. If you've tried and abandoned self-help twice already, that pattern is information, and the low-cost professional routes below are worth the effort.
Peer support groups
Who it's for: anyone who has never said this out loud to another person who gets it.
Cost: free.
What it is: the TLC Foundation ran four virtual groups on Zoom, for adults 18 and over, teens 13 to 18, parents, and the compulsive hair-cutting and cheek-biting community, alongside a directory of dozens of independent peer-led groups, several outside North America. As of writing, bfrb.org's support pages show a "coming soon" placeholder while the site moves platforms, so check before you plan around a specific group. The independent groups in that directory are run by their own organizers and carry on regardless of what happens to the directory listing them.
One concrete free room worth naming, because it's the unusual case of a clinician facilitating at no charge: Anxiety Specialists of Atlanta runs a free public BFRB support group on Zoom, the first Wednesday of every month from 1:00 to 2:00pm Eastern, open to adults 18 and over anywhere and led by a psychologist. The practice is plain about what it is: "This is not a treatment group, it's a support group."
The catch: support groups aren't treatment, and TLC has always said so about the independent listings. They won't teach you a competing response. What they do is remove the isolation, which for a lot of people is the thing that made the behavior unmanageable in the first place.
Free treatment inside a research trial
Who it's for: people near a university with an anxiety or OCD research center, who can commit to a schedule.
Cost: free, and some trials pay participants.
What it is: university research clinics recruit for BFRB treatment studies and deliver the protocol at no charge. Boston University's Center for Anxiety and Related Disorders tells prospective clients directly that they "may be eligible for free treatment as a part of our current research opportunities." Search clinicaltrials.gov for trichotillomania or excoriation disorder, filter to recruiting, and see what's running near you.
The catch: you have to fit the entry criteria, which often exclude people on certain medications or with certain co-occurring conditions. Recruitment windows open and close. And you may be randomized to a comparison arm rather than the treatment you wanted. When it works, though, this is the only route on this page where a genuine specialist treats you for nothing.
Information and referral lines
The NAMI HelpLine is free, staffed Monday to Friday, 10am to 10pm ET, and is explicitly not a crisis line. It's a peer-support and referral service, useful for finding out what exists in your county when you don't know where to start. 211, dialed like 911, connects you to a local information and referral specialist who can name the sliding-scale clinics near you, which is usually faster than an evening of searching.
Under $50 a Session
University training clinics
Who it's for: anyone within driving distance of a university running a clinical psychology, counseling or social work graduate program.
Cost: commonly $10 to $40 per session on an income-adjusted scale. UNC Wilmington's clinic publishes exactly that range. Others sit near it, and many go lower on documented low income.
What it is: doctoral and master's students deliver treatment under close faculty supervision. At Florida State's clinic, each trainee gets three to four hours of supervision a week plus two hours of case conference.
The catch: three real ones. Your therapist changes when they graduate, usually within a year or two. Waiting lists at the good clinics run months. And they close over the summer and between semesters, which is a genuine problem for a behavior that doesn't observe academic calendars. Ask about summer coverage on the first call.
How to find one: search the name of every university within reach plus "psychology training clinic" or "counseling training clinic." They're almost never in the consumer directories.
Open Path Psychotherapy Collective
Who it's for: uninsured or underinsured people in the US and Canada with household income under $100,000 (CAD $140,000).
Cost: a one-time lifetime membership of $65 (CAD $89), then $40 to $70 per 50-minute individual session, or $30 with a supervised student intern. Couples and family sessions run $40 to $80.
What it is: a nonprofit collective of over 40,000 vetted licensed therapists who agree to see members at those rates. The membership is once, not annual, and lasts as long as the financial need does.
Open Path is direct about who shouldn't use it. If you have usable mental health coverage or can pay market rates, they ask you to go elsewhere, because every member they take is a seat someone with no other option can't use.
The catch: finding a BFRB specialist here is unlikely. What you can realistically find is a behaviorally minded therapist willing to work from a protocol you bring. The $30 intern sessions are limited in number and go quickly.
Community health centers and community behavioral health
Who it's for: anyone uninsured, on Medicaid, or with income low enough that a sliding scale reaches near zero.
