Lately my focus has been on Commitment and Acceptance as I delve into ACT therapy. A member of my online support group had a great post about her methods (including acceptance and commitment) for managing trich. I have included her post below. The original can be found on the beating trich support group forum.
“In the last year and a half of being here at DS, I have learned a great deal about my relationship with trichotillomania. I can’t always maintain a PF, but I have done it enough to get to the point where I feel I am managing this thing. Perhaps my methods can be of help to others. I am a scalp puller, but I believe these methods can be adapted for brow and lash pullers. I call them my ABC’s, but really they are my CAB’s. Anyone is welcome to post their favorite methods of attack here as well.
1) To borrow from the 12 Step Programs, the first thing is to accept that you are a hair puller. To own it, and to take responsibility for it, and to work towards taking control. Only you can do this. On the other hand, you don’t have to do it alone. You can ask a Higher Power for help, and you can ask for support here at DS. There are so many of us in the same boat.
2) COMMITMENT: You must commit to fighting this thing. Make yourself that promise, even if you have to grit your teeth sometimes to keep it. Don’t make excuses. Without a strong commitment, I find that I falter. Remind yourself that it is rarely “just one” hair.
3) AWARENESS: Be aware of your triggers – study yourself. Is it food, stress, boredom? Where are you when you pull, what are you doing when you pull? Are you driving, reading, watching TV, at the computer, in bed, in the bathroom, looking in the mirror? Be aware of what your hands are doing. Be aware of when the urge hits. Be aware of when you pull. Stay present. Don’t let yourself get into the pullers’ trance.
4) BARRIERS: Have your barrier of choice readily available, anywhere, any time.
-I have lightweight driving gloves in the car;
-a bumpy drier ball and light cotton gloves by the computer;
-I wear jewelry that I can play with when I go to lectures, or have to work with other people;
-I knit when I watch TV, or I wear a baseball cap or gloves.
-I wear a baseball cap when I read. I also have gloves and a drier ball handy. (Gloves don’t work as well when I read, because I tend to pull them off. The hat works the best . It literally “caps” the urge.)
-If the urge is on fire, I will put ice cube or ice packs on my head.
5) SURF THE URGE: If I don’t have barriers handy, I utilize visualization techniques.
-I will imagine that my hands are very heavy, and concentrate on the weight of them in my lap. Or, I will see the urge as a wave or a strong misty wind. I see it approach, and I stand my ground, I will not be swept away buy it. Nor will I strain myself to try to hold it back. I will let it wash over and past me.
-The urge always passes. It may take 1,3,15,30 minutes, but it will pass.
-Another thing I do is jump on top of the urge on my surfboard (or not) and ride it out.
-Sometimes I see the urge as an angry insect, and I put a large glass lid over it and watch it frantically beat it wings into exhaustion.
-Sometime I visualize it being zapped into oblivion by a ray of white light.
-Or, I will imagine it is a cap on my head, and I will expel a large gust of air through my scalp to vanquish it.
-If visualization isn’t your thing, just breathe into the urge. Close your eyes and breathe it away with slow, steady breaths. Breathe from your belly, or look up some yogic breathing techniques.
6) I check in here almost every day. The support and community here is of incalculable benefit. If I falter, I don’t beat myself up, I just start all over again. It is a process.
Below I’ve posted a fantastic blog post by Claudia Miles MFT, a psychologist who specialises in Trich & CSP. The original post is on her blog “help for hair pullers”: http://helpforhairpullers.blogspot….
A Foolproof Plan For Recovery from Trich and Skin Picking
Whether you want to stop picking or hair pulling one thing will stop you from recovery: not understanding and accepting the gradual nature of recovery. The pattern generally goes like this: you suppress the urge to pull* (pull or pick) for an hour, a day, maybe a week or more. You are happy about it. Briefly hopeful. Then you find yourself pulling again, or suddenly feel unable not to give in to the urge. Then you may check the mirror, see a bald spot or scabs on your skin, believe you “undid” your progress and decide it’s hopeless. What’s the point of trying?
