Trichotillomania: Letting Go of Your Hair

Explore the realm of Body Focused Repetitive Behaviors (BFRBs) and demystify the puzzle of Trichotillomania. This webinar goes beyond providing insight; it’s also a call to action. Join us to discover a potent approach that combines mindfulness, acceptance, and action aligned with your values – Acceptance and Commitment Therapy (ACT).

Dr. Anna Urbaniak is a licensed clinical psychologist at the Stress & Anxiety Services of NJ. She is also an adjunct professor at William Paterson University where she teaches PsyD level students. Dr. Urbaniak specializes in the treatment of OCD, PTSD, BRFBs, Insomnia, as well as other anxiety disorders.



0:04 Good evening, and welcome. Thank you so much for joining us tonight for the webinar trichotillomania: Letting go of your hair presented by doctor Ana Urbaniak. My name is Katie Delaney and I’m the Family and Medical Outreach co-ordinator for the New Jersey Center for Tourette Syndrome and Associated Disorders. I will be your facilitator for this evening. Now, as some of you may have noticed, the webinar interface looks a little different with our new and improved name and … Masterminds comes new features and new engagement. 0:36 At the bottom of your screen you will see a react button. 0:41 To the right is an arrow, and if you click it, you will see some emojis appear, like a heart, thumbs up, thumbs down. Feel free to use this button throughout the webinar to let our presenter know how they’re doing. Go ahead and give it a try. If you guys have found the React button, give me a thumbs up. Give me a heart. 1:01 Yes, Oh, perfect, OK, great. So we’re very, very excited about some of these new features and so happy that you guys are enjoying them as well. 1:11 So, now, near the every act button, you’ll see a button with a piece of paper and a clip on it. 1:18 Now, those are handouts. Feel free to click them and download the content attached. 1:23 If you guys see those, give me a thumbs up or a heart, and that would be great, so I know you’re in the right area. 1:32 Beautiful, OK, so. 1:36 Now, throughout the webinar, if you have any questions, feel free to type them in the questions box at the bottom of your screen and click send. During the Q&A portion, in addition to the questions you have submitted, the audience will gain the access to unmute themselves and verbally ask their questions as well. 1:57 Because of this, we will be ending the recording right before the Q&A portion, so for those that are viewing that recording, you’ll want to have access to these features, However, you can still type your questions into the question box and hit Submit. These questions will be posted the following day into the question box. 2:17 And, I’m sorry, you, for those that are viewing the recording, you can type your questions, and hit Submit. They will be posted onto our webinar blog, the next business day, and our presenter will be able to answer your questions there. 2:35 Now, please note that these questions will be monitored, and any personal information is shared will not be posted publicly. The blog is located under webinars Blog, an archive, found on our website at … dot org, under the Programs tab. This blog will be monitored until Wednesday, November 22nd. 2:55 So, now to the disclaimer, the New Jersey Center for Tourette Syndrome and Associated Disorders, its directors, and employees assume no responsibility for the accuracy, completeness, objectivity, or usefulness of information presented on our site. 3:10 We do not endorse any recommendations, or opinion made by any member or a physician, nor do we advocate any treatment. You are responsible for your own medical decisions. With that being said, now it is my absolute pleasure to introduce our speaker for this evening, doctor Anna Urbaniak urbaniak. Doctor … is a licensed psychologist at Stress and Anxiety Services of New Jersey is also an adjunct professor at William Paterson William Paterson University where she teaches psi D. level students. Doctor … specializes in the treatment of OCD PTSD, body focus, repetitive behaviors insomnia, as well as other anxiety disorders. Doctor Banting, we are so happy to have you to have you here tonight. The floor is all yours. 4:06 Thank you so much for this beautiful heartwarming introduction. Thank you so much for having me here as well. I’m very honored, to present and introduce everyone, the Act, and hence, the therapy approach for trichotillomania, and diving a little bit more about what you’re telling me is. 4:26 Um, so as Katie mentioned, I am a Clinical psychologist and Stress and anxiety and also adjunct Professor at William Paterson University. 4:37 Before we begin with the presentation, I do have a quick poll that we’re going to run ads to start off and I just want to see how many reactions we are going to have to that very first or to start off with little bit other question here. 5:08 Check all is being run. 5:14 Katie, is the poll being submitted? 5:22 I’m so sorry, yes. 5:24 Is a poll being submitted? 5:26 Oh, I’m so terribly. Sorry. 5:31 OK, just submitted it. 5:37 Thank you so much. 5:39 Alright, so the first question is, have you ever pull your hair out or picked at his hat? 6:05 OK, so based on the poll, results, majority of individuals who voted, and thank you so much, for everyone who has voted, it’s an anonymous voting, and majority of us do pick, or poor here, at some point in time. 6:26 Sometimes, it’s a very natural reaction, And other times, it becomes something a little bit more, then, just a one-time thing, or a random situation of re-engaging it. 6:40 Thank you so much for completing that. 6:45 So, before we begin, 12 into, I like I like to do in sessions, I like to go through a bit of an agenda to provide a little bit overview of what we’re going to be talking about today. So, we’re going to start off with an introduction and discuss a little bit more in depth, what is derivative mania, and what other body focus repetitive behaviors or … or short. 