Tag Archives: trich

Unconditional Love

Jesus loves me unconditionally. Therefore, I have not earned His love nor could I earn His love. I cannot be separated from His love.

When I obey Him, God will bless me. When I disobey Him, there will be consequences. Jesus may not like my behavior, but He always loves me.

Because I have experienced God’s love, I know that I am lovable. I know there are people who could love me too. Therefore, I am able to trust people who love me. I am confident in my worth based on the love of Jesus.

from Beauty for Ashes by Joyce Meyer

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What Matters Most in Your Life

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What Comes First in Your Life?

Do you  value love most? God is love. By putting God first, everything else will fall into place. We will best love and support ourselves, our family and our friends. By choosing love, we put God first. He is a light in the darkness, our helper in the storm. If we seek Him first, He will help us and show us how to love others and how to take care of ourselves.

God loves us more than we can imagine and only wants the best for us. God does not cause bad things to happen. We live in a lost and broken world plagued with darkness. The good news is that light has overcome the darkness. This is not our home. and as the song says, “We are just taking the long way home”  (Steven Curtis Chapman-lyrics) There is something better. God sees the whole story beginning to end and He has defeated death. We only need to have faith. We can never earn His love. We are all broken in our own way. No one is perfect and God doesn’t expect us to be.

However, He knows our heart and true motives. If we honestly pursue God first and want His will for our lives, He will use all things for good. That terrible heartache, health problem, broken relationship, addiction, or other struggle is nothing compared to the power of God. In order to use that power to be an overcomer, we must have faith and rely on God’s strength to pull us through. We will never make it on our own.

I am going though a really hard time right now. After a while with stable moods, my bipolar disorder  is causing major issues in my life. My previously helpful medication and treatment plan have not worked to push this mania away. It crept up over a year ago. There have been ups and downs, but for the most part I have been hypomanic. Stress and other triggers cause it to flare up. This is the case these last few weeks. I am battling anxiety, struggling to sleep, my mind is scattered, memory disabled, and thoughts are constantly racing.  Although I try to contain them, my words keep spilling out. I try to do what I know works. I set A schedule, try and get enough sleep, prioritize tasks, spend time with God, and avoid triggers such as caffine. If I suddenly get the urge to organize everything, I need to step back and think about my thinking. Why do I suddenly have a desire to do the chores I usually put off because I dislike them so much?

I know I need to put God first. They only way for me to get better is to rely on Him. He loves me and wants what is best for me. When my mind is scattered and I struggle to make good choices. God leads me along the right path and carries me when I am too week to walk.

God also helps me through others. My family loves and supports me. I try to listen to their advice and accept their help. Normally, I try  to do everything myself. Obviously that has not worked. I need to let go of my pride and take care of myself. I know I will come through this and be better for it. My pain serves A purpose and I will persevere!

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How Do We Put God

First, ask God to help you put him, ask him to help you see what to do, and to guide your steps

Have faith that God keep His promises. You are loved more than you know. You are forgiven through grace. Trust that He wants what is best for you and that if you rely on Him, you will overcome your struggles and find true joy.

Eliminating obstacles such as, desires for fortune and fame, work overload, addiction, or other temptations by confessing them to God.

In place of sin, struggle, and heartache, we are to rely fully on Christ. We do this by being accountable to a Godly friend, spending time in God’s Word and prayer every day, attending and becoming involved with church worship regularly, and listening to Godly music and messages are a few ways to put on Christ. A little bit of sin can add up to making provision for the flesh, so putting on Christ will add up to making provision for the Holy Spirit.

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Prayer: You are Holy, Lord. Thank you for the Blood of Jesus to wash us and cleanse us from sin. As a born again believer I ask You to help me to put off these things that hinder my life from being completely surrendered to You and show me the ways to put on Christ so that I may please You. Amen.

“Long Way Home”
by Steven Curtis Chapman | from the album re:creation

I set out on a great adventure
The day my Father started leading me home
Said theres gonna be mountians to climb
And valleys were gonna go through

But I had no way of knowing
Just how hard this journey could be
Cause the mountians are steeper
And the valleys are deeper than I ever would had dreamed

But I know were gonna make it
And I know were gonna get there soon
And I know sometimes it seems like, were going the wrong way
But its just the long way home

Some rocks on my shoes
Fears I wish I could lose
That make the mountians so hard to climb
And my heart gets so heavy with the weight of the world sometimes

There’s a bag of regrets,
Should’ve beens, and not yets
That keep on dragging around
And I can hardly wait till the day I get to lay them all down