Let me explain why that will NEVER work. You will not go from being an active puller to being completely pull-free in one fell swoop. The nature of these disorders is such that as much as you consciously want to stop, there is a part of you that does not want to stop because you get emotional soothing from the behavior. Further your body has some dependence on the behavior. And while that doesn’t mean you can’t stop pulling or picking, it does mean there will be some resistance. And what THAT means is that recovery looks like this: you’ll have good days followed by some bad days, then more good days followed by less bad days, until you eventually have nearly all good days and almost no bad days.
In order to note good days and bad days, you’ll need to rate each day with one number. No extensive journaling or record keeping, but one number a day. The pulling / picking scale I have devised is similar to the pain scale that you may be asked about at the doctor. You rate each day from 0 to 10. Zero means zero pulling, and 10 means YOUR worst day (use the last year as a way to measure your worst day). This is a subjective rating and does NOT have to be exact. You will know the difference between an 8 on the scale and a 2 once you start doing this.
Here is the thing about good days: They aren’t zero pulling days, they are lower number days. Depending on what your average pulling or picking day is, the days you actually pull or pick if you don’t do it daily, you will choose a number that is not lower than 3, and that is within your reach right now, to be a good day. If you get lots of 5s and 6s, a few 3s and 4s, and a few 8s through 10s, pick 4 and below as your good day. If on the days you pull or pick you get mostly 8s, 9s and 10s, and a few 6s or 7s, use 7 and below as a good day. If you get mostly 4s, 5s and 6s, a few 8s and 9s, a fews 3s, 2s and 1s, use 3 and below as your “good day.” For many people 3 or 4 will be your good day. But again, if that is currently out of your reach and you never get 3s or 4s, then choose a 7 by all means.
The important thing is that what you consider a good day is a) not lower than 3, and b) not out of your reach right now.
You might keep a record of these numbers on your electronic calendar or on a paper calendar that you can make. But every day that is “Good” (a number you choose like 3, 4 or 5 or below) make a big X on that day. That’s a recovery day. The idea is that each month you will have more and more of these good days. Once that is easy, you can lower the number you use for your good day, and work toward a slightly lower number. Your goal always and only is to lower your numbers each month, NOT to have your hair back or your skin looking great. So long as your goal is focused on the results not the journey, you will get discouraged and give up.
So shift your goal from “having my hair back” or “having my skin clear” to collecting 30 good days, then 60 good days, then 90 good days, but NOT sequentially. That’s right. NOT sequentially. That means you can still have some very bad days. See if you can get 30 good days in a total of 60 days. (If you get 30 good days in 75 days, that’s great; now try again to get 30 good days in 60 total days. Once you achieve that, work toward 30 good days in 45 days. Keep counting the good days even if you reach 45 and don’t have the 30 good days. See how many days it takes. If it takes 50 or 60, great. Try again for the 30 days in 45 days.
If this is not going well for you, do NOT panic. That only means you must shift your goal. The most important thing here is to find a small goal you can achieve. If that means your good days are a higher number and in a larger total number of days, that’s fine. When you get there, see if you can improve it just a little the next time. If you do this, you will succeed. However, remember this: If you are someone like most pullers and pickers who a) cannot set boundaries (no Mom, I don’t want your opinion) or say no to people easily; b) who is a workaholic and perfectionist; c) has constant self criticism running through your head or d) who does not take time for yourself; or have any other issue that is troubling you including you depression, hating your job, being in an unhappy relationship, then you must deal with these things in order to recover. Get into therapy. Get into group. Go to a 12 step meeting if one applies. There are interns and trainees who can see you for little money. You must prioritize self care if you are to recover from these behaviors.
Being able to handle having had a bad day and put it in perspective may well be the single most important thing necessary to recovery. I believe that once we have a string of good days, the part of our psyche that has always had the behavior (addiction) to turn to, will panic. And the fear of never being able to do this again causes the addiction in those of us with these disorders to have really overwhelming urges on any one day. And the addiction always wins at that point if we look at our hair and skin and say, Ugh I have ruined it. What’s the point?
If however your goal is to get more good days in a shorter period of time, you cannot fail. See how long it takes to get 30 good days (days that anywhere from a 3 and below to a 7 and a below). Next time around try to do it in a slightly shorter period of time. No matter how much you pull or pick, you cannot “undo” the success of having worked toward 30 good days in, say, 45 (or whatever your goal is). Eventually yes you will have hair and skin you are far happier with. But racking up good days is always your goal.