7:12 ARR, we’re going to discuss some other treatments for Tigger, tell me more, I will introduce, briefly, because you could have seminars for days about acceptance and commitment therapy or act for short. Yes, the pace loves a typical act. 7:28 As I mentioned, a little bit about that in a second too, we’re going to talk about the hexagon, the Act, and hence behavior therapy approach, while you’re here. 7:39 And also we’re going to do a quick summary about all the information that you have learned today and I will present you with helpless sites That might be useful for you in the future. 7:49 And last but not least, I will leave some time, some 10 to 15 minutes to ask any questions about this presentation. 7:57 So, before we jump into further, I have a second, Paul, last fall. I are, now, we’re going to run, right now to just test your knowledge. 8:08 …, the question sets on which one of these do you believe would be considered a body focused, repetitive behavior? 8:32 Even if you’re in a chair, I highly encourage everyone to bullets. 8:37 There is no right or wrong answer. 8:39 There are here Tiller. 8:48 OK, wonderful. Thank you so much for everyone who participated. 8:52 Alright, and, yes, there are all of the above are correct. All of these are considered the body focus, repetitive behavior. 9:02 Thank you, Katie. 9:05 OK, so body for those repetitive behaviors. 9:09 So, as I mentioned before and the most common one that you’ve seen all of these on the questionnaire is Chickasaw Mania are hair bullying disorder and this is the one we’re going to touch base on in a moment. I’m going to dwell a little bit more in-depth about it. 9:28 Excoriation disorder refers to skim thinking. that’s the one that also looks at its skin. A step, so we have being on those and the acne. 9:38 Any imperfections pumps, that would go under umbrella of excoriation disorder only only show what’s easy. I’m always having difficulty with this one I’ve been pronounce practicing with Google to only show fun. 9:53 Idea is a nail biting, so anytime we have individuals’ biting their nails and consistently, especially when they’re nervous, that would go under this condition mischief biting as well. 10:07 An individual bites, the insights of their cheek, and there are several other ones as well from lip fighting, just thinking of their skin at their lives, et cetera. 10:18 There’s several other body focus, repetitive behaviors, and I didn’t wanna chicken from time to time with everyone. If we’re all good. And if there’s any questions, please let me know, But let me know if we’re all good to contain, yeah. We can have a little reactions her back. 10:38 I get some lovely thumbs up. Thank you so much. 10:41 So let’s continue. 10:42 Let’s talk a little bit more what does she could tell them anyway? 10:47 Mania has, on average, a prevalence rate of one to 2% in the general population. 10:53 What is it usually reported that the ratio between men and women reporting, having trichotillomania is tend to one ton of woman to woman. However, those rates have been questions and challenge because the rates of her children are pretty equal. 11:14 And a recent online study has found that individuals who reported having the current episode of … ammonia Mouse report a 1.8% that they had a while Females are 41.7%. So the rates seem to be pretty similar. 11:33 But there are still a lot of research to figure out the exact rates and the ratios between, OK, So, DSM refers to … 11:45 mania, as a only one’s hair and that would be recurrent pooling of one’s hair, resulting in hair loss. 11:54 And the hair sites are the most common ones are from our scowl Form. 11:59 Our eyelashes are my eyebrows but those are the most commonly reported ones. 12:05 The less commonly reported wants you should do stigma or a pubic hair. 12:11 Our pair here hair from the arms, et cetera. There’s a lot of other aerosols anywhere we have here. 12:19 That’s where … 12:21 can be impacted individual, whether continuously look at picking on the hair that results to hair loss over time. 12:29 one kind of with that as though that the hair pulling sites do change and older from time to time and individual puling episode. 12:40 It does vary as well. 12:41 For some individuals It’s pulling very infrequently throughout the day. 12:47 We’re very brief period of time, or if it can be pulling for extended period of time on more rare occasions. 12:54 But to qualify for a diagnosis of …, we do need to experience a little bit of that hair loss. 13:01 What I mentioned about it being tricky sometimes too, diagnose that is because a lot of individuals were particular to the ammonia, do hide the fact that they are bullying and that they experienced any hair loss. 13:13 There’ll be masking it either through the use of wigs, makeup, scarfs, hats, etcetera, to try to or, like, alternating more of their sites where they’re picking, to just hide the fact that they are losing hair. 13:26 That’s a criterion, a criterion B. 13:31 Peter attempts to decrease or stop hair pulling an individual, and that’s not only including two trichotillomania have attempted two, stop calling OSEP picking at some point in time in their life, and they were unsuccessful, unfortunately. 