Cognitive Behavioural Therapy (CBT)
CBT for Trichotillomania involves the use of Habit Reversal Therapy and Stimulus Control Techniques. Here is a brief outline of what is involved:
Habit Reversal Therapy (HRT)
HRT was developed by Dr. Nathan Azrin and colleagues in the 1970s.
The aim of HRT is to help people to learn to recognize their impulse to pull and then to teach them to redirect this impulse.
It involves the following steps:
Getting
patients to increase their awareness of their behavior by recording
(see example of diary in self help section below) and learning as much
as possible about when, where, and how it occurrs. With this awareness
it is possible to anticipate ahead of time when pulling is likely to
occur.
The next step focuses on reducing the tension that
precedes the hair pulling. This is done using relaxation and
breathing training.
The last step involves competing response
training in which people are taught to perform a muscular movement
that is the opposite of, and incompatible with the pulling, for example
clenching your fingers to make a fist. This alternative action should
in time become an overlearned behaviour.
Stimulus Control Techniques
Stimulus Control Techniques are often combined with Habit Reversal Training. The self monitoring of triggers etc that will have been wored on in HRT is used to develop stimulus control techniques. It involves helping sufferers first identify, and then eliminate, avoid, or change the particular activities, environmental factors, states, or circumstances that trigger hair pulling. The goal is to consciously control these triggers that lead to pulling, and to create new learned connections between the urge to pull, and new non-destructive behaviors.
Please read the article on the following page written by Dr Fred Penzel describing the cognitive behavioural treatment of trichotillomania.
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