From the Guidelines
Trichotillomania can be effectively treated with habit reversal therapy, a technique that involves awareness training and the use of competing responses, such as making a fist rather than pulling hair. This approach has been shown to be beneficial in reducing hair-pulling behaviors, as noted in a recent study published in the Journal of Child Psychology and Psychiatry and Allied Disciplines 1. The study highlights the potential of habit reversal therapy as a valuable tool in the treatment of trichotillomania, particularly when used in conjunction with other therapies.
Some key points to consider when using habit reversal therapy for trichotillomania include:
- Awareness training to help individuals recognize their hair-pulling behaviors
- Competing responses, such as making a fist or using a stress ball, to replace hair-pulling
- Systematic training in focusing attention externally, such as on sounds in the room or colors in a picture, to reduce self-focused attention
- Developing a plan for building on treatment gains and identifying potential triggers for relapse, as outlined in the study's discussion on relapse prevention 1.
It is essential to note that while medication may also be used to treat trichotillomania, the study does not specifically address this aspect. However, habit reversal therapy has been shown to be a effective and scalable approach, with potential implications for policy and cost-effectiveness, as demonstrated in recent studies 1. By prioritizing habit reversal therapy, individuals with trichotillomania can work towards reducing their hair-pulling behaviors and improving their overall quality of life.
From the Research
Treatment Options for Trichotillomania
- Behavioral treatments:
- Habit reversal training (HRT) and stimulus control are first-line treatments that can be used in cases of all severity levels 2, 3
- Acceptance and commitment therapy (ACT) and dialectical behavior therapy (DBT) can be employed to augment HRT/stimulus control, especially when negative emotions trigger the pulling or picking 2
- Cognitive-behavioral therapy (CBT) shows promise as a treatment for trichotillomania and might be preferable to pharmacotherapy 4, 5
- Pharmacologic treatments:
- N-acetylcysteine (NAC) should be considered for all severity levels and styles given its moderate gain/low side effect profile 2
- Selective serotonin reuptake inhibitors (SSRIs) should be considered in cases with significant comorbidities or previous behavioral/NAC treatment failure 2
- Clomipramine has been most effective in clinical trials among pharmacologic therapy 5, 6
Effectiveness of Treatments
- HRT has been shown to be effective in reducing symptoms of trichotillomania 3, 5
- CBT has been shown to be significantly more effective than clomipramine or placebo in reducing symptoms of trichotillomania 5
- Group cognitive-behavioral therapy has been shown to be a valid treatment for trichotillomania, with significant posttreatment improvement in hair-plucking behavior 4