13:48 So before criterion C, they are blind cause significant clinical distress or impairment in social, occupational, other important areas of functioning. 14:00 This criteria of the one I stressed out on the definition of distress, that refers to any negative effects that an individual might be experiencing that includes anxiety, anger, sadness, feeling of, loss of control, embarrassment, shame. 14:19 Um, OK, When it comes to criterion D, the hair, falling or hair loss is attributed to other medical condition. This is the condition we usually refer to as … 14:33 And, not only to that, and that’s in a condition where you would have a dermatologist assessing and providing a diagnosis for that particular diagnosis. 14:44 However, most of individuals’ who are engaging in hair pulling behavior will admit that they are, they are engaging in here. 14:56 So, that makes it some things easier to identify. 15:02 OK, so, To also let you guys know of Criteria E the hair pulling is that better explained by symptoms of another mental disorder or first till when individuals might be experiencing withdrawal symptoms is something for their hair Or they’re trying to get attention. 15:20 Or the RSA the psychosis, those are older conditions, them might better explain the pulling of the year, and that would then exclude thickness of … coming up, but not in all instances, unsung. 15:40 So, it’s triggered something maybe a habit, or disorder. 15:44 That’s a very common question I get from the individuals I worked with. 15:49 So, there haven’t, by definition, is a behavior that we’ve been doing, over, hand, over and over. It becomes automatic. 15:57 If we have to do something differently, I feel a little not good. We may feel a little uncomfortable. And habits can be also classify as good habits such as brushing our teeth or bad habits throwing a wet towel on the floor, or they can also be classified as neutral. 16:14 Neither good or bad, such as which but do we put on Our first stop on first, right, And I bet that everyone is going to wonder after Des, which there Are put A which are using for the sub bullet, putting on, sorry, grammar. 16:33 There’ll be there’s that habit to if I didn’t ask you to think of which foot do you put on the sacrum first you might wonder and then stop paying attention. And if you’re trying to change that, also might be a little difficult to create some form of discomfort. 16:49 And some individuals with … 16:52 do have a or any other P.f.r. 16:54 Bs, do experience Took it to me and more as a half. 16:58 And so the answer is here is sort of, for some, it’s just a temporary behavior, while for others, it’s less so, that, and it’s something that’s more chronic. 17:11 And some researchers, although it’s not fully known for why trichotillomania exist for individuals. 17:19 They did find for some that there is in different changes in brain where the receptors after suffering the consequences of hair pulling here is a little different. So for instance, some individuals when they pulled her out, that my experience pain is Thinkific, Ouch. Love, For some individuals of Gerald, tell Amelia. When they pull their hair out, they might actually experience sensations of pleasure of relief. 17:47 Feeling good. 17:49 And that’s what some differences here are. 17:54 Let’s talk more about terming as a disorder. So I do wanna mention and touch base on some of the impairments associated …. I want to start off with …. 18:04 So, approximately 48 to 77% of individuals with … 18:10 mania after pulling the hair that play Well. If there are some things like Robin around their face, they might put in her mouth and approximately from five to 18% of individuals. 18:20 The report, I do want to make an emphasis on that this is all self reported numbers. So five to 18% of individuals do end up ingesting the hair after playing with it afterwards. 18:35 And when they hear gets ingested and again becomes in this curve, the Emirate of hair and fun in the intestinal tract, it becomes a condition called …. It’s a very painful condition, it can be actually a very, very painful condition. 18:51 It can lead to waking when you love her weight loss, fever, vomiting, media. Mania, I’m sorry. 19:00 And few other few other side effects from this particular. 19:07 It’s like conglomeration of hair and intestinal tract. 19:12 And for some, a surgical procedure might be necessary to remove and so there’ll be able to be in less pain, OK, some other medical complications involved with … consist of sculpt the rotation, bulk O’Hare damage, a typical re growth of hair. 19:33 Dental damage caused Cassandra gum disease from chewing and playing, with the hair of enamel Erosion. 19:41 Thing of calluses Muscle Fatigue, Carpal Tunnel Syndrome, et cetera. 19:46 She could tell. I mean, yeah, I can also produce significant psychosocial impairment, as you can imagine, as well. 19:53 And majority individual swift trichotillomania feel that it has led to development of more older mental health conditions, such as anxiety, depression, higher levels of stress, OCD, and goes to its limit. It has been shown to have a high levels of comorbidity with all of those conditions. 20:16 They are also likely to experience a host of social academic occupational and financial difficulties as well. Avoidance of routine activities might be involving things like not. Going to swimming parties are going swimming, might avoid going to hair salons. Going outside on a Wednesday days. In some extreme cases, individuals with … mania. 