How Cognitive Therapy Can Help You Manage Trichotillomania

By: Suzanne Feinstein, PhD

When we talk about identifying anxiety and the need for treatment, we tend to focus on symptoms of generalized anxiety. These can include things like irritability, nervousness, difficulty breathing, and more. What if your anxiety is masked by one persistent behavior?

Many patients with trichotillomania, a condition that causes excessive hair pulling, don’t show many other signs of anxiety. In fact, the act of hair-pulling can act as a displacement of anxious feelings.

Read on to learn how cognitive therapy can help you manage trichotillomania and maybe even bring that compulsive hair-pulling to a halt.

What Is Trichotillomania?

According to the Anxiety and Depression Association of America, an estimated 5 to 10 million Americans have Trichotillomania. Yet, few people understand what it is. It’s possible that many more have symptoms of Trichotillomania but don’t know it due to a lack of awareness.

Trichotillomania describes the behavior of picking or pulling hair from any region of the body. It can coincide with other disorders, such as OCD, or it can stand on its own. In fact, some people engage in this behavior not to soothe anxiety but to self-stimulate when bored.

In either case, this behavior is often accompanied by secondary symptoms or feelings. These can include:

  • Shame
  • Embarrassment
  • Frustration
  • Low self-esteem
  • Social withdrawal

If a patient isolates hair-pulling to one area, it can cause temporary baldness or damage to the hair shafts, making regrowth difficult. In severe cases, hair-pulling can irritate the skin and create lesions, infections, and scars.

Does Trichotillomania Have a Cure?

Unlike physical diseases, mental disorders aren’t always easy to measure in an objective way. While tests can determine if you’ve cleared an infection or healed from a sprain, there’s no clear way to determine if something like trichotillomania is officially cured.

That said, many people do recover from trichotillomania. Research shows that the best approach to trichotillomania treatment is cognitive therapy.

The Basics of Cognitive Therapy

Cognitive therapy is a type (or group) of therapy that takes a direct approach to changing beliefs and their corresponding behaviors. Typically, patients meet with their trained and licensed therapist once a week for an average of 60 minutes. Individual sessions seek to meet individual goals that are all geared toward a larger goal.

Contrary to popular belief, patients in cognitive therapy don’t do all the talking, nor does the therapist tell patients exactly what to think or do. Instead, the patient and therapist work together to understand the condition the patient wants to treat. The therapist may constructively challenge a patient’s current beliefs or encourage them to follow through with goals.

Cognitive Therapy as Trichotillomania Treatment

How do we apply the model of cognitive therapy to trichotillomania treatment? While all therapy is individualized to a patient’s needs, there are a few ways in which the methodology of cognitive therapy works well for most patients.

Assessing Hair Pulling Triggers

In order to stop a compulsive behavior, it’s important to understand where it’s coming from. This occurs in two stages. The first is understanding each patient’s root trichotillomania causes and the second is understanding behavioral triggers.

For some, the goal of trichotillomania is to soothe feelings of discomfort or anxiety. In this case, the trigger is something stressful or related to a past trauma. For example, someone with a history of abuse may practice hair-pulling when someone around them raises their voice or makes demands.

For others, the goal of trichotillomania is to provide stimulation when bored. In this case, patient’s may start to tug at or remove hairs when sitting through a meeting, watching TV, or doing any activity that isn’t providing them with enough mental or physical stimulation.

Learning Habit-Reversal Techniques

Habit-reversal falls under the category of cognitive therapy. The idea is that patients start to learn more about what drives their own habits and engage with new behaviors.

This may begin with self-assessment or journaling. The patient must raise their own awareness of the behavior, as it’s often subconscious. They can then take note of what was happening at the time that they started hair-pulling and how they felt.

Then, patients can work with a trained CBT therapist to implement new habits. Short-term strategies may involve using the hands in a different way, such as playing with a fidget toy. Long-term strategies may involve learning to confront difficult emotions, rather than trying to mask them.

Implementing Therapy

Patients won’t stop hair-pulling overnight. It can take weeks or months of therapy to start seeing tangible differences. This is especially the case for patients who use hair-pulling to self-soothe because these patients must:

  • Accept that hair-pulling is a form of transference of anxiety
  • Understand what causes their stress and anxiety
  • Learn to process and work through painful emotions or difficult situations

The good news is that the recovery rate is high for patients who commit to their therapeutic practice. This includes committing to their progress outside of therapy. In other words, patients must carry out any strategies they develop with their therapist outside of their practice.

Preventing Relapse

Patients often notice an improvement after several months of therapy. At this point, they may not need weekly sessions.

However, you can still return for “maintenance” therapy. In other words, you can schedule sessions as needed when you sense a recurrence of the behavior or have to face a significant trigger.

In addition to maintenance therapy, patients will learn many useful tools to keep hair-pulling at bay. This may include grounding techniques or cognitive reframing. In the latter, patients learn how to recognize triggering or unhelpful thoughts to replace them with new ways of thinking.

Call Dr. Feinstein for NYC Cognitive Therapy

Do you believe that you have trichotillomania? Research shows that cognitive therapy can make a big difference. You don’t have to face your compulsive behaviors alone.

Dr. Feinstein is proud to treat patients with anxiety disorders across the full spectrum in NYC. Contact us to learn more about our services and schedule your first appointment.

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