Cost: income-based, often nominal, sometimes nothing.
What it is: federally qualified health centers are required to run a sliding fee discount program as a condition of their federal funding, and many now have behavioral health staff working alongside primary care. Find one at findahealthcenter.hrsa.gov or by calling 1-877-464-4772. Separately, Certified Community Behavioral Health Clinics must serve anyone who asks for care regardless of ability to pay, insurance status or residence, and they operate in most states.
The catch: these are generalist services carrying heavy caseloads. Sessions may be shorter, less frequent, and delivered by whoever is available. BFRB knowledge is close to nonexistent, and skin picking gets triaged well below depression and substance use. Say the words "excoriation disorder" or "trichotillomania" at intake anyway. Occasionally it routes you to the one person in the building who knows.
Your employer's assistance program
Who it's for: anyone employed by a mid-size or large organization, and often their household members too.
Cost: free to you.
What it is: the US Office of Personnel Management defines an EAP as "a voluntary, work-based program that offers free and confidential assessments, short-term counseling, referrals, and follow-up services." Typically three to ten sessions per issue per year. You call a number or register on a portal, get an authorization code, and take it to a provider.
Two things people get wrong about EAPs. The first is that their employer will find out. They won't; employers receive aggregate usage numbers only, and providers are bound by the same privacy rules as any other clinician. The second is that you have to be in crisis to qualify. You don't.
The catch: the session cap is the whole problem. Behavioral treatment for a BFRB typically runs twelve to sixteen weeks, and six sessions won't complete it. The realistic use of an EAP is as an assessment and a launchpad: get seen, get the condition named, and use the referral network to land somewhere you can stay. Many EAPs will help you find an in-network specialist afterwards, which is worth asking for explicitly.
Group programs
Who it's for: people who want BFRB-specific treatment and can't fund individual sessions.
Cost: roughly $50 to $140 per session depending on who runs it, against $150 to $250 for individual specialist work.
What it is: a BFRB therapy group, usually weekly and usually online, teaching the same behavioral material in a shared format. The OCD Center of Los Angeles has run low-fee BFRB groups for over fifteen years, now by video, though only for California residents. Juniper Mental Health runs a 12-class ACT-enhanced behavior therapy series online at $65 a class, paid on the day of each class rather than up front, Tuesdays at 5pm Mountain Time; because its psychologists work under PSYPACT, it's open to adults sitting in any participating state during class, which is most of them. Others run in Minnesota, Texas and elsewhere, some with multi-session packages that lower the weekly cost.
Groups exist because there aren't enough trained clinicians to treat everyone individually. That constraint happens to produce something useful: sitting in a room, even a virtual one, with other people describing your exact behavior does something no individual session replicates.
The catch: most are restricted to residents of the state where the therapist is licensed, which is the single most common reason a group you find turns out to be unavailable to you. An assessment before admission is standard. And a group moves at the group's pace, not yours.
Self-Directed, With Evidence Behind It
Two things worth owning outright, in this order.
The Free from BFRB manual is free to download and is the one with the trial data. Start there, not with a purchase.
Overcoming Body-Focused Repetitive Behaviors by Charles Mansueto, Sherrie Mansfield Vavrichek and Ruth Goldfinger Golomb, published by New Harbinger in 2020, is the ComB model in book form, written by three of the clinicians who developed it. It's a paperback with worksheets, not a memoir. Before buying, check your public library, which can usually get it through interlibrary loan at no cost, and many library systems lend the ebook.
Both teach a version of the same core skill. If you want the mechanism before you start, the step-by-step shape of habit reversal training and what a full course of behavioral treatment actually involves are covered in detail elsewhere on this site.
The limitation of every self-directed route: the review that found self-help works also found therapist-guided versions probably work better, and that people who used the material frequently improved more than those who dipped in. A workbook on a shelf does nothing. Six weeks of daily logging plus one technique practiced consistently does quite a lot.
The Problem All of These Share
You can get the price down. Getting the price down and finding someone who has treated a BFRB before is much harder, because the two run almost inversely. Specialists are concentrated in private practice at full fee. Sliding-scale, community and trainee providers are generalists.