20:43 We’ll avoid intimate relationships, as well as other social relationships, or even going to work. 20:49 Millions of days of work have been missed due to … 20:52 condition, um, OK. 20:56 So, some things that trigger the hairpins. 21:01 So I know I’m going to be breaking this all down here but I will be going back to this information later on as well in the slides for when I talk about the different triggers that lead to the hair pulling or increase the likelihood of the hair pulling to occur. 21:17 So one of them aren’t environmental triggers and their environmental triggers consist of, not only location, awesome activity. 21:26 And a type of hair we’re dealing with, environment refers to location of where an individualist are here. 21:34 Meaning, are they put in their bedroom, bathroom, living room, school bus? 21:41 Where are, where’s the location of the most common area? Where are they willing to share? 21:48 What? So then create an association for the break-up embed links that are watching TV. 21:55 And I’m going to engage in here. 21:58 Nicely leads into the activities. 22:01 A lot of sedentary activities do are, I mean, like more likely, to trigger pulling hair or triggered an urge to pull hair. 22:11 So whether they’re watching TV or reading, studying, doing homework, lying on a computer on, a tablet scrawling, on Instagram, will tick tock or any other social media at this moment I’m trying to catch up! 22:26 But Innocent our behavior they’re doing sitting in the car for loan car, right. 22:31 Also is likely to increase the likelihood of hair pulling. 22:36 And lastly, is a type of hair. So, a lot of individuals with Trichotillomania will look for a specific type over here. 22:43 So, for older adults might be also including hairstyle, such as a gray hair or force a hair, daycare hair, earlier hair. There’s something different about the hair when they’re feeling it While for young individuals outside of the great air, there will be more. 23:03 Also, just the feeling of agendas around then, or just the color might be different if they liked, et cetera. 23:14 OK, so also, with increases of cooling here, we have emotional factors, as you can see, you can imagine. 23:27 So some of the emotional triggers are, different emotional states, individual …, from emotions, such as anxiety, tension, boredom, loneliness. 23:38 Hunger, fatigue, guilt, anger, indecision, frustration, and even excitement. 23:45 There’s a lot of different emotional states. 23:47 An individual may experience that leads them to haven’t sugar, urge to cool. 23:53 Must also experience a bodily sensation of either tension or discomfort around the here, or even itchiness, where they feel like they have to play around with, or be around the era scratch, and the engage employees. 24:08 And, lastly, we also have cognitive factors. So cognitive factors refer to any dysfunctional beliefs. We might have Our hair up, our looks, or even just war. 24:20 I’d just like the symmetry, for instance, silica, oh, I see my eyebrows so unnecessarily symmetrical right now. So we’re gonna start pulling until it feels, right? Or it feels just symmetric. Symmetry is perfect. 24:34 Or need to remove the gray hairs. 24:37 Are these areas bad, that is growth, is not even slim and tried to even it out, which leads to more, and more. 24:44 Happily, so I’ll take this moment and check in with everyone. How we are doing. Am I speaking too fast, so if I’m doing a proper pace for everyone, please give me a thumbs up. 24:57 Perfect. 24:58 All right. Awesome. Thank you so much, everyone, just wanted to make sure I know I have a tendency to talk, and I just wanted to make sure I got to cover all the information for y’all. 25:09 All right, great. 25:11 So let’s talk about different types of treatments. 25:13 The most common type of treatment for took a tele mania and other be if our bees, but here we are only focusing that you could tell me is habit reversal. 25:22 Long standing, very thorough. You probably have heard of it, however, so that’s when we’re trying to combine with different behavior. 25:31 So instead of pulling over here, we’re going to play with some fidget toys that’s habit reversal. 25:38 Minnesota and colleagues 997 introduce a comprehensive model for behavior. Change an object until mania or come be or short and it’s also beautiful treatment that can be utilized for the … as well. 25:52 In this treatment, they’re trying to focus, not only on the habit reversal, but also incorporate a stimulus control, without it refers to, is to provide some interventions to prevent, then likelihood of pulling. 26:06 So basically, to …, to make it harder to pull, at, easier, not to pull. 26:13 I’m going to put it in that way. 26:15 For fiddling sheep, it’s a variation of come be treatment, buffer kits. 26:21 A book called The Hair Pulling Habit and You How to Solve The Puzzle is a great way to incorporate our fellowship. This is a nice workbook. That it’s, it’s very kid friendly. 26:34 A lot of kids, and their parents, his school teachers, educators, can utilize this book, or even other therapists, and work through combi with kids when it comes to act. And I’ll mention this in a second, too. We can So, Copyright Act. 26:51 Were fiddling sheep a swap and incorporating it web copy. 26:56 So with act, what the act focuses on. 27:02 It’s about experimental avoidance, So the other treatment focuses on what triggers us to pull. what other external factors make us trigger war to urge us. 27:12 Also, what, they’re not necessarily touching base on the … base on, is experiment, experiential avoidance, meaning we’re avoiding the internal experiences, such as, like, oh, I don’t like to feel anxious. 