So in the case of even if you have to white knuckle it (holding on so tight to something your knuckles turn white) to not get many 8-10s in row, do it JUST for today. Just till midnight or 6am the next morning. Not forever. Tell yourself, I can pull or pick tomorrow if I need to. (And you can.). And that there’s a good chance after that day passes the craving will be a little easier the next day. The reason you can’t stop is you tell yourself, I’ll never be able to resist this forever so I may as well just pull / pick. And no you can’t resist the urge forever. And you won’t have to. As you pull or pick less and less, IF you are adding in self care to the recovery process, the urges will slowly die. Self care means checking in on your emotional and bodily needs, saying NO & setting boundaries when you are too tired or sad or hungry or in need of down time to say yes. If you “have a hard time saying no,” then you will need to get help with that. Because until you can set boundaries, you will not fully recover.
You’ll also need to begin integrating relaxation into your life as you slowly pick or pull less and less. One simple example is the 4-4-4 technique. Close your eyes. Inhale slowly to the count of four. Hold for a count of four. Exhale slowly to the count of 4. Do this before you sit down at the computer or to watch TV or before drive or go to bed. You can do it more than once but even once will help.
I marked days off on a calendar with Xs. At that time I didn’t think about the numbers. X was a pretty good day. And I would focus on how I just needed to get through another hour. Or I would shower. Or go to the gym. I figured that if I could string 30 days together that were low pulling if not zero that it would get easier. That’s all I thought about. Not my hair. Just trying to get 30 pretty good days. If I had a bad day I would still see my monthly calendar on the wall with lots of Xs. So I just kept going.
Each day when I wanted to pull badly or in fact had already started to pull, I told myself I just had to do this for the day. NOT forever. The “stopping forever” feeling is sure to cause a strong desire to pull. So I knew it wasn’t forever. Just one more day. If possible. I promised myself I could pull if I needed to the next day. And sometimes if I had to be reading or just needed to relax and I could not stop, I would slather my hair with conditioner (which I’ve told you) because otherwise I couldn’t lie there still. For skin pickers, cover your mirror. Or put a mask on your face at those times. Or change the energy. Jump in the shower. Make tea. Sit and know the tea is symbolic of a needed time out and symbolizes starting over.
It’s basically like, Ok This is the path. It is ALWAYS just for today. Just till midnight. You keep going & you get there eventually. And “there” is having 30 pretty good days within a larger period of time as an initial goal. Nothing more. Ultimately the mind is more in control than the body because the mind can choose to keep trying. The body may force you to give in but the mind will help you to not give up.
Any one day that isn’t good in terms of pulling or picking is a chance to tell yourself, Hey this was going to happen. This is hard! The addiction is what is telling me that this bad day means it’s “hopeless.”. That you will “never” get better so you “might as well keep pulling or picking.). Because the addictive part of the brain just wants to give you one more reason you won’t be able to stop (so you continue doing the behavior the addiction is craving.) One more rationalization. One must say, “ah, there is the addiction talking. Thanks for sharing.” to that thought. It is NEVER about the current state of your hair or skin. It is never about perfection or stopping forever. It is always about doing a little bit better just in this moment.
If you had a bad day, be kind to yourself. You are already bummed after all. You didn’t ask for this disorder and it isn’t your fault you have it. Your addiction wants you to give up and give in because then you will indulge in the behavior you are addicted to. No matter how bummed you are, I PROMISE you this, it is NOT hopeless. I pulled daily constantly for 25 years. Now I don’t. And I know so many people who picked or pulled and have gone through this and have stopped you cannot imagine. Recognize that it is the addiction whispering to you to make you feel and think, there is no point, it’s hopeless, I’ll never get better SO I MIGHT AS WELL PULL OR PICK Whatever else it does, if you refuse to let the addiction get you to give up, that is the most important thing, and then you are in recovery. And it gets easier. It really does.
If you continue to blame yourself and attack yourself and feel you are weak or “pathetic” because have this “disorder” (and perhaps you don’t even believe it’s a “real disorder”), then you will need to work on that attitude first and foremost. Read “Radical Acceptance: Living Your Life With the Heart of a Buddha” by Tara Brach. When you are able to integrate those ideas into your relationship with yourself, you will be able to start making progress.
I wish all of you healing and comfort as you continue on your journey.