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



Culturally Responsive Therapy: How to Apply Anti-Racist Values in Session

Christy Tadros, LPCC and RaQuel Neal, LCSW
February 4th, 2022 from 1:30pm-4:45pm
and February 5th from 9:00am-12:00pm

This 2 day 6-hour training will help therapists develop their ability to support clients from a different racial background than them, with a particular focus on Black, Indigenous and People of Color. Through a multicultural social justice framework, it will integrate research and clinical experience to teach a therapeutic model for rapport building, assessment, and treatment. This model is not a rigid therapeutic modality, but provides a contextual lens to build a strong, culturally grounded therapeutic relationship. It is a flexible model and can align with many therapeutic modalities, including a contextual behavioral approach to therapy. Read More.


Truffle Hunting: Bringing Values to Life in the Therapy Room

Jenna LeJeune, PhD
February 25, 2022 from 12pm-2:00pm

This brief workshop is designed to help clinicians deepen their values work with clients by shifting the focus from the content of values conversations to the quality of those conversation. By listening for and deepening the qualities of effective values conversations participants will get a taste for how more experiential and relationally-based values work can supercharge therapy. Participants will have opportunities to both observe demonstrations and practice in small groups with the benefit of feedback. Read More.


Values Prototyping: Using Action to Help Clients Explore Their Values

Jenna LeJeune, PhD
March 11, 2022 from 12pm-2:00pm

This workshop will focus on one specific experiential tool called “values prototyping” that helps clients learn more about their values through engaging in intentional valuing. As participants will hopefully already have a solid foundation of some of the core concepts of the values process in ACT, this workshop will dive right in on how to use values prototyping to help clients learn more about what they would choose to value in their life. You will have the chance to practice developing a values prototype in small groups with the benefit of feedback, so that by the end of the workshop you will be able to use this tool in your work with clients. Read More.


An Introduction to Psychedelic-Assisted Psychotherapy for Clinicians

Brian Pilecki, PhD and Jason Luoma
April 1, 2022 from 9am-12:15pm

Psychedelic assisted therapy is emerging as a highly effective form of mental health treatment. This workshop will provide health care professionals an overview of this new clinical area. The basic model of psychedelic-assisted psychotherapy will be explained so that workshop participants will have a better sense of how this treatment works. The workshop will highlight the importance of preparation and integration, as well as how to use a harm reduction approach to provide therapeutic support to clients using psychedelics on their own. The current legal status of psychedelics will be reviewed, including Oregon’s developing a legal psilocybin-assisted therapy program. Diversity issues around lack of access for underserved and non-majority populations will be explored, as well as the prevalence of cultural appropriation and colonialism in modern psychedelic medicine.  Read More.


Acceptance & Commitment Therapy: Growing a Flexible, Process-Based Practice

Robyn D. Walser, PhD
April 2nd & 3rd, 2022 from 8:30am-4:30pm
at Hilton Garden Inn Portland Airport
Done with intention and presence, ACT links us to the very qualities of what it means to be alive and whole, to be a conscious and experiencing being. ACT may be learned and understood at many levels, but may remain challenging to implement in a flexible, consistent, process-based, and effective fashion. Multiple levels of process are present in any therapy, including those processes beyond ACT’s 6 core. Moving beyond simple technique and into a fluid ACT intervention requires attending to intrapersonal, interpersonal, and overarching and ongoing processes in the context of the psychotherapeutic relationship. Engaging in an on-going functional analysis feeds these processes and informs the case conceptualization. Connecting workshop participants to on-going functional analysis and the multiple levels of process found in ACT from a more in-depth, experiential, or heartfelt place will be the focus of this workshop. Didactic presentation, role-play and experiential exercises will be used to convey the material. Read More.


The Invitation to Change Approach: Helping Families Affected by Addiction

Jeff Foote, PhD and Cordelia Kraus, LPC, CADC 1, certified CRAFT clinician
May 13th and 14th, 2022 from 9:00am-5:00pm
at University of Portland, Terrace Room
This two-day in-person workshop will provide skills training for professionals focused on the process of working with clients who have a loved one struggling with substance use issues. The Invitation to Change Approach draws on CRAFT (Community Reinforcement and Family Training), MI (Motivational Interviewing), and ACT (Acceptance and Commitment Therapy) to provide a compassionate and collaborative way of working with the families and concerned significant others of people who struggle with substance use. 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.

February 11th, 2022 – Drug-Drug Interactions Between Psychiatric Medications and MDMA or Psilocybin with Aryan Sarparast, MD

May 13th, 2022Implementing Culturally-Attuned & Anti-Racist Psychedelic Therapy: Impact over Intention with Jamilah R. George, M.Div, M.S.