27:27 I’m going to pull what I’d like to be in the situations I’m going to end up pulling. 27:32 Although, that might not necessarily be the very logic that they’re thinking off, but that’s just kinda reaction off to avoid and to escape. 27:42 An act loves to tackle that. And that’s what they’re adding. On top of the other ones, the symbolist control, and habit reversal in acceptance and commitment therapy. Medical treatments are available as well. 27:57 There’s not much study research yet, the fully up providing all the benefits for medication use for the most common medications are being used are ended up in a family of selective serotonin re-uptake inhibitors of SSL rice. 28:16 Oh, OK. 28:18 So X, I love my X So the reason, as I mentioned, alluded a little earlier before. what Act. 28:28 First two is acceptance and commitment therapy. 28:32 and why I see patients love to use it for the term app instead of a C T Is because he wants to emphasize that we’re acting on their life. 28:43 We’re being an active participant of our life. We’re not being in our head or out of our mind. We’re into our life. 28:50 So we’re doing things we’re not just going to talk about or when it is contemplated. 28:54 We actually just doing hence acceptance and commitment and reacting. 29:00 So this treatment can be beautifully done as standalone treatment, and it can also be used as a supplement network. I’m going to mention that. What I mean, as I mentioned, I went to, as I mentioned before, we’re fairly cheap. 29:15 We can use that also there as a supplement. 29:18 And I’ll explain a little more about just a second. 29:22 This is a treatment that is beauty can be used beautifully across different diagnoses. Extras like, trends, diagnostic, It can be used for treatment of depression, anxiety, different types of personality disorders. 29:37 It can be utilized for ticket Dilemma and you have PTSD, OCD, the list goes on, There’s more and more treatment done. 29:46 Me, more and more research done for other diagnoses as well. So it’s a very 1 to 4 treatment that can be utilize ober. 29:55 It’s very process focused, so we’re not focusing on the outcome. Where to focus your feelings about removing the bad, We’re focusing on how we are behaving and how we are changing our experience and how we’re changing. 30:10 Our interaction are the way we are responding, and the way we are, engaging, or in some terms, in that, engaging with our internal processes. 30:21 And lastly, it really focused on psychological flexibility. 30:25 Psychological flexibility refers to being able to allow experience, for instance, having anxiety or anxious thoughts around while, at the same time, being, OK, I have my anxious thoughts. 30:38 I have, or I have an urge to pull, but I am doing my homework now, so I’m going to focus on my homework and having the psychological flexibility of moving from one, where the brain wants to pull us and we’re shifting into where we want to be or where we have to be. 30:58 So let me talk to you about the act hexagon. So what I mean, by that is, the app has six components and they are acceptance mindfulness, lie, values self, us, concept commitment, and diffusion. 31:11 So, all of those concepts, all of those components, ARR, to strengthen and to facilitate development of psychological flexibility. 31:22 Acceptance of first, to not being, like, OK, well, for me, I’m pulling here, it’s more like, I am accepting the fact that I have an urge to pool, and that’s where I’ve been engaging in. 31:33 But it doesn’t mean that we’re OK with it, which is accepting that excess, we’re accepting the fact that the artist, less uncomfortable emotion, or internal experiences we have, or experience. I like to use a lot of force with this, too. And act is all, Of course, if you’re familiar with that. 31:53 But one of the metaphors for acceptance I like to say is, like, we’re accepting that. 31:59 Right now, it’s really early on, And yet it’s pretty dark out. We accept the fact that that’s what happens. 32:06 Are we continuing on with our day? 32:08 To our tried to find it. When I’m trying to negotiate with the weather or Mother Earth? 32:13 We’re just going, like, OK, that’s what happens. We’re accepting it. 32:17 That’s the kind of acceptance we’re talking about here. 32:19 For mindfulness, we’re referring to being in the present moment, Rather than thinking about the future. 32:23 When I’m thinking about the past, it says, sorry about that. We’re talking about the future. We’re looking about the past. 32:31 We’re just being in the present moment for life, I, so far as to what is important to an individual. What are the things that guide our life were like? 32:44 Very inspirational things, not just inspirational, but where things are important to us, Florida things and how we want to live our life. 32:52 I’m self as concept refers to us observing the experiences that primary experiences, observing the anxiety, observing the urge to absorb into depression, et cetera. 33:04 But knowing at this is, we are ourselves, and that’s an experience we have. Those are the thoughts we have. 33:12 We’re observing them, we’re not being there, and I’m going to quickly just jump towards the fusion aspect, because they really go along together. 33:18 The fusion refers to when we have thoughts, and we have an emotion and a fuse. 33:24 And what we’re trying to do is we help an individual to diffuse. The thoughts are just thoughts and emotions. Just an emotion or diffusing that wanders night with the other. 