I know that day is coming
I know its gonna be here soon
I won’t turn back even if the whole world says I’m going the wrong way
Cause its just the long way home

When we cant take another step
The Father will pick us up and carry us in His arms
And even on the best days, He says to remember were not home yet
So don’t get too comfortable
Cause we are just pilgrams passing through

I know that day is coming
I know were gonna be there soon
I keep on singing and believing
What all of my songs say

Cause our God has made a promise
And I know everything He says is true
He promised He would never ever leave us
He’s gonna lead us
He’ll lead us home

Every single step of the long way home
So keep on, were gonna make it
Were just taking the long way home
So keep on, were gonna make it
I know, were gonna make it
Its just the long way home

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The Power of Faith and Prayer


“Truly I tell you, if anyone says to this mountain, ‘Go, throw yourself into the sea,’ and does not doubt in their heart but believes that what they say will happen, it will be done for them. Therefore I tell you, whatever you ask for in prayer, believe that you have received it, and it will be yours.
Mark 11:23‭-‬24 NIV

https://bible.com/bible/111/mrk.11.23-24.NIV

I Am Human. I Need Help.

It was close to midnight when I drove into an empty mall parking lot. The sound and sight of rain is distinct in my memory. “Where are you, God?” I shouted, pain coiling itself around my heart, torment gripping my mind. “Where are you?” I sobbed again. I parked my car and began to write the truth in my journal: I am absolutely terrified. My life is completely out of control. God, I need help.

Fourteen years ago I was struggling with an eating disorder (among other things, hello). But in that parking lot, I finally pressed beyond denial and admitted to myself and to God that I had a problem I couldn’t fix. I wasn’t ready to admit the same to others, but at least the pressure of pretending began to lift.

It took a few years for me to open my pain to close friends, and for my life to actually change, but I gained a level of freedom that night as I gave myself permission to say it, to write it: I am human. I am broken. I need help.

Brokenness opens a path for obedience. Not because it’s more spiritual to be jacked up across fourteen areas of life, but because of the humility it takes to engage in an honest relationship between the Holy Spirit and us. It takes guts to say, “I don’t have it all together and I’m not going to wait until I have it all together. Jesus, I need you now. Where are you? Can you please come to me now?”

He has all wisdom. He has all power. He is at peace with our humanity, with our brokenness. He comes to us in our pain, not in our pretense. He gives grace to the humble, but he resists the proud. And the Holy Trinity is the only force able to transform our lives completely, for good.

How I hated those first few times I risked taking off my mask. How I loathed giving up control of my environment and of how others saw me. How I despised living in that grey space between who I was and who I wanted to be. Denial was so much easier – at least my coping mechanisms were familiar, and pretending I had it all together was so much better than sitting in the ugly truth.

But truth-telling started the process of freedom. I began walking wholeheartedly towards integrity. And this opened my heart to receive the truth of the word of God as well. This opened me up to a life in the Spirit.

Jesus said, “If you abide in my word, you are my disciples indeed. And you shall know the truth, and the truth shall set you free.” And when we make the simple, albeit difficult, decision to be honest with where we are, we can obey Jesus at each step of our discipleship journey, on our way to where we’re going. We tap into the power of the Holy Spirit and, by His grace, we can respond to our past with His love, remain present where we are, and look to the future with hope.

Humility in obedience is hard; but, oh, my friend, you’re worth it. Eugene Peterson, in his book, A Long Obedience in the Same Direction:

“I Am Human. I Need Help.”

It was close to midnight when I drove into an empty mall parking lot. The sound and sight of rain is distinct in my memory. “Where are you, God?” I shouted, pain coiling itself around my heart, torment gripping my mind. “Where are you?” I sobbed again. I parked my car and began to write the truth in my journal: I am absolutely terrified. My life is completely out of control. God, I need help.

Fourteen years ago I was struggling with an eating disorder (among other things, hello). But in that parking lot, I finally pressed beyond denial and admitted to myself and to God that I had a problem I couldn’t fix. I wasn’t ready to admit the same to others, but at least the pressure of pretending began to lift.

It took a few years for me to open my pain to close friends, and for my life to actually change, but I gained a level of freedom that night as I gave myself permission to say it, to write it: I am human. I am broken. I need help.

Brokenness opens a path for obedience. Not because it’s more spiritual to be jacked up across fourteen areas of life, but because of the humility it takes to engage in an honest relationship between the Holy Spirit and us. It takes guts to say, “I don’t have it all together and I’m not going to wait until I have it all together. Jesus, I need you now. Where are you? Can you please come to me now?”

