Areas of Specialization - Adults

Habit Reversal for Trichotillomania Treatment

What is cognitive behavioral therapy for trichotillomania?

Cognitive behavioral therapy for trichotillomania has multiple treatment components. At the center of behavioral therapy for hair pulling is habit reversal training. Habit reversal training is the most thoroughly evaluated behavioral treatment for trichotillomania and consists of thirteen major components. The following is a brief overview of certain habit reversal treatment components. The client first engages in awareness training to develop an increased understanding of the times of day, emotional states, certain acitivities (e.g. watching television, talking on the phone, driving), and other factors that promote hair pulling. This is an extremely important precursor to being able to control the behavior. Increased awareness is achieved by having clients complete customized self-monitoring sheets in between appointments. Clients are instructed to track when hair pulling episodes occur, the duration of the pulling, the amount of pulled hairs, and the strength of the urge. In accordance with the cognitive behavioral model for treatment, clients additionally monitor what they were thinking, feeling and doing before, during and after pulling. Clients are also taught progressive muscle relaxation and diaphragmatic breathing as a method of reducing tension and focusing their attention. Clients are next instructed in how to acquire a muscle tensing activity that is incompatible with hair pulling, known as a "competing response."

Cognitive therapy for trichotillomania helps the client cope with the embarrassment and shame associated with hair pulling. Clients learn how hair pulling interferes with their social interactions and they develop skills to better manage themselves in distressing situations. Clients are also taught to change faulty thinking patterns leading to negative emotions that often prompt an episode of hair pulling. Common thoughts that are targeted in treatment include "I will never be able to stop the pulling." "People will always stare at me and think I am ugly." "I should have been able to stop pulling already." Another cognitive technique is the use of covert self statements in which clients are encouraged to practice telling themselves things which will help them resist or cope, such as "I can get better control of my pulling if I keep trying." Clients are also supported to employ self-instruction statements to help continue the habit reversal training, such as "Get ready to use your skills, you are entering a stressful situation."

Thus the overall goal of cognitive behavioral therapy is to reduce hair pulling by identifying the precise factors that trigger hair pulling (e.g., emotions, thoughts, behaviors) and learning skills to interrupt and redirect responses to those triggers.

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