33:35 So lastly, the commitment refers to being like, OK, I am willing to do these things, willing to sit through these negative or less uncomfortable experiences, and I’m not going to avoid them. 33:49 How are y’all holding up? 33:51 Just wanted to say, thumbs up, thumbs down. Smiley faces all righty. 33:57 So glad that everyone is here, where I have not kept you going. 34:01 It’s actually just yet. I know it’s dark out. All right. 34:05 Great job, everyone. So let me talk about this finally long awaited act and hence, behavioral therapy approach. 34:13 I love to use this version, a treatment that works, the …, the app, and has behavior therapy approach. 34:21 This is, they have a workbook for the therapist, the manual, the guide. And they also have a version, or the patient, or the students for whoever you’re working with are two different variations of it. 34:34 So I just wanted to let you guys know what it looks like. 34:37 So with regards to this treatment, this is a 10 session manual, this treatment, a combination of habit reverso training, stimulus control, an acceptance and commitment therapy. 34:53 So the first two of the habit of … 34:56 control are based on offering conditioning. 35:00 Wow. 35:01 Acceptance and commitment therapy are more like a relational frame. 35:05 As I mentioned earlier, relation of frame refers to more. 35:09 How we are changing our way of experience, How we are dealing with the experiences that we have, the private experiences and thoughts, the emotions, et cetera. 35:19 So the purpose of this treatment is to educate individual about ways to tell a mania. each of the awareness that will bring a lot of awareness without any of the act treatments and of. 35:34 So we’re building the awareness of the pulling. 35:37 What causes them to pull their different anthocyanins, the use of different self management strategies to prevent or stop, pulling this up, fighting against having those private experiences. I don’t want to have anxiety, so I’m gonna do something else about it. 35:54 No work on preventing, doing them. 35:58 And we’re teaching different skills such as diffusion and acceptance, of work consistently towards improving the quality of life with the reason why we are incorporating the habit reversal and seamless control because there are amazing in feeding to automatic bullet. 36:15 So that’s type of bullying that just happens without necessarily much of many other triggers. 36:23 So the goal of act, enhanced or behavioral therapy approach is to not alter the private experiences. So we’re not making our exotic, be happy emotion, or just letting exotic being cited. 36:36 It’s one of our human emotions, we’re allowing it to be the way it is. 36:41 So we’re learning to observe banat act on our private experiences. 36:47 And lastly, I’d like to mention that to the street men, and through any of the treatments, we teach the clients that we’re working with, making sure students to almost recognizing this fork in the road. 36:59 That they have a choice that they either can’t engage in the here pulling behavior, or any other behaviors that we are treating. 37:08 Or we can do the therapeutic response, where we can have the private experience is half those are just and yet still do what we need to do or have to do. 37:18 We’d rather do So what did he gem the different choices they have. 37:24 OK, so, As with many manual, a strict sense, really love to do assessment. So, When it comes to this treatment, in particular to, that’s no different. So, at the beginning, we want to get a very thorough history of pulling endpoint attempts to treatment. 37:44 As I mentioned before, a lot of individuals will have tickets. 37:47 How many have attempted to something here, in their hair pulling, a behavior in many different ways, whether it be through use of therapy, different types of therapy, or where they’ve tried to do it themselves. So, we really want to get the full history, and this also helps us determine our beliefs about treatment, their attitude towards treatment, whether they have hope that it’s. 38:10 another one I have to go through, my parents made, me, Laura isn’t more like, you know what, let’s give this a try. I am really cool, I want to work on this. 38:19 So, that’s something to just consider, OK, super current symptoms and severity is pretty self explanatory. 38:27 We want to know where they currently stand, what areas are pulling from, right, etcetera, and also, the functional assessment of pulling. 38:36 So those, all those different things I mentioned earlier about the trigger specialists settings, what location is the individual bullying? 38:46 What are the behaviors or activity? So engaging it in the moment? 38:51 What are their emotional states? Why before polling? 38:55 What are their thoughts? 38:56 And last but not least, what were the consequences of bullying? 39:01 Were they being made fun of what a yelled out by the parent, would someone noticed, Right? 39:07 So, we want to be able to identify all of those informations without using any tools to pull the mirror, or their pupils, the pool in front of, while, versus the other people that they’re not. 39:19 Look at what kind of things they’ve tried to stop bullying. 39:23 And last but not least, we also want to identify and assess for any other comorbid conditions and differential diagnoses, so we can get an idea of what else might be interfering or be another obstacle. 