He has all wisdom. He has all power. He is at peace with our humanity, with our brokenness. He comes to us in our pain, not in our pretense. He gives grace to the humble, but he resists the proud. And the Holy Trinity is the only force able to transform our lives completely, for good.

How I hated those first few times I risked taking off my mask. How I loathed giving up control of my environment and of how others saw me. How I despised living in that grey space between who I was and who I wanted to be. Denial was so much easier – at least my coping mechanisms were familiar, and pretending I had it all together was so much better than sitting in the ugly truth.

But truth-telling started the process of freedom. I began walking wholeheartedly towards integrity. And this opened my heart to receive the truth of the word of God as well. This opened me up to a life in the Spirit.

Jesus said, “If you abide in my word, you are my disciples indeed. And you shall know the truth, and the truth shall set you free.” And when we make the simple, albeit difficult, decision to be honest with where we are, we can obey Jesus at each step of our discipleship journey, on our way to where we’re going. We tap into the power of the Holy Spirit and, by His grace, we can respond to our past with His love, remain present where we are, and look to the future with hope.

Humility in obedience is hard; but, oh, my friend, you’re worth it. Eugene Peterson, in his book, A Long Obedience in the

Same Direction: Discipleship in an Instant Society, said, “And yet I decide, every day, to set aside what I can do best and attempt what I do very clumsily–open myself to the frustrations and failures of loving, daring to believe that failing in love is better than succeeding in pride.” Yes and Amen.

PRACTICE: What thoughts come into your mind as you think about leaning into the grey space of where you are now and where you want to be? Are you uncomfortable, afraid, lonely, angry? Share your thoughts with the Lord. He wants to hear you. Discipleship in an Instant Society, said, “And yet I decide, every day, to set aside what I can do best and attempt what I do very clumsily–open myself to the frustrations and failures of loving, daring to believe that failing in love is better than succeeding in pride.” Yes and Amen.

PRACTICE: What thoughts come into your mind as you think about leaning into the grey space of where you are now and where you want to be? Are you uncomfortable, afraid, lonely, angry? Share your thoughts with the Lord. He wants to hear you.

WHO am I?

I am Mommy to four very special kids. They are 10, 6, 4, and 2. I have been married to my soul mate and father of my children for almost 11 years. I was an elementary teacher and am now a tutor for students with a wide range of needs. I love helping others and tutoring is one way I can do that. It is also the reason I started my blog.

I have lived with trichotillomania since age 6. In the past 24 years I have tried every treatment, strategy, medication, and therapy. I still pull, but I use strategies I know work for me. I do hope to overcome this demon, but its presence in my life will not keep me from loving myself and enjoying life. Everyone is fighting some battle or has hurts that we do not see. It is learning to live despite these trials that I find very important.

Personally, I seek recovery while still accepting the reality of trich. There is no right or wrong way to view or live with trich. I simply blog about my experience in hopes of helping others feel less alone.

ACT Therapy: Acceptance

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ACCEPTANCE: allowing urges, emotions, thoughts and feelings to occur without attempts to control them.

Acceptance does NOT mean a hopeless acceptance of the fact you have trichotillomania.

ACT is an acceptance-based, behaviorally oriented therapy.  It was first proposed by Hayes et. al. (1999), but I believe Dr. Woods is the first to study treating ttm with ACT.

ACT Therapy � TLC Retreat Notes
Credit Sue Price notes – TLC Conference Session

TLC Retreat Session September 2002
Acceptance and Commitment Therapy
Douglas Woods, Ph.D.

Why work on acceptance? Dr.Woods conducted an online study which showed that pullers who are less accepting of private events tend to have stronger urges to pull and more severe pulling. [I found the concept of “private events” confusing at first. From what I can tell, it’s anything that happens inside you that you experience privately. As he said: thoughts, feelings, emotions, urges].

People follow rules not experience. He cited a study where people played a slot machine that was rigged to never pay off for the player. The people who were told that the machine WOULD pay off eventually, played longer than the people who were not told anything. The point is, people follow rules over their experience.

Where this fits in with trich: the rule is, “if you feel bad, get rid of it.” This is what society teaches us. This works well in many situations (if the kids are too noisy, send them outside; if someone is tailgating you, change lanes, etc.).  But this does not work with private events such as feelings. Trying to just get rid of bad feelings, urges, etc. does not work long term. But we keep doing this anyway because that’s the rule we’ve been taught.

