Hi Everyone,
We work with many clients who are living with Trichotillomania - we think the national Trichotillomania website is awesome for information and support - see below for the link. If you are interested in learning more about treatment options available - pease read the information below or feel free to call or come in for a free consultation with one of our technicians to discuss the hair replacement options we can offer.
Judi Wygant-Collier
Trichotillomania Treatment Options
Research into treatments for trichotillomania and skin picking has grown steadily over the past decade. Although no one treatment has been found to be effective for everyone, a number of treatment options have shown promise for many people. At this time, management of these behaviors should begin with education about the disorders, followed by consideration of the treatment options listed below. Special considerations for treating children and adolescents are discussed in the Clinician's Guide for Treatment in Children and Adolescents – view this at the Trichotillomania website at https://www.trich.org/treatment/options.html
Treatment Options: Cognitive-Behavioral Therapy (CBT)
Note: the following treatment overview was written for hair pulling, but also applies to skin picking. More in-depth information about skin picking treatment is coming soon.
Cognitive-Behavioral Therapy (CBT) is a form of therapy that seeks to alter behavior by identifying the precise factors that trigger hair pulling and learning skills to interrupt and redirect responses to those triggers. Broadly stated, CBT is based on learning theory which has shown that as we practice new behaviors and thoughts in response to familiar emotions or situations, our brain's physical structure actually changes, too. We develop new neural pathways and, with repetition, the new behavior becomes an automatic response.
CBT should be performed by a psychologist trained in this method and well versed in treatment of these behaviors-something that may be easier said than done as there is not an abundance of psychologists with this specialty. The therapist will encourage hair pullers to develop an increased awareness of the times of day, emotional states, and other factors that promote hair pulling as an important precursor to being able to control the behavior. Some hair pullers have had success with simple behavioral devices such as putting bandages on their fingers to interfere with pulling, keeping records of their hair pulling, or changing environmental cues that can trigger pulling.
Methods of cognitive-behavior therapy, such as Habit-Reversal Training and the Comprehensive Model for Behavioral Treatment of Trichotillomania, have shown to be the most successful treatments for trichotillomania known today.
Treatment Options: Medications
Questions about pharmacological treatment are among the most frequently asked of TLC. Understandably, many want to know, "What can I take to make me stop pulling?"
As of yet, there is no magic pill for the treatment of trichotillomania or skin picking. In fact, people respond very individually to medications, so there probably will never be a single drug that helps everyone. There is also a strong possibility that there is more than one form of trichotillomania, and that different forms will respond to different treatments.
That said, some people do benefit from drug therapies, either alone or in conjunction with cognitive-behavior therapy. Many experience a reduction of the urge to pull, and some have experienced total cessation. The effect, however, is often (though not always) temporary. It can be useful to use a period of relief to explore additional treatment or support resources that may help you in the long term.
Because reaction to medications is so individual, it is often necessary for you and your doctor to try more than one drug or combination of drugs before finding one that helps. Medications in the SRI or SSRI category have shown to be the most useful to date, but results are mixed. Please see our "Clinicians' Guides" for more detailed information.
The use of medication for the treatment of these behaviors in children or adolescents brings additional concerns. Very few drug trials involve children and to date there have been no studies of the use of medication for treatment of TTM in children. Due to the limited evidence supporting its effectiveness, as well as concerns about the long-term effects of medications on the developing brain, TLC's Scientific Advisory Board advises that for most children and adolescents with trichotillomania, medications should not be used as a treatment of first choice.
It is important for you and your doctor to be aware that many people with trichotillomania and skin picking suffer with additional problems, such as depression and anxiety, which should be screened for and treated. In addition to being serious or even life-threatening in their own right, the existence of additional disorders can hinder one's ability to benefit from treatment of trichotillomania.
Treatment Options: Alternative Therapies
The most well-documented methods of reducing hair pulling and skin picking are cognitive-behavior therapy and medications.
But none of these approaches works for everyone. Because we do not have all the answers about trichotillomania and its treatment, TLC works to provide information about additional ideas that may be useful to you. Dietary changes, meditation, hypnosis, prayer, yoga, and herbal remedies have all been reported to be helpful by some individuals.
In many cases, these ideas have not been scientifically tested and are supported only by anecdotal evidence. So we explore them with an open, but also cautious, mind.
When making decisions about what treatments to pursue, we suggest asking yourself a few questions:
•What do I want to achieve through this treatment (or tool or diet, etc.)?
•Can it do me any harm? (Please note: Sometimes the answer to this question isn't obvious. It is especially important to do your own research and consult a doctor if you are going to ingest any medication, herb, vitamin, or alter your diet. Even seemingly benign substances can have harmful effects if ingested in too great a quantity or in combination with certain other conditions or medications.)
•On what basis do I believe that this treatment will help me?
•What is the likelihood of this method being useful compared to other options?
•Can I afford the money, time, or emotional energy involved in pursuing this idea?
Treatment Options: Support Groups
Individuals who suffer from hair pulling and skin picking have often spent years coping with these behaviors alone. However, many report that participation in either therapist-facilitated or peer support groups helps to improve their self-image and sometimes even helps reduce pulling and picking behaviors.
Parents and loved ones may also experience feelings of frustration or guilt about the disorder and may benefit from communication with others who share their experience.
TLC provides information about local support groups and will assist those who would like to start heir own group. TLC also moderates parent and teen email groups.