Behavior modification
Most of the following methods were compiled by someone on the board. The habit reversal article was added later and incorporates many of the methods listed earlier but I'm not removing any of the descriptions, so please bear with any redundancy and consider it a "review" of useful methods.
This summarizes Dr. Fred Penzel's talk at the 1995 TLC retreat. (Additional comments by the author of this note are in brackets.)
Habit Reversal Training (HRT) was first studied in 1972 by Azrin and Nunn. They wrote a book called Habit Control In A Day which unfortunately is out of print. The book showed how to apply the technique to many different habits including hair-pulling. [I have this book, and it was valuable for me to have found as a teenager, because it was the first place I had ever seen trich explicitly discussed, the first place I had ever seen it estimated that the number of people who do this in the MILLIONS, and the first place to assure me that in the authors' view, these habits can emerge in any well-adjusted person. In some ways, these guys were ahead of their time.]
This technique takes a lot of work and many rehearsals. It's a retraining process.
[My own experience: keeping a journal like this is very helpful in and of itself.]
[The book mentioned that if you are writing, you can grasp your pen tighter, and grasp the notebook with your other hand, and continue writing. Or if you're reading, grasp the book tighter with both hands. The idea is that you can do a competing response without drawing attention to yourself if you happen to be around other people. ]
Or do this sequence 6 times per day.
At this point, the record-keeping changes. Don't keep track of the # of hairs pulled anymore. Instead, for each episode, record whether you did the HRT, and did you do it before, during, or after pulling? And, did it work, i.e. did it prevent or curtail an episode? The goal is over a period of time, to see more "befores" than "afters".
The reason not to record the # pulled any more is the same reason dieters aren't supposed to weight themselves every day. There is bound to be fluctuation, and you don't want to get discouraged by that.
He cautions not to expect lots of success at first. Don't have an all-or-nothing attitude. Remember we have done the hair-pulling action thousands or millions of times, and it will take time to retrain ourselves to do this alternate behavior.
[The book also discussed "secondary habits" which can lead into the main habit we are trying to avoid. For hair-pullers, examples are scratching our heads, scratching our faces, rubbing our eyes, sitting with our heads cupped in our hands, brushing hair out of our face, etc. Any activity that gets our hands close to our hair, lashes or brows. The book suggests gaining awareness into what your particular secondary habits are -- again, keeping the journal is a real help -- and do the competing response when you start to do those secondary habits, too.]
Message Number: # 13762 [...] first of all it's great that your doctor knows to supplement meds with another form of therapy, since meds in most cases do not completely eliminate the urge to pull. Cognitive therapy is one methods used to combat the urge. I've seen presentations on this at conferences and TLC's retreat, and will be discussed at the Atlanta conference. I find it very helpful, as one tool in my arsenal. Cognitive therapy usually involves identifying the thoughts you have that make pulling more likely, and working on replacing those thoughts with new thought patterns. For example, one type of thought pattern that often leads to pulling is anxiety-producing thoughts, such as "I'll never figure this out," "I'm going to fail this test," "I'm going to get a bad performance review" and so on. The kind of thoughts that combat this could be, "This may take a while, but I will figure it out" and so on. Another group of thoughts are those that give permission to pull, such as "Just one", "I'll feel better after I pull", "I already pulled today." "That white/kinky/stubby/etc. hair has got to go" These can be combatted with (for example) "It's NEVER 'just one'. I need to keep from pulling even one." "I WON'T feel better after I pull, I'll be upset at the damage I've caused" "Even if I've already pulled today, that doesn't make it OK to pull any more. I can always start the day over." "It's better to have a white/kinky/stubby hair there, than to have a bald spot." OR "Every hair has a right to be in my head." OR "Every hair is SUPPOSED to be in my head." I have found those last two to be VERY effective. I have actually stopped pulls at the last minute, meaning the hair was in my hand and I was about to yank, by reminding myself that the hair is supposed to be there and has a right to be there. Not all the time, but the batting average is improving! Your mileage may vary; you need to find the ones you can relate to. It also can take some time, because you are more used to the old ways of thinking and find them more "persuasive" than the new ways of thinking. Think of it as trying to convince a friend of something. The first time you give your argument, they may not be persuaded, but over a period of time after they hear it many times, they will start to see the validity of your argument. In this case, the friend is yourself! A few years ago, I kept myself from pulling while completing something under deadline, for the first time EVER, by identifying my anxiety- producing thoughts and combatting them. I walked on air that entire weekend. It was the first time I KNEW, really knew, this thing could be controlled and I could do it. Another term that is used is "cognitive behavior therapy." I believe this is a combination of aspects of cognitive therapy like I've described, and behavior therapy such as habit reversal.
