CBT Treatment for Trichotillomania
Cognitive behavioral therapy (CBT) is widely considered the treatment of choice for trichotillomania, with more people responding well to CBT than any other treatment. Unlike traditional psychotherapy, CBT treatment for trichotillomania is brief and action oriented, designed to immediately address the problems that are bringing people to treatment. Rather than focusing on early upbringing, as would a traditional talk-therapist, a CBT therapist helps the patient target and problem solve the symptoms that are occurring now. This takes place through assessment and problem solving in session, and more importantly, through the use of homework assignments designed to reduce symptoms outside of session. Hundreds of research studies have consistently shown CBT to be most effective for treating a variety of psychological problems, including trichotillomania.
Cognitive behavioral therapy for trichotillomania begins with assessment of the factors involved implicated in hair pulling. For instance, what times of the day hair pulling occurs, what emotions are present, whether people are around, etc. Some of this information is gathered during the first CBT session, and the remaining data comes from the patient’s own self-monitoring and tracking via CBT self-monitoring forms. Interestingly, there is evidence that the mere act of completing self-monitoring forms can significantly reduce hair pulling.
Following assessment, the therapist and patient collaborate to identify the more important factors involved in hair pulling, and using this to create a habit-reversal training (HRT) plan. HRT consists of mindfulness training and competing response training. Mindfulness involves training people to be more conscious of when they are pulling, and be more vigilant in situations in which they are more prone to pulling. Competing response training is strategizing to develop alternate behaviors and habits that do not allow for pulling to take place.
Newer treatments for trichotillomania incorporate the addition of elements of what is known as acceptance and commitment therapy (ACT), which utilizes acceptance of urges and sensations as a way of coping with them. For trichotillomania, this involves learning to accept urges to pull or uncomfortable emotional triggers to pulling, rather than trying to control these internal experiences. Paradoxically, acceptance of unpleasant experiences leads to less distress, and usually the duration of the experiences is dramatically curtailed.
Treatment for trichotillomania generally lasts 10 – 12 sessions. However, if there are underlying psychological problems associated with the hair pulling, such as depression or clinical anxiety, more sessions may be needed to effectively treat the hair pulling and the underlying psychological problem.