trichotillomaina hair pulling reduction techniques
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Trichotillomania hair pulling reduction techniques

A group of scientists from the Department of Clinical Psychology at the University of Nijmegen, in The Netherlands conducted a study on techniques to reduce trichotillomania hair pulling in 2003.

Obsessive-compulsive hair pulling is also called trichotillomania. Trichotillomania affects the young and old alike and the Massachusetts General Hospital, USA has created a scale to measure the severity of hair pulling. Different types of therapies have been suggested and tested to reduce this problem. This study references the previously discovered successes of both behavioral therapy and serotonin uptake inhibitors in controlling trichotillomania. In the view of the authors, this study was necessary because the comparison between behavioral techniques and pharmaceutical techniques is needed to discover which is more effective in reducing trichotillomania.

The patient-group in the study was found from respondents who called in after a nationally televised show about trichotillomania. Of these respondents, 50 were initially selected although in the end only 40 were ultimately used. The other 10 either declined the treatment or had to leave part way through the study for personal reasons. By the end, the patient-groups were made up of 14 behavioral therapy recipients, 11 fluoxetine recipients, and a control group of 15. Patients were over the age of 16 and had to be free of a variety of conditions (as varied as brain disease and pregnancy).

Prior to the beginning of the treatment, two clinical interviews were conducted within an hour of each other in which the patients were diagnosed and categorized. After that, they were randomly assigned to one of the three groups: the behavioral therapy group, the fluoxetine group, or the control group, which was called the waiting-list group. These three groups were monitored for 12 weeks and a post-treatment interview was conducted.

Here is what each of the three groups did during their 12 weeks of treatment.

The Behavioral Therapy Group
The members of the behavioral therapy group each underwent an individual 45 minute manual-based session every other week for the 12 weeks. The purpose of the session was to develop self-control. They did this with three methods:

• stimulus control (making sure the environment is conducive to supporting their behavior modification – like putting on gloves to eliminate the ability to tear out hair).
• stimulus response intervention (interrupting the chain of response with other activities – such as going for a walk or calling a friend).
• response consequences (giving rewards for being successful - this included allowing the hair to be pulled only after a tedious task had been done, like cleaning the bathroom).

The Fluoxetine Group
The members of the fluoxetine group were given daily doses of fluoxetine in the amount of 60 mg per day. Thirty minutes were spent with a psychiatrist every other week to monitor their progress. They were also given no other treatments, homework, or suggestions, in order to make sure that they were not using a combination of behavioral therapy and fluoxetine which could throw off the results. Throughout the course of the treatment analysis revealed that by the end of the treatment seven patients reported mild symptoms of fatigue, headache, insomnia, and weight loss and moderate to severe sexual side effects. One patient had to have their dosage reduced by one third because of severe, prolonged insomnia.

The Waiting List Group
The waiting list group was a control group that underwent no therapy during the 12 weeks, but was simply told they were on a waiting list.

After the results were analysed, behavioral therapy was proven to be much more successful at reducing hair pulling than the fluoxetine group or the waiting list group experienced. As measured by the Massachusetts General Hospital hair pulling scale, 64% of the behavioral therapy group experienced significant improvement, while 9% of the fluoxetine group experienced significant improvement, and a surprising 20% of the waiting list group experienced significant improvement.

Unfortunately, none of the treatments displayed any significant improvement in the overall disorder, but simply in the amount of hair pulled. While behavioral therapy can reduce hair pulling significantly, neither it nor the pharmaceutical solution were successful in improving the depressive symptoms.

The study was also honest enough to point out some areas where the results may be skewed. They make the following clarifications:

• Fluoxetine treatment was shown to be ineffective in this experiment but it has been proven more effective in other experiments. This discrepancy could be result of the dosage or the length of time in which the patients were observed in this study compared to other studies.
• The surprising improvement in the waiting list control group can be attributed to the expectancy of forthcoming treatment as well as the top of the mind awareness that came from the pre-experiment information on trichotillomania provided to all participants of the experiment. It was also assumed that perhaps they picked up some treatments from the leaflet provided. Conversely, the fluoxetine group experienced so little improvement perhaps because they were relying solely on the pharmaceutical solution and therefore did not look to the leaflets for any other suggestions.
• Another problem that could skew the results of this experiment is that many of the successes and failures of the behavioral therapy group were self monitored and self-reported.
• Another potential problem was that the participant group was made up of 40 people who telephoned into the experiment in response to a television show, so they are self referring participants.

In spite of these clarifications, the scientists who performed the study were confident that their findings still held true: that behavioral therapy is the most effective means available so far of reducing trichotillomania.

Trichotillomania hair pulling reduction techniques references

  • van Minnen A, Hoogduin KA, Keijsers GP, Hellenbrand I, Hendriks GJ. Treatment of trichotillomania with behavioral therapy or fluoxetine: a randomized, waiting-list controlled study. Arch Gen Psychiatry. 2003 May;60(5):517-22. PMID: 12742873
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