ACT breaks down rules by emphasizing experiential exercises over verbal rules. The idea is that the person accepts that while the rule they’ve been taught is “get rid of it”, their experience shows that this has not worked, and then they can learn a willingness to experience those private events. [Side note: the addiction book that I’ve found so helpful makes similar points: that our society teaches us that feeling bad is intolerable, to be avoided, and if you feel bad you must do something to stop feeling bad RIGHT AWAY. This is the kind of thinking that fosters addiction, and changing this way of thinking and being willing to FEEL bad is a major part of combating addiction.]

Steps to Acceptance

1. Creative Hopelessness

Focuses on getting the person to see that attempts to stop, alter or avoid private events such as thoughts, emotions or feelings have been unsuccessful. Pulling is often another way to avoid or control private events. He asked us to think about an uncomfortable private event that we’re dealing with right now. He asked how we tried to deal with it. The common answers people gave were: avoided thinking about it, distracting themselves from it, and denial. We confirmed that none of these things work long term in dealing with the private event. It comes back.

2. Willingness

Focuses on getting the participant to be willing to experience negative or uncomfortable private events. If trying to control private events is the problem, willingness to experience uncomfortable feelings may be a solution.

– Willingness is not the same as “wanting”. He had a “Joe the Bum” metaphor (acknowledging that “bum” is not PC.) Say you are having a party that all your neighbors are invited to, and everyone is having a great time. Then Joe the Bum shows up. You don’t want him there, nobody likes him, he’s dirty, he’s smelly. But if you spend your time trying to physically keep him out, you won’t be enjoying your party. But if you are WILLING to accept that he’s there and not fight it, even though you don’t WANT him there, you can still enjoy your party.

– Willingness is all or nothing

3. Diffusion

He said that even if urges etc. are not originally language-based, they become so because WE are language-based. (There was a lot of clinical stuff he went over making this point.) We need to understand language for what it is, and that words are powerful only because we let them be. This step is about de-literalizing private events. We did two exercises to illustrate this.

First he asked us what we associate with the word “milk”. We said white, cold, frothy, things like that. Then he has us say, out loud,”milkmilkmilkmilkmilkmilkmilk. . .” over and over. (Try it, it’s physically not easy to keep this up!) Picture an entire room of us saying it over and over, and he had us keep it up for what seemed like forever. When he finally stopped us, he said, “I bet you’re not thinking of that white frothy stuff anymore.”

The idea is that “milk” made us think of the white frothy stuff, but only because of what WE associate with that word. By repeating the word over and over, we de-literalized it. It became just a word, the letters m-i-l-k. Similarly, an urge that’s felt as “I need to pull” can be de-literalized by repeating “I need to pull I need to pull I need to pull” until they are just words, not something that must be acted on. Those words don’t have power unless we give it to them.

The second exercise is to imagine you are watching a parade and a band is marching by. Imagine that your thoughts, whatever’s bothering you, are written up on cards that the band members are carrying. And just watch those “thoughts on cards” go past you.  Acknowledge them but separate yourself from them.

4. Understanding the Self

Who are “you?” Who is your “self?”

– Conceptualized Self: who do we say we are? What do we stand for? How do we see ourselves? (we typically think of this as our only self, and defend it)

– Knowing Self: the “self” that is experiencing events as they are occurring

– Observing Self: the “self” that has always been and always will be. He made an analogy to a chessboard: I am the board, not the game that is happening on it. Whatever happens on the board does not have to affect me.

5. Valuing

– You have the ability to choose your behavior. You must choose to move in your valued direction.

– What do you value? What do you want your life to stand for?

– Need to make psychological room for private events while you move your life in the valued direction.

[I think an example of what he means by the last item is: a valued direction for me, is not pulling. By trying to move my life in that valued direction, I will have uncomfortable private events and I need to accept this and be ready for this.

He also said:

-Committed Action Invites Obstacles (disguised as private events)

– The Journey in the Valued Direction involves fear and action. So I take it as, anything I do to move my life in a direction I value(trich-related or not) can bring up private events that will be uncomfortable. He is saying “choose to move in your valued direction” while experiencing these private events.]

**The idea is to combine acceptance techniques with other behavior therapy procedures. A clinical study showed this is effective, based on five different measures of pretreatment and post treatment hair pulling.

For more info, this book is very helpful:

Trichotillomania: An ACT-enhanced Behavior Therapy Approach Therapist Guide (Treatments That Work), March 31, 2008, by Douglas W Woods and Michael P Twohig

When God Doesn’t Move the Mountain

Why can’t I  stop pulling my hair?

Why do I still have manic episodes?

Why does this cloud of depression try to consume me?

