Treating Trichotillomania

Abstract

except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights.Printed on acid-free paper. 9 8 7 6 5 4 3 2 1 springer.com v PREFACE The first and perhaps most important step in writing a treatment manual for use in clinical practice is to clearly explicate the logic of how the treatment, and hence the book, should be organized. Accordingly, our goal in this section is to lay out the structure of cognitive-behavioral therapy (CBT) for trichotillomania (TTM) and other body-focused impulse control disorders, clearly explaining critical decisions such as the chosen sequence of techniques or whether a given technique is considered a core component or a module to be used in some but not all cases. The structure of this particular book is influenced by the work of experts who have gone before us in pioneering CBT for TTM, and is also informed by over a decade of our own clinical work and research on TTM across the developmental spectrum. We are indebted to those who developed this approach to treatment and also to those who built the extant literature on the psychopathology of TTM and related disorders. These clinicians and researchers did so in order to help alleviate the suffering of those afflicted with these conditions, and we endeavor to follow in their footsteps in continuing this important work.One of the first decisions we needed to make about the book's emphasis was whether to create a treatment guide that focused primarily on the treatment of adult TTM with a separate chapter on developmental adjustments needed to conduct CBT with children and adolescents. We chose not to do this for several reasons: 1) much of our work with TTM in the last decade has been with youth, and we felt that our experiences with this population warranted more discussion than was feasible in a single chapter; 2) although there is a clear need to adapt treatment to the developmental level of the patient, the underlying core principles cut across the developmental spectrum and hence were more efficiently considered together; and 3) TTM is typically a pediatric onset disorder, and thus its treatment should be given equal weight compared to the treatment of adults. We encourage therapists with an interest in CBT for TTM but have worked primarily with adults to consider seeking additional training, supervision, and clinical experience in treating youth: there is a serious problem with treatment access for TTM in general, but this problem is particularly pronounced for families seeking help for their children.The book is organized into four subsections: 1) Overview and Assessment; 2) Treatment: Core...

Recent Advances in the Understanding and Treatment of Trichotillomania

“…Multiple tailored approaches could be used. Modular approaches (i.e., Franklin & Tolin, 2007; Mansueto et al., 1997) would attempt to match a patient’s particular pulling profile with specific therapeutic techniques. Other strategies could employ standard-package behavior therapy techniques (i.e., HRT and SC) with treatment strategies (i.e., DBT, ACT) designed to address what traditional behavior therapy for TTM does not (i.e., emotional control function of pulling).…”

Diagnosis, Evaluation, and Management of Trichotillomania

“…TTM severity can be assessed by measuring hair loss (e.g., photograph ratings, measuring bald spots, collecting pulled hair), but this approach has challenges (Franklin & Tolin, 2007). First, patients sometimes are reluctant to allow a clinician to examine, or photograph, areas from which they pull.…”

“…Some have noted that disorders involving affect regulation and self-injurious behaviors (e.g., Borderline Personality Disorder-BPD), can have features similar to TTM (Franklin & Tolin, 2007). Although there are surface similarities, in that self-injury and pulling may regulate emotion and lead to noticeable physical damage, there are important differences between the two conditions.…”

Trichotillomania and its treatment: a review and recommendations

“…Questions on the MIST questionnaires include information about the patient’s level of urge awareness, level of active pulling behaviors and use of implements to pull; its purpose is to help determine the overall level of pulling awareness. Clinically, many have suggested that automatic pulling is probably more amenable to reduction via standard behavioral methods incorporated into habit reversal training protocols [44], whereas focused pulling may require more clinical attention to the affective cues that often drive this form of pulling [14]. As the MIST questionnaires survey this information, it is strongly recommended that clinicians make use of them as a routine part of initial and repeated assessment during treatment.…”

“…Behavioral interventions for TTM (e.g., [44]) have generally included three core elements: first, awareness training, wherein techniques (e.g., self-monitoring) are implemented to improve the patient’s awareness of pulling and, better yet, the patient’s awareness of the urge that precedes pulling; second, stimulus control, which includes a variety of methods that serve as ‘speed bumps’ to reduce the likelihood that pulling behavior begins; and third, competing response training, where patients are taught at the earliest sign of pulling, or of the urge to pull, to engage in a behavior that is physically incompatible with pulling for a brief period of time until the urge subsides. These core methods were initially developed and tested by Azrin and Nunn [47], and comprise the main elements of contemporary behavioral treatment, although some habit reversal training protocols have also included other techniques (e.g., relaxation training and cognitive strategies to address dysfunctional thoughts that precipitate pulling).…”