Trichotillomania: Workbook: An ACT-Enhanced Behavior Therapy Approach

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Trichotillomania (TTM) is a complex disorder which involves at least two levels of psychological functioning. At one level, it is a habitual behaviour. This type of TTM involves 'automatic pulling' and typically occurs without a person's awareness. The second type of TTM is more closely related to emotional functioning or regulation and is known as 'focused pulling'. Generally, it is believed that most individuals with TTM exhibit both types of pulling. THe most common treatment for TTM is Habit Reversal Therapy (HRT), and its main focus is the habitual, or 'automatic' aspect of the disorder. In this new treatment program, Drs Wood and Twohig have designed a treatment which combines the basic aspects of HRT with Acceptance and Commitment Therapy (ACT) to address the 'focused' aspects of the pulling. ACT seeks to alter the thoughts and feelings surrounding the pulling, and removes the compulsive aspect of the pulling urge, while HRT focuses on increasing the awareness of the pulling and teaches the person to utilise a competing behaviour instead of pulling. Together, these two techniques work to decrease all incidents of pulling, and help the client understand and come to terms with the emotional triggers of their disorder. In a clinical setting, this combined treatment was proven very effective, with high maintenance rates over a three-month period. This treatment consists of 10 60-minute sessions spread out over six weeks, with the final two sessions taking place every two weeks to ease the client out of the therapeutic environment and intrduce relapse prevention techniques. This corresponding workbook will contain monitoring forms to help the client maintain an awareness of their pulling, as well as self-assessment tests and other homework exercises.