39:38 Ford. 39:41 Make a very quick note here, too, that a lot of the assessments are available in this book, that every single assessment that they’re asking for, they have a beautiful question near into Appendixes. 39:52 So I just wanted to do it. Nice. Shout out for this workbook. 39:57 OK, and just wanted to see how everybody else is doing I just wanted to check in. 40:06 Right, wonderful, I hope everyone is funny. 40:11 Some helpfulness here, Thank you so much, I see some people have raised their hands. But we are going to answer the questions in just a bit OK! 40:22 So now let me talk to you about what those sessions look like. I’m going to give a very nice overview about these. 40:30 So, for our first session, after an intake, what we’re doing is introducing the treatment We’re talking about what is X we’re talking. 40:39 What is the habit reversal, stemless control? 40:41 We’re educating the clients on what the treatments are also reviewing their triggers. We’re teaching them what different self monitoring to go to do to build the awareness of cooling behaviors, and other different things that trigger. They’re pulling. 40:58 We’re also going to talk about the treatment expectations. 41:01 Again, we want to build the hope, that they can, so overcome this because a lot of times you might have been burdened by other treatments. 41:10 FM flows out its back again, I have to do this again. 41:14 So we want to really help motivate and have an individual be committed to dis treatment in session two and a yes and all of the end of the session. There’s homework assignments done and, again, in this book because this is a manual as treatment, it beautifully described. 41:34 I show a little bit over here, so like we have a nice session outline of what we’re focusing on that session. 41:40 We’re talking about what kind of assessment measures we want to complete prior to the start of the session, so usually with a waiting area with her coming in to complete those What kind of materials we’re reviewing and previewing reviewing the homework. 41:57 Also, what kind of discussing any main sources of the topics are going to continue here in a second of the treatment, like, well, what we’re focusing on that session. 42:07 They also have lovely of nets to practice for, for you and different types of metaphors, because as I mentioned before, act loves metaphors so we’re gonna be focusing on those metaphors as well. 42:22 And of course last but not least, homework and yes, every single session I mentioned in the second before consist of homework. 42:29 Because we have 160 hours in a week and meaningful only 45 minutes, it’s a drop in a bucket. We want to be able to make this like a new lifestyle change. 42:40 Not just something we’re doing temporarily and letting go, OK, So sorry, this one, first, we’re implementing a different symbol is controlling how the reverse of training. 42:53 Again, that is when we’re engaging the triggers, we’re trying to figure out ways to maybe reduce some stress, and it’s like four or preventing situations where we might be engaging. 43:02 So let’s say individuals’ laying in bed and they’re always watching TV, or scrawling, Twitter, Instagram, they have their hands on their head. 43:13 It’s easier to then start to play with their hair and fold them. 43:17 So we would be implementing, like, OK, maybe instead of laying in bed doing that, you sit on your desk and watch. And while you’re watching that, you’re going to play with some fidget toys. 43:28 So there’ll be an example of that. 43:30 So, in session three, we’re establishing the client’s values. This is where we’re introducing the live values. We’re trying to figure out how has struck a time when it prevented them from living their life to the fullest. 43:41 What areas has their life been impacted by, Triggered our mania and how we can get it back. 43:47 Then for our session for identifying different barriers to treatment, that consists of different on what the private experiences, either they don’t want to feeling. Sorry, I don’t want to discourage us, and what those challenges they have been implementing so far to stop. 44:03 They’re pulling behaviors prior to engaging in treatment. 44:07 In Session five, we’re continuing continuing with our session for identifying barriers of treatment. 44:15 We’re talking also about acceptance, commitment, and mindfulness. 44:19 There’s other parts of the hexagon, the first three, we want to teach them about being able to sit with those private experiences, committing to the choices that they have made. Like, yes, I’m going to go swimming, or Yes, I’m going to finish my homework without getting distracted with my hair pulling, and being in the present moment. 44:39 For the remainder of the session, session 6 and 7 focuses on introduction and practicing of cognitive diffusion. 44:45 There are several different types of exercises we do to teach an individual where we can just identify different thoughts, emotions, and just noticing how we can create this sense. This is a practices of the exercises. 44:58 I’m like, OK, how if the anxiety is not me. I am seeing the anxiety I am having, Say, I am not Exactly. 45:07 Then session eight, we’re practicing all the previous materials, and we’re teaching of urge surfing. 45:13 Earth surfing refers to sitting with the urge of like, I really want to have, like, let’s say with the scratch. Oh, I really have. That is. I want an itch? We’re noticing how that it’s starting to grow in my peak, it’s gonna be extremely difficult to edge, and I feel like some of your needs to scratch yourself. 