Inclusion Criteria:  18 years of age or older; meet diagnostic criteria for TTM using the TDI-R have a MGH-HPS total score ≥ 12 at baseline;  (3) have an "automatic" pulling score ≥ 15 on the MIST; (4) able to wear the Keen2 device for four weeks; (5) able to attend three study visits; (6) unmedicated or a stable dose of psychiatric medication for 8 weeks prior to enrollment; (7) be English speaking.  Exclusion Criteria:  an inability to complete rating scales, and an inability to attend study visits