 I know God can heal me. The creator of the universe can do anything. So I wonder, will He ever heal me? I pray and pray and try to fight through His strength. Some days are better than others, but the bottom line is that these strongholds are the anchors trying to drag me down.  I am the child of the one true King and nothing the devil throws at me will change my unwavering faith and love for my God, my Savior, and my closest Friend.

Through my most recent manic episode that lasted about four months, I have begged for healing.  Through my prayers and seeking God through His Word, I keep getting the same message.  There is a purpose for my pain. God will use me and my struggles in His time. I know His plans are perfect and He is preparing me for what lies ahead.

In 2 Corinthians, Paul talks about his disability. Paul is the guy with an insurmountable faith. He commanded people to be healed in the name of Jesus, and they were healed instantly. He told a demon to flee simply  because he was annoyed, and the demon fled. Paul clearly lacks no faith. He’s the guy that could say to a mountain, “move,” and it would have to move. He says:

“…I was given the gift of a handicap to keep me in constant touch with my limitations. Satan’s angel did his best to get me down; what he in fact did was push me to my knees. No danger then of walking around high and mighty! At first I didn’t think of it as a gift, and begged God to remove it. Three times I did that, and then He told me,

‘My grace is enough; it’s all you need. My strength comes into its own in your weakness.’

Once I heard that, I was glad to let it happen. I quit focusing on the handicap and began appreciating the gift.”  {2 Corinthians 12:7-12}

The poster child of faith could not pray his own disability away. Three times he prayed, using a level of faith that is hard to wrap my mind around…and God still said no. God wanted Paul to rely on His grace to make it through, not on Paul’s own ability. God wanted to bring Paul to his knees so that he would have to rely on Him to get by.

But sometimes God says no.

You don’t have to tell yourself that the faith you just tried so hard to muster up, so intensely that it made you physically sick, wasn’t enough. That if you could just try a little harder, you could make God change the situation. That you could somehow control God.

Because, surprisingly, it’s incredibly comforting to know that God can say no. And he does, often. There’s strength in knowing we can’t control His decisions, and that the outcome does not always, in fact, depend on our level of faith.

And there’s strength in knowing that sometimes God doesn’t move the mountains, simply because He wants us to rely on Him to climb them.

A Beginner’s Guide to Treating Trichotillomania

Clinical Psychologist

I often tell my colleagues that trichotillomania (hair pulling disorder) represents the wild west of psychological disorders. Unfortunately, it remains one of the least researched and most misunderstood disorders in the DSM. Additionally, there is a lot of pseudoscience, snake oil, and plain old quackery on the internet about the best way to treat it.

In this article, I will highlight what we do know about scientifically supported treatments for trichotillomania. As a disclaimer, this is only an introduction to treating trichotillomania and is not intended to formally train clinicians. Lastly, I will not be reviewing medical treatments for trichotillomania (you can learn more about those here).

Historical Treatments

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Photo by Gregory Parker

The first scientifically based treatment for trichotillomania was Habit Reversal Training (HRT) (Azrin, Nunn, & Frantz, 1980; Duke, Keeley, Geffken, & Storch, 2010). During HRT, individuals become more aware of their hair pulling behavior and practice interrupting the behavior by engaging in incompatible behaviors. For example, people who use their hands to pull from their scalp might practice reaching down towards one’s knees. While HRT has been effective in the treatment of tics and Tourette’s Disorder, it doesn’t work for everyone who has trichotillomania and also has a high rate of relapse. Why? As I described in a previous article, trichotillomania is a very heterogeneous disorder and affects each person differently. A “one size fits all” treatment just won’t work for trichotillomania.

Modern Treatments

Recently, researchers have developed more comprehensive approaches to treating trichotillomania. Dr. Charles Mansueto pioneered the Comprehensive Behavioral Model (ComB) for trichotillomania (Mansueto, Stemberger, Thomas, & Golomb, 1997). In ComB, clinicians first understand the function of hair pulling. Does it relieve stress? Does it end boredom? Does it reduce anger and frustration? Next, clinicians identify the main types of hair pulling. Some individuals pull for sensory stimulation (trying to find the hair that feels just right), others due to specific thoughts (I have to get rid of all the grey hairs), etc. Lastly, clinicians create treatments that address all aspects of trichotillomania including emotional regulation (learning more adaptive ways of dealing with stress, anger, boredom), physical habits (using HRT and objects to stop motor behavior), and environmental interventions (covering mirrors, getting rid of tweezers).

