Cognitive restructuring is the process of evaluating, challenging, and changing maladaptive core beliefs that often perpetuate a problem. Since many individuals with Trichotillomania report pulling to reduce a negative thought or mood, cognitive restructuring can help by identifying and changing irrational or negative beliefs which lead to pulling behaviors. Cognitive restructuring involves two steps, the first of which is to identify the thought(s) or belief(s) that prompt a negative thought or emotion. Second, the therapist helps the patient to critically evaluate those thoughts or emotions for accuracy and usefulness. The therapist can then help the patient to replace any inaccurate or irrational thoughts with ones that are more accurate and useful to the patient.
dialectical behavior therapy-Enhanced Habit reversal therapy
Mindfulness training techniques have been shown to be efficacious as conjunctive to an acceptance-based treatment components and Dialectical Behavior Therapy (DBT). The therapy consists of mindfulness training (e.g., patients are taught to experience urges or negative emotions as they occur in the present moment and learn to allow them to pass without pulling), teaching patients skills to regulate negative emotions without pulling, and building a distress tolerance (e.g., tolerating urges or stressful events without pulling).
Acceptance and Commitment Therapy (ACT) is a subsidiary component of HRT in which patients are asked to experience urges to pull and accept the urge without acting on it. The negative emotions involved with pulling are also engaged but not acted upon. The idea is that understanding, feeling, and experiencing the fact that the individual does not have to respond to an urge or emotion can help the patient to feel more in control of his or her pulling.
Online Therapy. Online therapeutic tools have also been developed by expert clinicians with a substantial amount of experience treating Trichotillomania, including at www.stoppulling. com. The behavioral therapy offered online seeks to help the patient to identify situations or triggers prompting hair pulling and subsequently strategize ways in which the patient can address and change those behaviors. Online therapy has been reported as particularly useful for individuals living in rural communities, those with a hectic schedule, or for those who prefer to engage in therapy without leaving their home (due to, for example, embarrassment or shame from bald patches where pulling has occurred).