Trichotillomania Blog

Trichotillomania: Will internet-based treatment help if you’ve been in therapy before?

The short answer is yes. For a variety of reasons, many people with trichotillomania do not get treatment. Those who do sometimes have negative experiences which causes them to stop treatment. Internet-based therapy and support is a promising way to reach those people with trichotillomania who do not have access to face to face therapy or who do not feel comfortable sharing their experiences face to face. A recent study showed that no matter the symptom severity or treatment history internet-based treatment is still effective.

Trichotillomania: the impact of treatment history on the outcome of an Internet-based intervention

Seeking treatment for Trichotillomania

The decision to get treatment for trichotillomania is a difficult one. One of the biggest barriers is embarrassment and shame followed closely by not recognizing that symptoms are treatable and not knowing where to go for treatment. Therefore, less than 50% of those with a hair pulling disorder get treatment and sometimes it takes up to 9 years after hair pulling starts to get treatment. Rates of co-occurring depression tend to increase as treatment is delayed (2).

Research: Genetic Predisposition for Trichotillomania

The Institute for Genomic Health (IGH) at SUNY Downstate Medical Center is conducting research on Obsessive Compulsive Disorder and other related disorders (Hoarding Disorder, Body Dysmorphic Disorder, Hair Pulling disorder/Trichotillomania and Skin Picking Disorder/Excoriation Disorder. We've been asked to publish the following info about this reseach to help recruit participants for the study. Here're the details:


Current research has indicated that some people are more likely to develop this disorder than others. We at Downstate, along with other collaborating research sites are working towards identifying the genes associated with this disorder in the hopes of contributing to the development of better, more effective treatments.

Our study is NIMH-funded and approved by Downstate Medical Center, study ID # 759153.

Participation for patients is one-time only. It includes:

Emotional Freedom Technique

The mind and the body are connected and therapeutic modalities such as the Emotional Freedom Technique (EFT) or “body tapping” address the cognitive and the biological. The methods of action remain unknown, but published research shows it can be effective for mental health issues.

What is EFT?

EFT combines psychotherapeutic methods of cognitive therapy and exposure therapy with the biological method of acupressure. Cognitive therapy focuses on how we see the world, our thoughts about the world, and how those thoughts influence emotions and behaviors. It is one of the most-used methods of therapy for many disorders. Exposure therapy is based on the idea that small, incremental exposures to traumatic thoughts, feelings, or events, combined with relaxation, can help desensitize someone to the effects of traumatic thoughts, feelings, or events. Exposure therapy is most often used with people who have phobias and post-traumatic stress disorder.

The guilt and shame of hair pulling

Not many people have tolerance for anything outside of their “normal.” Most of the world lives within strict confines of a defined “normal.” Anything outside of that version of “normal” is considered “weird,” “strange,” “gross,” or “out there.” In the case of creativity, those who fit into the “out there” category are perceived as innovative, but when it comes to mental illness, most people do not have a sympathetic, empathetic, or compassionate response to things that are “weird,” “strange,” “gross,” or “out there.”

Anxiety – where does it come from?

Anxiety is everywhere. The new buzzword. But what does it really mean and is it really the culprit it is made out to be?

Simply defined, anxiety is a sense of unease, nervousness, or worry. It manifests on a continuum of physical, mental, and emotional symptoms from the feelings of butterflies in the stomach before a performance, athletic event, or speech all the way to a panic attack. There is a biological basis for anxiety. It is our stress response system, or our fight, fight, or freeze response. When our brain senses any kind of imbalance or potential threat to the body system, the stress response is activated in preparation for “survival mode.” For example, walking to your car alone in a half-lighted parking lot, you feel uneasy. This is an appropriate signal to you to be alert for danger. Sometimes, however, it is activated when it doesn’t need to be or it is often activated, leading to anxiety disorders.

The difference between a trigger and a cause of hair pulling

When we talk about behaviors in psychology, the word “trigger” is used a lot. A trigger, however, is not the same thing as the cause of a condition. They are two separate things unrelated to each other.

Trigger

Let’s talk about triggers first. One of the first things addressed in therapy for compulsive hair pulling is identifying what triggers someone to pull. The inclination may be to assume that question is trying to figure out the cause of pulling behavior, but it’s not. Think of it more like identifying the internal or external cues that occur right before pulling. Internal cues are things such as emotional states, thought processes, or physiological sensations. External cues are people, places, or situations. When any of those cues happen, someone with compulsive hair pulling may respond to those cues by pulling hair. The pulling serves a purpose in dealing with those cues, which is something addressed in therapy.

 

Be present or be mindful - Aren’t they the same thing?

One of the things that make human beings amazing is our metacognitive abilities. Meta-what? In fancy psychological terms, it means humans have higher-order thinking that allows us to analyze and control our thinking processes and our memories. We can think about how and why we think as well as how and why we have memories. We are aware of our abilities to think and form memories, we have thoughts and feelings about those abilities, and we evaluate them in the past and for the future. We are not born with this ability; it develops over time.

How to cover bald spots and regrowth

People who suffer from trichotillomania struggle with more than a disorder that carries stigma. There is a lot of guilt and shame felt because of the disorder itself. Trich is not experienced by many and few people understand what it entails. All someone knows or sees is that someone pulls out their hair. In addition, the behaviors are magnified by the visual consequences of pulling out hair. Once the hair is out, it takes a long time to grow back. If it does, it will probably be weaker and look different from other hair. And sometimes it doesn’t grow back at all. Try explaining that to someone who doesn’t get it.  

Slightly Robot Review

The wearables market is booming and this wave reached the mental health fields too. What is significant to our readers is that some of those companies are focused specifically on BFRB disorders such as excoriation disorder and trichotillomania. We decided to reach out to all vendors who are creating devices for the BFRB market, and put their products to the test. This is going to be the first post in a series of reviews dedicated to such devices. This following is a thorough review by a member of our team:

 
Hello – Slightly Robot

SlightlyRobot is a young and small venture run by two brothers from Seattle (we interviewed them last fall).  As their website states:

“The Slightly Robot Bracelet tracks your hands and vibrates when you forget what they're doing, whether it's pulling your hair, biting your nails, or something else.”

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