Psychiatry Advisor Informational Page on Trichotillomania

Psychiatry Advisor Informational Page on Trichotillomania

I’ve been working with trichotillomania (i.e., hair pulling) for several years now and am always happy to see this understudied problem receive more press.

I recently came across a useful informational page on trichotillomania on the Psychiatry Advisor website. The page provides concise, up-to-date info on “trich,” including behavioral and pharmacological treatment, and diagnostic considerations. It is a great reference for anyone new to trichotillomania.

You can check it out here.

Brian Thompson Ph.D.

Author: Brian Thompson Ph.D.

Brian is a licensed psychologist and Director of the Portland Psychotherapy Anxiety Clinic. His specialties include generalized anxiety, OCD, hair pulling, and skin picking.

Treating Skin Picking with Acceptance-Enhanced Behavior Therapy

Treating Skin Picking with Acceptance-Enhanced Behavior Therapy

Excoriation or skin picking has often been in the shadow of its nearest relative, trichotillomania or repetitive hair pulling. One good thing to come out of the DSM-5 was that it finally made skin picking disorder an official diagnosis—excoriation. Prior to the DSM-5, there was no official diagnosis for this condition. I suspect the lack of official diagnosis slowed research into skin picking disorder. As a consequence, there are few published treatment studies for excoriation.

A recent study looked at the use of an acceptance-based protocol that was originally created for trichotillomania. The protocol is Woods & Twohig’s Trichotillomania: An ACT-enhanced Behavior Therapy Approach therapist guide, part of the respected Treatments That Work series of treatment manuals published by Oxford Press. The protocol combines Habit Reversal Training (HRT) with Acceptance and Commitment Therapy (ACT). From the study description, the protocol remains largely the same as the published trichotillomania version, except that information about hair pulling is swapped out for skin picking.

The study

Four people with excoriation completed courses of AEBT. Three of the four completed treatment in 10-sessions—the standard protocol length—whereas the 4th completed 25 sessions of treatment. All four responded to treatment, although the individual who completed 25 sessions (“Rose”) struggled with periodic lapses (sudden increases in picking) during treatment. Of note: one of the primary treatment responders (“Amy”) completed all but the initial session through web-based video-conferencing. Treatment appeared to successfully address both skin picking as well as co-occurring problems including anxiety, depression, and life stress.

Because this is a small, uncontrolled study, results should be interpreted cautiously. However, it provides some additional evidence that the AEBT protocol is as effective for skin picking as it is for hair pulling. One prior multiple baseline study of AEBT included 2 participants with skin picking and also found reductions in pulling.

For therapists interested in treatment excoriation and trichotillomania, the AEBT protocol is a commercially available and flexible treatment manual with very good research support for hair pulling and some very promising evidence for its use in treating excoriation. Additionally, this study provides some evidence that treatment produces changes in conditions that are co-morbid with picking such as anxiety and mood problems. I draw from the treatment manual in my own practice and have found the handouts and treatment framework particularly helpful.

If you’re interested in reading the full study, you can download a pre-publication copy here.

Using TLC to Learn About Hair Trichotillomania

Using TLC to Learn About Hair Trichotillomania

A few years ago, my clinic director suggested I check out trainings offered through the Trichotillomania Learning Center (TLC), a grassroots hub for information on trichotillomania and skin pulling (or dermatillomania). He knew about my interest in structured treatments for anxiety disorders and thought it might be useful for me to look into training.

Although TLC offered a DVD training program, I decided to wait until there was an actual physical workshop. In retrospect, I don’t know why I was so attached to in-person training. Having attended my fair share of workshops and even having co-led some myself, I’m fully aware that 1-2 day workshops are pretty limited in what you actually can learn. Intellectually, I figured the training DVD’s were probably a better value, but I allowed my conditioning to overrule my reasoning.

Also, I’m a little embarrassed to admit, but when I read that the previous training was run by the Behavior Therapy Center of Greater Washington, I assumed “Washington” meant neighboring Washington state, and that the training would be held in Seattle. More than a year later, I checked back, realized, “Oh, it’s Washington, DC!” and dutifully ordered their Virtual Professional Training Institute (VPTI).

I have no excuse for my mistake—I had even clicked on their website and somehow missed the distinctive JEFFERSON MEMORIAL on the website landscape banner!

 

The Virtual Professional Training Institute is Awesome!

For under $10, the VTPI is a bargain. It features over 9 hours of DVD training and a collection of pdf’s of research articles. You can send in the post-test to earn 16 CE credits and certification on their website. Developed in 201, the information is pretty current. The DVD kicks off with a documentary called Bad Hair Day, and the remainder includes lucid presentations by experts Charles Mansueto, Ph.D., Ruth Golomb, LCPC, and Fred Penzel, Ph.D. (Mansueto and Golomb are part of the center in DC.)

TLC

Not long after I finished the training, I ordered some books from TLC. (I figured they could use my money more than Amazon.) Included on the packing slip was a charming personal touch that illustrates the grassroots origins of TLC. Written in green ink was a quick note: “Thank you – Donna – TLC.”

UPCOMING TRAINING EVENTS


Using Acceptance and Commitment Therapy to Guide Exposure Therapy: The Basics

Brian Thompson, PhD, Brian Pilecki, PhD, and Joanne Chan, PsyD
September 17th, 2021 from 12-3pm

This is a beginner workshop intended to provide the foundations of exposure therapy including types of exposure interventions and design effective exposure exercises for various anxiety disorders and OCRDs. Participants will learn how to use ACT processes to guide the implementation of exposure techniques and how ACT processes may be enhanced by traditional exposure methods. This workshop will provide some background in theory and will emphasize applying exposure to clinical contexts using case studies, exposure demonstrations, and the practice of new skills by participants. Read More.


Overcoming Barriers to Effective ACT-Informed Exposure Therapy

Brian Thompson, PhD and Brian Pilecki, PhD
October 15th, 2021 from 12-3pm

This workshop will offer a brief introduction to Acceptance and Commitment Therapy-informed exposure and focus on practical ways to address common problems in implementation. Case examples will be provided to illustrate common client barriers such as lack of buy-in and difficulty grasping core ACT concepts. Strategies for overcoming these barriers will be offered and participants will have the opportunity to practice newly acquired skills through role-plays and break-out rooms.Read More.


Therapy and Research in Psychedelic Science (TRIPS) Seminar Series

Second Friday of each month from 12:00 PM – 1:00 PM (PT)

TRIPS is an online seminar series that hosts speakers discussing science-informed presentations and discussions about psychedelics to educate healthcare professionals. This series was created to guide healthcare providers and students preparing to be professionals towards the most relevant, pragmatic, and essential information about psychedelic-assisted therapy, changing legal statuses, and harm reduction approaches in order to better serve clients and communities. This seminar series is a fundraiser for our clinical trial of MDMA-assisted psychotherapy for social anxiety disorder that Portland Psychotherapy investigators are preparing for and starting in the Fall of 2021. All proceeds after presenter remuneration will go to fund this clinical trial. Read more.

September 10th, 2021 – Cultural Considerations in Outreach to and Assessment of Minoritized/Marginalized Individuals in Psychedelic-Assisted Psychotherapy with Terence Ching, Ph.D.

October 8th, 2021Presentation Title TBA – Dr. Elizabeth Nielson

November 12th, 2021Presentation Title TBA – Anthony Bossis, Ph.D.

December 10th, 2021Presentation Title TBA – Jamilah R. George

January 14th, 2022Presentation Title TBA – Jordan Sloshower, MD, MSc