April 11, 2008

Friday, April 11, 2008
As promised, here are some brief excerpts from my paper regarding the treatment of trichotillomania. This is simply a follow-up to the previous post: Assessment of Trichotillomania.

"Trichotillomania typically presents many challenges to effective treatment. The extant literature suggests that a minority of patients respond to a single intervention, for example, habit reversal or a specific pharmacological agent" (Christenson, Hollander & Stein, 1999, p. 93). Following careful investigation of data pertaining to treatment, findings point toward a high need for long-term controlled studies in order to determine the most appropriate methods for treating trichotillomania. The current research implies that there is no explicit procedure designed to be effective in all cases, rather because individuals have responded differently to various treatments and since studies have produced varied results, the ideal treatment could be some combination of techniques dependent on the individual. Because of this lack in concrete evidence to support the most successful method; this paper will explore the most effective treatment modalities currently in place. Accordingly, the existing appropriate methods are behavioural and pharmacotherapy or some combination of the two. There have been numerous techniques employed over the years; therefore a short review of these other methods will also be presented. [...]

Basically, in some form or another, HRT models consist of the following components: competing reaction training, awareness training, identifying response precursors, identifying habit prone situations, relaxation training, prevention training, habit interruption, positive attention (overcorrection), competing reaction, self-recording, display of improvement, social support and annoyance review (Christenson et al., 1999, p. 156). "Habit reversal training remains the most widely accepted treatment with the most convincing documentation of its efficacy" (Christenson et al., 1999, p. 161). [...]

Similar to behavioural treatment, pharmacotherapy has very little research to confidently support the most useful medications (Christenson et al., 1999, p. 171). Consequently, there has been a great deal of disagreement regarding the most effective medication to treat trichotillomania (Kelly et al., 2004, p. 5). That being said, there have been a multitude of medications prescribed over the years in an attempt to uncover the most effective drug. There is significant variability among medications due to the wide range of the disorder’s symptoms and the lack of long-term studies (Christenson et al., 1999, p. 96). [...]

"Treatment studies are plagued with conflicting results, a lack of large-scale controlled treatment trials, and limited long-term follow-up of patients" (Baer et al., 1998, p. 561). Because of this deficiency in terms of concrete support for the most effective method to treat trichotillomania; this paper has focused on exploring the most successful modalities presently in place. Therefore, behavioural and pharmacotherapy or some combination of the two have been considered as the most appropriate methods of treatment. Specifically, habit reversal treatment has proven to be the most successful form of behavioural treatment, while anti-depressants have been considered the most reliable medications currently being prescribed. In summary, thorough investigation has revealed a critical need for additional research of treatment modalities in order to ensure that the most effective methods are being applied in treating trichotillomania.

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Anonymous said...

Although i am not sure about the term,but i think is great to share.

Anonymous said...

I have lived with trichotillomania since approx. 11 years of age. It encompasses many feelings; mostly embarrassment, low self-esteem regardless of one's appearance as judged by the general pubic i.e. pretty, handsome, homely and so forth.

To this date, I have found my most effective form of tx. is to administer it myself i.e. using strong resistance to the compulsion, permitting intermittent pulling but not enough to 'let others know'.

I am a masters level therapist with 20 years of professional work under my belt. It is quite rare, but for one who 'has it', it's pretty easy to spot on another. I try to open the door as I realize the intimidation attached to the diagnosis may mean it will never find its surfacing.

I've taken certain drugs meant to control OCD and still, nothing brings noticeable difference.

Of course I am not a person who believes that 'those folks with mental illness should just pull themselves up by their bootstraps.' Clearly, I would be a very inadequate therapist with that philosophy. Yet, when it comes to 'trich', I'm thinkin' it really boils down to that: Yank those bootstraps hard and ongoing!

meg said...

Thanks for sharing! :)

Unknown said...

I would be interested in reading your papers on trich in entirety. Is this possible?
Best Regards

meg said...

Of course, I can email you the full version if you like.

Anonymous said...

I am 12-13, and i think i have trich. i pull, then i stop. Repeat. I learned that floss HELPS. Just FLOSS. Floss you teeth, pull out the floss from the container. Workd for me every time.

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