Message Number: # 13817 [...] Cognitive Therapy: THINK about what you THINK By David Donivan The Greek philosopher Epictetus wrote that people "are disturbed not by things but by the views which they take of them." Centuries later the psychologist Adler stated that "we do not suffer from the shock of our experiences -- the so-called trauma -- but we make out of them just what suits our purposes." In other words we are self-determined by the meaning we give to our experiences, not by the experiences themselves. From this tradition emerged Cognitive Therapy, which maintains that emotions and behavior are determined by our attitudes and assumptions: we learn to master life's problems and situation by reevaluating and correcting our thinking, hopefully in a realistic and adaptive manner. But when we are depressed our thinking is dominated by negative ideas, many of which occur as "automated thinking" or "thoughtless thinking." We may see ourselves as being somehow defective, inadequate, diseased, or deprived; the world is full of obstacles and makes exorbitant demands on us. We may feel defeated and that our difficulties will continue indefinitely with nothing but hardships, frustrations, and endless burdens. Drug therapy not withstanding, Cognitive Therapy offers a method of utilizing a person's own psychological resources towards coping with depression. The basic premise is that the "Automatic Thoughts" may feed or contribute to the depression. A person who is depressed or depression-prone will frequently maintain that their automatic negative throughts are valid in spite of evidence to the contrary. Some of these types of thoughts are: - All-or-None Thinking: This is the tendency to see things in extremes or absolutes, as "either-or," and not allowing anything in between. It involves words like "always," "never," "nothing," and "everything." A typical statement might be, "I did not do well at that so I am a total failure." - Overgeneralization: This includes taking an isolated incident, drawing a broad conclusion, and applying it to other related or unrelated situations. The incident seemingly becomes a never ending pattern of defeat and negative generalization about oneself, the world, and the entire future. For example: "I did not do a good job; I never do anything right." - Mental Filter: The person takes negative details and magnifies them while filtering out the positive aspects of a situation. They make mistakes worse than they are by blaming themselves. - Minimization: This is the tendency to ignore one's good points or explain away their accomplishments. They reject positive experiences since they "don't count," allowing them to maintain a negative belief that is contradicted by their experiences. - Arbitrary Inference: Drawing conclusions even though there is no evidence for them. Also it may involve focusing on one detail out of context while ignoring everything else. - Mind Reading: We conclude that someone is reacting negatively to us without checking it out. - Fortune Telling: The person anticipates that things will turn out badly as though it is an established fact. -Awfulizing or Catastrophizing: Exaggerating the importance of things, such as your mistake or someone else's achievement. We hear everyday statements, such as "I can't stand it if..." or "I'll go crazy if..." -Emotional Reasoning: The person mixes their feelings with reality and makes negative assumptions such as "I feel so bad I must be bad." -Should Statements: There is a rigid code as to how the person and other people should act. They feel guilty or angry when the rules are broken. - Labeling: Instead of describing our own or someone else's error, we use a negative label such as "I'm a loser." - Rationalizing: This perhaps most of all is something we all do to some extent. It is making excuses, frequently to make us feel better about something we have done or not done. - Entitlement: Believing that we rightfully deserve things just for being who we are, without having earned them. We know that the thinking of depression-prone people is constricted and dominated by negative ideas, many of which have been mentioned here. They can penetrate every aspect of our lives, but not just in "depressed" people. Listen for them in "normal" people too!