So the realistic version, for most people reading this, is a low-cost generalist plus a protocol you supply. That works better than it sounds, if the therapist is willing. What you're screening for isn't BFRB expertise but behavioral orientation and a willingness to follow a manual. A trainee who has never heard of trichotillomania but is supervised weekly and will read what you send them is a better bet than a warm generalist who wants to talk about your childhood for a year.
If your budget improves later, or you want to know how to score the answers you get, vetting a genuinely BFRB-trained therapist is a separate piece of work covered in full on its own page.
Outside the US
Most of the above is US-only. The exceptions and equivalents:
Free from BFRB works anywhere. German-built, English-language, country-neutral. If you're outside the US, it's the first thing to open rather than the last.
Canada: Open Path covers Canada, at CAD $50 to $90 per session with a CAD $89 membership and a household income ceiling of CAD $140,000.
UK: NHS Talking Therapies takes self-referrals in most of England without going through your GP, and it's free. In January 2026, 88.7% of referrals were seen within six weeks. The service is built around anxiety and depression rather than BFRBs, so expect to explain what you have and to ask specifically for someone familiar with habit reversal. Your local service's website will have the self-referral form.
Elsewhere: the IOCDF directory lists providers internationally and is a better starting point than any US-centric list. Peer-led BFRB groups run in the UK, Ireland and several other countries through the support-group directory.
Cross-border teletherapy is generally not permitted, so a US sliding-scale therapist can't see you in another country even when they'd like to.
While You're Waiting
Waiting lists are the tax on affordable care. Months is normal. Two things are worth doing in the gap, and neither is a consolation prize.
Start logging now: what happened in the ten seconds before, where you were, what your hands were doing, what you felt. Every protocol you might eventually be assigned opens with exactly this, so arriving with six weeks of it already done moves you forward rather than back. Logging also interrupts automatic behavior slightly on its own.
And join the waiting lists, plural. People cancel and courses of treatment finish.
SkinAware does the logging side, with episode and urge tracking for picking, pulling and biting, plus a habit reversal course. It isn't free: $5.99 a month or $34.99 a year, with a two-week trial on iOS. On a page about not being able to afford care that has to be said plainly, and it's why it sits here at the end rather than at the top. A paper notebook does the logging part perfectly well and costs nothing. If you want to compare what's out there, the roundup of BFRB apps covers the free tiers too. Free from BFRB comes first regardless.
Frequently Asked Questions
Yes, in two forms. Research trials at university clinics deliver treatment at no charge to people who meet the entry criteria. And an employer assistance program gives you a small number of free sessions with a licensed therapist. Both are limited, and neither is available to everyone, but both are real.
Usually not. Screen for willingness to work from a protocol rather than for existing expertise, and expect to bring the material yourself. Behavioral orientation matters more than prior BFRB experience when the price is the constraint.
In the US, excoriation disorder and trichotillomania both have diagnostic codes, so treatment is billable in principle. Whether your plan covers it in practice depends on your behavioral health benefit and network. Call the number on the back of your card and ask about your outpatient mental health copay and deductible before assuming you can't afford it. If your copay is above $70, Open Path may cost you less than using your own insurance.
University training clinics and community health centers commonly run one to four months. Open Path is usually faster, since you contact therapists directly. Research trials depend entirely on their recruitment window. NHS Talking Therapies met its six-week standard for 88.7% of referrals in January 2026, though regional variation is wide.
For BFRBs specifically, self-guided habit reversal and decoupling have randomized trial support, so it's treatment. It's treatment without a therapist attached, which makes consistency the deciding variable. The stepped-care approach in the research is a reasonable model to copy: start with the least intensive thing, escalate only if it isn't enough.
Common, and not a character failure. What it usually means is that the accountability had to come from somewhere other than yourself. A group, a trainee therapist at $15 a session, or a friend checking in weekly all supply that. Pick the cheapest source of accountability you can access rather than trying the same solo approach a fourth time.
The order that works for most people: download the free manual tonight and start logging. Call 211 or check findahealthcenter.hrsa.gov this week. Email every university training clinic within reach and join their lists. Ask HR whether there's an EAP. Then, if none of that lands, join Open Path.
None of it is fast. All of it is cheaper than the private rate you already looked at, and the first step costs nothing at all.