Biofeedback Therapy for Trichotillomania

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Biofeedback is the use of alternative therapy to help a person learn how to change negative behaviour and control physical responses and ingrained habits such as OCD (obsessive compulsive disorder) or body-focused repetitive behaviours. This type of therapy is used to treat or prevent certain mental or health conditions. It helps individuals gain control over normally involuntary body functions.

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What does it entail?

Biofeedback requires a biofeedback monitor; a machine that monitors when your body is stressed. Electrodes or finger sensors attached to a person’s skin send signals to the monitor which responds with a sound, image or colour computerised display that represents your heart rate, blood pressure, skin temperature, breathing rate, sweating, or muscle activity in your face, neck, shoulders and back. These body functions alter when you are stressed; your heart rate increases, your blood pressure rises, your breathing quickens and you start sweating. You can see the responses on the monitor as they are occurring, and get immediate feedback as you try to stop them. This type of treatment is usually done in a therapist’s office but a biofeedback sensor can be connected to your own computer. Biofeedback therapy promotes relaxation which relieves conditions related to stress, which is often a trigger for body-focused repetitive behaviours. The idea behind it is that ‘by harnessing the power of your mind and becoming aware of what’s going on inside your body, you can gain more control over your health.’

So how can biofeedback assist in treating or preventing trichotillomania?

Trichotillomania is a body-focused repetitive behaviour which causes sufferers to pull out the hair from their heads or other parts of their bodies resulting in patches of baldness. There are five different types of biofeedback which can be used to monitor different body functions resulting in trichotillomania. An electromyogram measures muscle activity and tension and can be used for pain management and anxiety disorders. Neurofeedback or electroencephalography measures brainwaves, which helps in patients suffering from ADHD, epilepsy and seizures. Thermal feedback measures skin temperature; while electrodermal activity measures sweating, which increases in patients suffering from pain and anxiety. Heart rate variability measures a patient’s heart rate: this speeds up when a patient is stressed. A biofeedback therapist can help patients suffering from trichotillomania practice relaxation exercises which can be fine-tuned to control different body functions.

Two Strategies

There are two strategies which can be used to teach a patient how to change and control their physical response to stress triggers.The first strategy which can be used is muscle feedback. The biofeedback monitor is attached to the patient via electrodes or finger sensors and measures muscle tension levels on the face, forehead and neck areas. The goal is to reduce muscle tension in these areas and to provide a healthier focus on the face and head in terms of stress relief. The therapist teaches the patient how to alternately tighten and relax different muscle groups. The patient is preoccupied with reducing muscle tension which turns her focus away from pulling out the hair on her head and body.

The second strategy is breathing feedback which also includes temperature feedback and feedback involving sweating of the palms. Patients are taught deep breathing exercises which reduces anxiety and distracts attention from the undesirable behaviour of hair pulling. When done well this strategy promotes a reduction in temperature and sweating and results in overwhelmingly good feelings of relaxation.

A combined approach

Once the patient’s heart rate slows, her blood pressure lowers, and her muscle tension eases, habit reversal training (HRT) will be implemented. The therapist will get the patient to relax further by cultivating a variety of positive self-care behaviours and self-regulation skills through various different techniques. Mindfulness meditation teaches the person suffering from trichotillomania to focus her thoughts and let go of negative emotions. Guide imagery, which is concentrating on a specific image such as waves breaking on a sea shore, assists the patient in focusing her mind and allowing her to feel more relaxed.

After approximately ten to twenty session of biofeedback therapy, a patient will learn to control these functions without the biofeedback equipment. She herself will become aware of her body’s responses when stressed or anxious and will learn how to control those responses on her own. Biofeedback is a non-invasive alternative therapy for trichotillomania sufferers. It helps patients recognise when they are feeling anxious. It provides anxiety relief and teaches the patient how to respond when stressed or anxious. Biofeedback interrupts the chain of bad habits or behaviours by substituting self-care practices for the negative emotions and behaviours in the moment of emerging awareness.  

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