Behavior Therapy Introduction and Week 1 This 5 week Behavior Therapy Program was designed by a Therapist that also suffers from Trichotillomania. If you would like to talk to others that have tried this Therapy join BrendaC's website at BrendaC's Message Board Home Page Week 2 Week 3 Week 4 Week 5 Hello everyone. I have to condense this as much as I can. What I have here is a therapy manual that I have written previously and I am trying to get the key points here for you to consider. All I ask is that you.consider the information that I give you. Then you can accept it or reject it - it is up to you. But if you want to try the program, then the activities part is not negotiable. If any are left out, then you risk your success with it. It is the activities that people reject that often turn out to be the most beneficial to them even if they don't think a particular one applies to them or won't help them. Nothing you will be asked to do is difficult or humiliating or anything - just time. You have probably done many of the things before but maybe not in a set way. First you will be given a condensed version of the philosophy of the program and a discription of the techniques that are used. This is followed by a set of activities that are to be completed during the week which will enable you to learn all about your "habit"- not about trich in general but about how it manifests in you. To be able to do this you need to give yourself permission to pull for a few weeks. But we have to be careful here. By allowing yourself permission to pull, what I mean is, don't try to alter your behavior from how it is now for four weeks (except for how I tell you to). For some people permission to pull without any control can have devastating consequences and this won't be helpful. But if you try to change your behavior (by controlling your pulling) too much at the beginning of the program then you will not learn as much about your usual behavior as you could and then you might miss addressing a particular trigger. The program is usually conducted as therapy sessions where the week's activities are reviewed and discussed with the therapist at the end of each week, but we'll see how this goes. Most trichsters who have read something about trichotillomania will have read that there is no cure for it. While this might discourage some trichsters, it doesn't really mean much at all. The idea of a cure for trich is absurd anyway if you believe as I do that ttich is a learned behavior. I believe that particular sets of circumstances (different sets for different trichsters) caused them to learn to regulate their stress/relaxation by pulling hair. The act of pulling and the release of tension (although not everyone is necessarily conscious of the tension release) that often accompanies the pulling reinforced (rewarded) the behavior. Behavior that is rewarded is repeated. This is the basic principle of learning theory - which is what behavior therapy is based upon. Hair pulling is a learned, but inappropriate, form of self soothing or stress management. It is absurd to think that learned behaviors might be cured. The success of particular drugs in the treatment of trich is more likely to be found in people who suffer from depression or anxiety. If the depression or anxiety is treated then a trigger for trich is eliminated in these people and the condition improves. But that is treating a trigger- not the trich itself. Any behavior that can be learned however, can be unlearned! You can teach an old dog new tricks by applying the principles of learning therory (behavior therapy) to more appropriate forms of stress management. Behaviour therapies are based (in this case) on the theory that the development, maintenance and cessation of hair pulling involve learned behaviors. The aims of behavior therapy are to change the antecedents (the things that precede it) to hair pulling (including cognitions ie., thoughts), to reinforce non-pulling and to teach skills to avoid pulling in high risk situations. Specific Behavior Therapy Techniques 1. Skills training and relapse prevention. This involves the development of problem solving strategies, coping skills and assertiveness in the person ready to stop pulling. Likely relapse situations are explored and the ways that these can be cope with are explored. For example, the repatterning of behavior in certain pulling trigger situations may be helpful. Cognitive restructuring (challenging maladaptive thoughts) is an other technique that is useful in the prevention of relapse (more about these when we get to activities).A common misconception of trichsters is to view a slip as a catastrophe and allow it to develop into a full-blown spree. Cognitive restructuring is also a useful technique to use when the aim is to stengthen the trichster's beliefs in his/her ability to stop pulling. 2. Stimulus Control This involves the trichster in self - monitoring to determine his or her personal triggers for pulling. It also involves removing stimuli associated with pulling when the trichster stops in order to reduce the urge to pull. Stimulus control is a useful multicomponent of behavior therapy programs. 3. Social Support Social support involves the use of buddy systems, increasing cohesion in group therapy and encouraging spouses or friends (if they know about the person's trich) to reinforce (reward non-pulling). Lack of social support sometimes undermines attempts to stop pulling. 4. Relaxation The teaching of relaxation may help trichsters to manage relapse situations associated with stress and anxiety. Other psychosocial interventions such as self-help materials, educationa and supportive groups may be incorporated into the treatment program. Whilst the efficacy of these interventions alone (without behavior therapy) has not been demonstrated, clinicians suggest that group support is important for some people and may be beneficial if included in a treatment program. WHAT TO DO THIS WEEK (you must do them all) YOU NEED TO BUY A NOTEBOOK FOR ACTIVITIES 1. Set a date exactly 4 weeks from the day you start the program to stop pulling permanently. Write the date in your notebook. Make the time you stop midnight on the date you set. 2. Plan something very special for that day for yourself to celebrate (don't include alcohol because it weakens your resolve). This doesn't have to cost money. Just plan something very special for yourself. Don't choose a known trigger!!! For example; you might love reading but if reading is a trigger for you then you will be making stopping more difficult for yourself at the beginning. Don't plan anything stressful or go to a wild party. Have an easy day. 3. Begin making a list of all the reasons why you should stop pulling your hair. These can be the obvious ones but also include any reason (even ones that might seem unimportant). Brainstorm. The more reasons the better. Keep adding to the list and READ THE LIST EVERY DAY. 4. In another section of your book make a list of goals. These do not have to be related to hair pulling. Just a list of your personal goals. Read these everyday as well. 5. Keep an accurate record of every time you pull in your notebook. Enter the time and the length of the spree. 6. Keep an accurate record of the hours that your three main meals are eaten, hours of retiring at night and hours of awakening in the morning. Do this each day. Looking for patterns here. 7. Delay pulling for the first 30 minutes whislt watching TV and reading books, internet material etc (any kind of reading). Once the first 30minutes is up you can please yourself (for now) - but make sure you enter any pulling sprees in you book. 9. End each day with a positive affirmation. (don't leave this out). That is all you have to do for week one. Simple isn't it!! Just follow the instuctions and believe in yourself that you will stop pulling for good at the fourth week because we will be working to bread trigger situations over that time. Activities will be added to each week and the program will unfold. I will need feedback from you as time goes by. Usually I would check people's notebooks to see how many reasons for stopping and goals are entered and check sprees etc to tailor the program to the individual. And to make sure they are doing their homework. Changing behavior takes effort. It won't just happen if people don't follow all instructions I hope this helps you all. Best wishes to you. Carry .Website maintained by BrenDakota.