HMA Guidelines for Trichotillomania Management Programme
Trichotillomania Management Programme
The management of Trichotillomania has not been clearly defined and is an area of ongoing research. The programme we use at Lucinda Ellery has been developed from the realisation that the Intralace System™ could be used as an important part of behaviour modification to 'break the cycle' of pulling. The use of the Intralace System™ has been integrated with psychological and pharmaceutical approaches to produce a management programme that continues to be developed and researched in an attempt to provide the best possible outcome for patients with trichotillomania.
The techniques and support for patients that form the HMA guidelines
for the management of Trichotillomania were developed at Lucinda Ellery
and are at present unique to Lucinda Ellery.
It is hoped that they will soon be formally recognised as important and
necessary tools in the management of this condition.
The Intralace system™
The Intralace System™ is attached over the area of the hair loss. It is useful as a barrier and as a reminder to find alternative activities. We attach the Intralace System™ in rows front to back and side to side. We note the number of connections. Perimeter connections are called locks and the interior connections are termed tracks. The terminology helps us to have a clear understanding when we are communicating with you and helps us to record your progress accurately. When the hair is too long or there is too much volume to continue to use the Intralace System™ we may then use single strand Medi Connections™ to act as reminders and this does give some protection the hair strands. This gradually allows access to the scalp and enables hair growth to become uniform.
Cognitive Behavioural Therapy (CBT)
We suggest that all Patients undergo CBT. Specific CBT such as habit reversal training has been shown to help the impulse to pull. Your general practioner will be able to refer you to a local NHS or private psychologist for this.
Medication
Trichotillomania may be associated with anxiety and or depression, some patients find medication helps. There are specific medications that have been found to be useful. We suggest you see your GP to discuss this.
Habit Reversal Techniques
Distraction
It will have been suggested that you find something small that you are able to carry around with you to busy your fingers when you feel the urge to pull. Many patients have found making a beanie bag helpful but anything similar that distracts you and that you have to concentrate on would be fine e.g. crotchet, knitting, computer games, tapestry, jewellery etc.
Behaviour Monitoring
We will ask you to notice when and in particular where you are when you pull and if possible move away from that particular environment when you feel the urge. This is important for self monitoring and is a positive action place of a reaction to pull.
Relaxation
Abdominal breathing
This is a well recognised technique that helps to relieve anxiety and tension. It requires practice. Try it first when you are not tense so that you learn what it should feel like. Place one hand flat on the middle of the tummy over the tummy button. Breathe in and concentrate on pushing the air into that park of your stomach to make your hand move outwards. Breathe in through your mouth for a count of four. Repeat until you feel back in control and less anxious.
Meditation Tape
You will have been given a mediation tape to try. Like all methods of relaxation meditation takes practice. It does not suit everyone and you may prefer to try other ways of learning relaxation e.g. yoga, Pilates, tai chi.
Sanctuary Website
This is a secure website for you. Every member with login access has received a personal consultation with Lucinda Ellery. It is a forum where you can exchange thoughts, ideas and offer support to others with trichotillomania.
Buddy System
You will be given the opportunity to have a ‘buddy’ who us in the programme who will be available to talk to you and offer support.
Peer Support
There are regular social meetings at the consultancy where there is an opportunity to share views and ideas
Reading List
There is a reading list available on request that details books some patients have found helpful.
Access to an out of hours crisis line
If you need urgent advice this line is available for you to leave a message and a senior member of the team will return your call within 24 hours.
Follow up appointments
As part of the programme, you will be offered to follow up appointments at regular intervals, to answer any concerns you may have about the management skills and your progress.
To schedule an initial consultation at Lucinda Ellery please call 0208 7418224.
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