While research is underway to evaluate Mansueto’s ComB model, other researchers have found support for this approach to treating trichotillomania. In a recent pilot study, Dr. Nancy Keuthen and her colleagues found that Dialectical Behavior Therapy (DBT) was effective at reducing trichotillomania symptoms for at least 3 months (Keuthen et al., 2010). DBT is a form of cognitive behavior therapy that focuses on learning new ways of regulating one’s emotions. Additionally, in a review of all published scientific treatment studies on trichotillomania, Dr. Michael Walther and his colleagues concluded that behavior therapy (HRT), emotional regulation, and acceptance together represent the most promising treatment for trichotillomania (Walther, Ricketts, Conelea, & Woods, 2010). Furthermore, Dr. Martin Franklin and his colleagues have demonstrated that this comprehensive approach to behavior therapy not only works for adults, but it can help children as young as 7 (Franklin, Edson, & Freeman, 2010).

So what does this all mean? To the best of our scientific knowledge, effective trichotillomania treatment includes three things:

  1. An increased awareness of when, where, and why hair pulling occurs.
  2. An effort to control or change hair pulling behavior.
  3. Emotional regulation training to find alternative ways of dealing with negative feelings.

Here’s how I use these scientific findings to treat trichotillomania.

Increasing Awareness

Photo by Wim Mulder

Before creating a treatment plan, I collaborate with my clients to understand the unique patterns of their hair pulling. This usually includes a 1-2 week record of all hair pulling episodes. I ask each client to record the following information after each hair pulling episode:

  • What part of the body was the hair pulled from?
  • Where was the person when they pulled their hair?
  • What time was it when the person pulled their hair?
  • Was an instrument (e.g. tweezers) used to help pull hair?
  • What was the person doing while they pulled their hair?
  • What was the person feeling before, during, and after the hair pulling?
  • What was the person thinking before, during, and after the hair pulling?
  • Was anyone else present during the hair pulling?
  • What did the person do with their hair after they pulled it? (Sidenote: You’ll want to look out for individuals who swallow their hair, this could lead to a potentially lethal condition known as a trichobezoar and will need immediate medical attention).

Changing Hair Pulling Behavior & Emotional Regulation

Photo by Aimee Quiggle

A key component of Dr. Manysueto’s ComB model is the SCAMP Intervention. SCAMP stands for Sensory, Cognitive, Affective, Motor, and Place. Once my client and I have a firm understanding of the hair pulling behavior, I use the SCAMP Intervention to create a customized treatment plan.

Sensory: For individuals who seek sensory activation on their scalp, we might use brushes, combs, pens, massages, or ice to ease sensations. For hands, individuals can get manicures, use lotions, or file their nails. For the face, bath oils, baths, facial scrubs, or a loofah could be used.

Cognitive: Often specific thoughts can lead to hair pulling. Common thoughts include, “My hair has to look perfect”, “I need to get rid of that blemish”, “I’ll just pull a little”, “I’ve already pulled once, so why try holding back?” Here, individuals practice thinking in more realistic way (e.g. “It’s okay to be imperfect”, “The best way to fix it is to let it heal”, and “A slip-up is not a failure, any progress is helpful”).

Affective: When specific emotions lead one to pull their hair, the best way to address this problem is learn more effective ways of regulating your nervous system. To become more relaxed, individuals can use diaphragmatic (belly) breathing, progressive muscle relaxation, practice meditation, listen to white noise, use a heating pad, drink a warm beverage, take a slow relaxing walk, use an eye/face gel mask, or take a long bath. To address intensity and pain, individuals can stick their fingers in frozen ice cream, put their face in a bowl of ice water, suck on a lemon, snap a rubber band on your wrist, take a cold shower, go for a fast run, or chew a large wad of gum. To deal with boredom, individuals can learn about a topic of interest on the internet, write in a journal, draw, play a musical instrument, read a book, paint, take photographs, do a crossword puzzle, and garden.

Motor: In addition to HRT, physical barriers can often help reduce hair pulling. For example, rubber fingers, band-aids, sleep masks, head wraps, glasses, hats, gloves, thumb braces, and tape can all be used to create barriers to hair pulling. Also, changing the condition of your hair and hands can help (e.g. wetting hair, placing Vaseline on your eyelids/brows, wearing false nails, using hand lotion). Objects such as loud bracelets, elbow braces, and perfume can increase awareness of hair pulling. Fiddling toys can sometimes provide alternatives to hair pulling (e.g. koosh balls, silly putty, clay, knitting). For oral rituals, chewing gum, eating sunflower seeds, chewing raw pasta, chewing a toothpick, and eating gummy bears can help.

