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What Treatments are Available
OCD hair pulling is often treated by a combination of methods. These include the following:
- Medication including serotonin reuptake inhibitors and tricyclic antidepressants
- Lesser used medications include lithium and naltrexone
- Cognitive behavioral therapy is generally considered the best way to treat trichotillomania but it may be used in conjunction with medications
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The Most Effective Treatments
Cognitive behavioral therapy has produced good results in treating OCD hair pulling. It is a complex form of treatment and is a combination of behavior therapy and cognitive therapy. These work in the following ways:
- Behavior therapy involves working with environmental factors that seem to trigger certain actions, or provide reinforcement or punishment for behaviors. When an action is reinforced by a reward such as food, pleasure or money, people tend to repeat it. Conversely, a behavior that is followed by punishment in the form of criticism or the loss of privileges will become more and more undesirable.
- Cognitive therapy involves the mental processes and responses that occur in response to an event or stimulus in the environment. It works to identify negative thoughts and ultimately change them. This is done by examining what caused the thoughts and reframing the circumstances to create new thought patterns.
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How is Cognitive Behavioral Therapy Used
A combination of behavior therapy and cognitive therapy is often used for treating OCD hair pulling. This is commonly referred to as cognitive behavioral therapy. A therapist will work closely with the person suffering from trichotillomania and may employ some of the following techniques:
- The person is asked to write down the thoughts and feeling they experience before, during and after hair pulling. These thoughts are then examined in depth and any incorrect assumptions will be addressed and worked on. These often involve thoughts of failure and anxiety.
- A daily thought record is a good way to identify problem areas in the person’s thought processes.
- It is possible to change thought patterns but it will take dedication and determination and possibly help from a professional.
- The behavioral aspect of therapy may involve exposure and response prevention. The therapist may introduce circumstances that would typically result in a hair-pulling episode. By exposing the person to anxiety, stress or other triggers while disallowing hair pulling, they weaken the need to hair pull as it is not being reinforced.
- Habit reversal is a multicomponent treatment that has been successful in treating OCD hair pulling. Steps include identifying environmental stimuli that cause hair pulling and replacing the hair pulling with a new behavior such as clenching one’s fist or stroking and squeezing a ball. Breathing techniques may be taught to reduce anxiety and tension.
Once a therapist has devised a treatment program, it is up to the person to follow through with it. As the concepts are repeated and reinforced, the process becomes easier and many trichotillomania sufferers find they are able to stop pulling their hair out.
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Help for Hair Pullers – Understanding and Coping with Trichotillomania, Nancy J Keuthen, Dan J Stein, Gary A Christenson, New Harbinger Publications, 2001
Obsessive-Compulsive Disorder – Help for Children and Adolescents, Mitzi Waltz, O’Reilly and Associates, 2000