In many cases Trichotillomania is defined as an Impulse Control Disorder characterized by “unfocused” hair pulling. Stimulus control and competing response behaviours can be counted as a “high risk” situations only if those situations have been identified.
One of the most important parts of Trichotillomania treating is Awareness Training. Instruction in awareness training begins in the first therapeutic session after the assessment. Self-monitoring is one of the important methods used to improve awareness. The rationale for self-monitoring is an analogy about cautiously scrutinizing a phenomenon to what is happening right before responding appropriately. Here are two techniques for self-monitoring:
Saving pulled hairs. This technique designed by Franklin and Tolin (2007) to improve awareness of pulling and to serve as a test for the patient on the carefulness of self-monitoring, which is the collection of pulled hairs in an envelope that will be brought to each of the posterior therapeutic sessions.
Warning Signs. Visual signs can be quite obvious, like the words “No Pulling – No Pain” or a big stop sign in a bedroom. Of course, visual signs can be more subtle when they are to be displayed in more public spaces in which the patient is concerned about other people learning about their problem. In such cases therapists often use symbols for pulling, which can vary from the numbers, a picture of a hat or a comb. These signs should be placed in full view, and can serve to meliorate awareness and help patients later on in the therapy to use their own techniques in high-risk situations. The signs themselves can also serve a stimulus control function, such as a patient who put her “no pulling” sign right in the middle of the mirror in her/his bedroom – because mirrors served as a trigger for her/him pulling, the sign both reminded her to be aware of Trichotillomania and prevented any unintentional visual cues that could begin the chain of pulling.
For more information, please, read Treating Trichotillomania: Awareness Training And Self-Monitoring