Place: Comprehensive interventions should also target the environment in which hair pulling takes place. Individuals can try changing light levels, covering mirrors, getting rid of tweezers (or placing them in the freezer), using sticky notes, keeping certain doors open (to decrease privacy), rearranging furniture, and sitting in different positions.

Monitoring Progress and Revising Treatment

As a client and clinician begin treatment, it’s important to keep a daily log of the hair pulling episodes and the attempted interventions. Some interventions will work right away, others will need to be fine tuned, and some will lose their effectiveness over time. The client and clinician must work together, constantly monitoring and reevaluating the treatment until a plan is developed that fits the needs of the client. This process could take weeks or months. Additionally, since trichotillomania changes as we age, treatments that worked at one phase of life may not work in another.

Advice for Treatment Seekers and Treatment Providers

As you can tell, treating trichotillomania is a complex and long process. It takes a lot of time, courage, and motivation on the part of the individual and a lot of training and experience on the part of the clinician. If you are someone who is suffering from trichotillomania, make sure that your clinician is using scientifically supported treatments. Ask them about the type of treatment they are using. If you don’t hear anything about increasing awareness, changing behaviors, or emotional regulation, their treatment may not be based on science. If they start using personal testimonials and wild theories to backup their treatment, or say their treatment cannot be evaluated by science, run away – they’re probably selling you snake oil.

I recommend using the Trichotillomania Learning Center’s list of health care providers to find individuals trained in scientifically supported treatments. If you are a health care provider wanting to learn more about these treatments, I highly recommend attending a Trichotillomania Learning Center Professional Training Institute and browsing through their clinical resources.

References:

Azrin, N. H., Nunn, R. G., & Frantz, S. E. (1980). Treatment of hair-pulling (trichotillomania): A comparative study of habit reversal and negative practice training. Journal of Behavior Therapy and Experimental Psychiatry, 11, 13-20.

Duke, D., Keeley, M., Geffken, G., & Storch, E. (2010). Trichotillomania: a current review. Clinical Psychology Review, 30, 181-193.

Franklin, M. E., Edson, A. L., & Freeman, J. B. (2010). Behavior therapy for pediatric trichotillomania: Exploring the effects of age on treatment outcome. Child and Adolescent Psychiatry and Mental Health, 4, 18.

Keuthen, N. J., Rothbaum, B. O., Welch, S. S., Taylor, C., Falkenstein, M., Heekin, M., Jordan, C. A., et al. (2010). Pilot trial of dialectical behavior therapy-enhanced habit reversal for trichotillomania. Depression and Anxiety, 27(10), 953-959.

Mansueto, C. S., Townsley-Stemberger, R. M., McCombs-Thomas, A., & Goldfinger-Golomb, R. (1997). Trichotillomania: A comprehensive behavioral model. Clinical Psychology Review, 17, 567-577.

Walther, M. R., Ricketts, E. J., Conelea, C. A., & Woods, D. W. (2010). Recent Advances in the Understanding and Treatment of Trichotillomania. Journal of Cognitive Psychotherapy, 24(1), 46-64.

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Suffering Produces Perseverance

I no longer wish I never had trich or bipolar disorder. Although both come full of pain and suffering, there is another side. Working through my struggles has made me the person I am today. I don’t know if I would have have the same faith, spirit of perseverance, or compassion. I think my best traits have been developed through my pain. God did not cause my suffering, but He will use it for good.

I still hope to be pull free, but I am happy now as I am. My moods are relatively stable and I have settled on a set of meds that works for me. I still pull, but it does not rule my life. Yes, I do spend a considerable amount of time practicing awareness and coping strategies. However, I do not feel like less of a person because I do this or because I am missing some hair. Everyone has some form of struggle in their life. Learning to use that suffering for good is the key to moving through it and finding a purpose for your pain. I read this devotional earlier today and thought that it lined up so well with the verse that has been on my heart, Romans 5:3-4.

