Can i stop pulling by willpower alone?

One of the frequently asked questions on forums and support groups from compulsive hair pullers is whether or not the inability to stop pulling ones hair is due to lack of willpower and can strengthening the willpower enable them to stop? Partly this question stems from the deep inner feelings of shame and guilt at not being able to control a behavior the person is inherently aware is not healthy and so desperately does not want to engage in despite the damage it may cause to the area of targeted pulling. But it also stems from the common societal ignorance regarding mental illness where behavioral control is compromised such as is the case with addiction, obsessive compulsive disorder, and body-focussed repetitive behaviors (BFRBs). Society is quick to judge, with those who have no understanding easily pointing fingers at the afflicted individual saying that they just have to exercise strong will in order to stop. This is even more so in the case of BFRBs such as trichotillomania because of the lack of awareness that it is a clinical condition and the lack of understanding as to why anyone would want to pull out their own hair? It is almost easier to understand the attraction to drugs or alcohol because there is a tangible chemical element of pleasure attached to the addiction. But why on earth would you want to pull out your own hair right?

What is willpower?

There is no clear cut definitive knowledge about what causes trichotillomania. Some evidence points to genetic predisposition, some links have been found with other mental illnesses such as OCD and Anxiety, but one thing the evidence is clear on, is that it that trichotillomania, like addiction, is a chronic disorder of the brain, not a case of poor willpower. So what is willpower and if lack of willpower doesn’t cause trich, can we at least employ it to help us overcome it?

According to most psychological scientists, willpower can be defined as:

• The ability to delay gratification, resisting short-term temptations in order to meet long-term goals.
• The capacity to override an unwanted thought, feeling or impulse.
• The ability to employ a “cool” cognitive system of behavior rather than a “hot” emotional system.
• Conscious, effortful regulation of the self by the self.

Recovery in mental illness is complex. There is no quick fix and often requires a multi-faceted approach. The road to recovery is therefore long and arduous and often riddled with many obstacles and setbacks along the way. This is where willpower will play a significant role. So no you cannot stop pulling your hair by willpower alone, but developing a strong willpower will play a significant role in any successful treatment program.

A Combination Approach

One of the preferred treatment modalities for BFRBs such as triochotillomania is the combined cognitive behavioral method where by classical cognitive behavioral therapy (CBT) methods such as cognitive diffusion is combined with habit reversal training, mindfulness and Acceptance and Comitment based therapy. In the online therapy program offered by Trichstop we offer just such a program. Habit Reversal is introduced first. Taking this first step requires a commitment to avoid people, places or situations that are triggers to your hair pulling. Practicing these stimulus controls will require willpower. As in the definitions willpower is about meeting long-term goals. So in order to be internally motivated to work toward those goals we need to have a clear understanding of what those goals are. This is where values-based therapy comes in. It is important that the life goals we pursue and the actions and behaviors we prioritise in life are in line with what we truly value for our lives.

Cognitive Diffusion

Trich sufferers often report that pulling offers some kind of release either physically or emotionally in response to some unwanted negative thought or feeling. In order to override these unwanted thoughts and feelings cognitive diffusion is a useful skill taught where individuals can learn to look at their thoughts objectively and understand how these thoughts affect the way they feel and how this in turn impacts on behavior. This also provides the person the tools to deal with problems in a cognitive frame of reference rather than an emotional one, which may contribute to diffusing the urge to pull before it occurs.

Acceptance and Commitment

Another important aspect on the program is Acceptance and Commitment based therapy (AcT). The individual is guided to acknowledge and accept the existence of the urge to pull rather than try to resist in, but then make the choice to respond to the urge in a manner that is more in line with their values. An interesting study by Ibrahim Senay of the University of Illinois at Urbana-Champaign lends scientific support to the recovery concepts of surrender and openness. He found that people who kept their minds open were more goal-directed and more motivated than the people who firmly declared their objective. Having the freedom of choice seemed to create more intrinsic motivation—and thus, a greater likelihood of long-term abstinence—than feeling obligated to take a particular course of action.

Empowering the will- a collective effort

But what if you find intrinsic motivation hard to find? What then happens to the power of your will? This is where support is essential in the recovery process. Whether it be a close family member or friend, an online support forum or following the numerous vloggers and bloggers on the internet who share their personal experiences with trich, it is important that you have a place to go to when you are feeling like your efforts are hopeless. It is for this reason that our online therapy program, although text-based, comes with full therapist support. The therapist’s role is to support and encourage you during these difficult times and to help you exercise your will to put all the skills you will learn in the program into practice so that you may disempower the urge to pull and empower your own will instead.