Your Pain Often Reveals God’s Purpose for You

BY RICK WARREN — NOVEMBER 25, 2014

Your pain often reveals God’s purpose for you. God never wastes a hurt! If you’ve gone through a hurt, he wants you to help other people going through that same hurt. He wants you to share it. God can use the problems in your life to give you a ministry to others. In fact, the very thing you’re most ashamed of in your life and resent the most could become your greatest ministry in helping other people.
Who can better help somebody going through a bankruptcy than somebody who went through a bankruptcy? Who can better help somebody struggling with an addiction than somebody who’s struggled with an addiction? Who can better help parents of a special needs child than parents who raised a special needs child? Who can better help somebody who’s lost a child than somebody who lost a child?
The very thing you hate the most in your life is what God wants to use for good in your life.
The Bible says in 2 Corinthians 1, verses 4 and 6, “God comforts us in all our troubles so that we can comfort others. When we are weighed down with troubles, it is for your comfort and salvation! For when we ourselves are comforted, we will certainly comfort you. Then you can patiently endure the same things” (NLT).
This is called redemptive suffering. Redemptive suffering is when you go through a problem or a pain for the benefit of others.
This is what Jesus did. When Jesus died on the cross, he didn’t deserve to die. He went through that pain for your benefit so that you can be saved and go to Heaven.
There are many different causes for the problems, pains, and suffering in your life. Sometimes the stuff that happens you bring on yourself. When you make stupid decisions, then it causes pain in your life. If you go out and overspend and buy things you can’t afford and presume on the future, and then you go deeply in debt and lose your house, you can’t say, “God, why did you let me lose my house?” You can’t blame God for your bad choices.
But in some of your problems, you’re innocent. You’ve been hurt by the pain, stupidity, and sins of other people. And some of the pain in your life is for redemptive suffering. God often allows us to go through a problem so that we can then help others.

Conflict in Relationships

img_5156Any type of stress, anxiety, anger, or conflict makes my pulling worse. It is a self-soothing behavior that helps me calm down and often dissociate from my feelings. Over the past few years, I have been working to use helpful strategies that help me relax without pulling my hair (which only leaves me feeling worse in the end).
As a high stress person, I have suffered with anxiety for most of my life. It still plagues me at times, but I have learned strategies to calm my mind and body. Taking a quick break from the situation, praying, practicing deep breathing, and trying to find a more positive outlook are some simple tools that have helped me.

If I catch myself being negative or getting stressed out, I try to take a step back and look at the situation objectively. In the past, I would catastrophize my situation. Now, I can identify those feelings and look for the truth.

  • Are my concerns based on truth?
  • Can I do anything about this?
  • Is there a more positive outlook I can strive for?
  •  If the worst case senario does play out, is it really that bad?

Beyond my stress and anxiety is anger that can cause relationship problems. The following article presents 3 ways to create conflict (and therein, 3 ways to avoid it). I know I am guilty of these and am making it a priority to avoid them. Reducing conflicts in our relationships, greatly increases our overall well-being.

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Three Sure Ways to Create Conflict

By Rick Warren

“Any fool can start arguments; the honorable thing is to stay out of them” (Proverbs 20:3 TEV).

Wise people are peacemakers, not troublemakers. Wise people don’t carry a chip on their shoulder. They’re not always looking for a fight, and they don’t intentionally antagonize other people.

The fact is, if you’re around anybody for any length of time, you’ll figure out what that person does that irritates you, and you file that information in the back of your mind as a tool to use when you get in an argument. It becomes a personal “weapon of mass destruction”! When you get in an argument, and that person says something that hurts, offends, or slights you in any way, then you pull out the big gun. You push the hot button. And it works every time!

You know what the Bible calls that? Foolishness! You’re not getting any closer to the resolution. You’re not helping the relationship. In fact, you’re hurting it. It is not wise.

Proverbs 20:3 says, “Any fool can start arguments; the honorable thing is to stay out of them” (TEV).


We all use tools, tricks of the trade, and skills in relationships that are actually counter productive. They’re hurtful, they’re harmful, and they don’t get you what you want out of relationships. In fact, they get you the exact opposite behavior. But when we lack wisdom, we use them anyway.

There are many of these tools, but here are just a few:

1. Comparing. Never compare your wife, your husband, your kids, your boss, or anybody else, because everybody’s unique. Comparing antagonizes anger.

2. Condemning. When you start laying on the guilt in a relationship, all you’re going to do is get the exact opposite of what you expect. It doesn’t work. It’s foolish.

3. Contradicting. William James, the famous psychologist said, “Wisdom is the art of knowing what to overlook.” There’s some stuff you just need to overlook.


The Bible says in Proverbs 14:29, “A wise man controls his temper. He knows that anger causes mistakes” (TLB). Have you ever said or done anything stupid out of anger? Yes? Because when you get angry, your intelligence goes out the window. When you get angry, you say and do foolish things that are actually self-defeating.

Did you ever think about the fact that there is only one letter difference between “anger” and “danger”? When you get angry, you are in dangerous territory. You are about to hurt others — and yourself — with your own anger.

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