45:32 And so we’re right, we’re known as a peak, or not scratching, And eventually, Jessica Way, where we’re surfing the urge decreases. When we don’t engage with that, I live the more practices. The wave gets smaller, and smaller, and smaller. 45:50 And it’s easier to surface fun session tonight. We’re continuing the practices of all those previous materials and start to wrap up the treatment. We’re doing treatment review. 45:59 Then Session 10, reviewing the remainder of the treatment will continue the review and discussing relapse prevention. Which is something I love that this treatment does. I do it in my own personal practice, too. 46:12 Like to focus a lot on relapse prevention and maintenance. 46:15 of how we can get you to maintain these lovely gains that you had, grabbed the treatment, and not experiences ebbs and flows, or minimize, at least ebbs and flows, you might potentially experience throughout this treatment. 46:30 Hi. 46:32 So, to quickly summarize. 46:35 So the time you have been today, hopefully, a little bit more knowledge about what VFR bees are body focus. And repetitive behaviors are, we’re also talking about increasing your awareness of the different types of treatments for these conditions. 46:51 Building your awareness of what is act, and how you can hopefully use it, not only in your day-to-day life, I have plenty of books recommendations to put on, but also incorporating it in your daily practices, and different conditions you might be working with, or how we are working with different students, as well. 47:12 And last, but not least, let’s just start building your familiarity and hopefully pique your interest about what is App Enhance Behavior Therapy Approach, or trichotillomania. 47:24 So thank you so much. But I just wanted to also, as I build the agenda ahead of time. 47:32 So I wanted to share with you two sites, it particularly CLC Foundation, is a great website. Not the change that to a B, or B dot org. 47:42 And this is a website that focusing on different VFR obese. 47:47 And this is a lead in particular dumpling for hair pulling, since we are talking about trichotillomania today in particular. 47:54 And lastly, I’m also incorporating the A B C T, or the Association of Cognitive Behavioral Therapies, and I’m incorporating her fact sheet. 48:04 So this fact sheet about what is trichotillomania is a very lovely, the accessory, lovely handout. 48:13 We can use in schools, in different advocacy’s to spread the word about what does trichotillomania and it will kind of help we can get. 48:22 I also want to make a quick mentioned that in the TLC Foundation, there are ways to also find support groups for individuals who are experiencing VFR Bs. 48:32 As well as finding therapists, in addition to different types of treatments you might be able to find. 48:39 All right, so if all that being said, I want to leave the room or questions. because I wanted to mention as much as I can, and thank you so much, everyone, for bearing with me of how quickly I spoke for this presentation. 48:56 You are more than A, OK, I think your pace was good. I don’t know if it’s just me, what are you guys? And I think I have a few other people that agree. Yes. Hi, I’m so glad. OK, I was very worried about that, because I know I have an accent and there’s no subtitles. So it’s just like act. 49:15 Totally fine. So, as we go into the Q&A section, since the audience is going to be gaining access to unmute yourselves, we’re going to be stopping the recording. But, before we do, I just wanted to say a couple of things. So, for those that are watching the recorded version of this webinar, thank you so much for attending. 49:36 Um, sugar tele mania, letting go of your hair presented by doctor Anna Urbaniak. When this webinar ends, there will be an exit survey, which we appreciate you completing. An archived recording of this webinar will be posted to our website and … dot org, under the Programs tab. 49:52 All questions submitted during the recording will be posted to the blog for the presenter to answer by the end of the next business day. This blog will be open and monitored until Wednesday, November 22nd. Please note any personal information will not be included in the posting. Our next presentation CB IT Journey to tick relief presented by doctor Maier Flank. Science Bomb is scheduled for Wednesday December 6 at 7 0 PM Eastern Standard Time with the recording the following day, Thursday, December seventh at 2 0 PM Eastern Standard Time. We offer Professional Development certificates for teachers and nurses that attend the live or recording of the webinar. To register for either time, please visit … dot org slash webinars, And with that, we’re going to stop the recording.


  1. Emory says:

    Wondering about hair pulling related to chin hairs in menopausal women. Is it the same thing?

    • Dr. Anna Urbaniak says:

      Another wonderful question. With regards to pulling chin hair during menopause, that would need to be differentiated if the act of pulling hair afterwards cause impairment of some sort, whether skin irritation or social.

  2. Murphy says:

    Is the helpful workbook you are referring to the one by Woods and Twohig?

    • Dr. Anna Urbaniak says:

      Yes it is!

  3. Lisa says:

    Do you think that a BFRB urge can be kind of like a tic? The feeling can build up and has to come out intensely if controlling it for a long time.

    • Dr. Anna Urbaniak says:

      Great question. It can have some similarities for sure. When we discussed urge surfing it helps with not engaging with the urge (meaning not evaluating it, judging it, etc. which strengthens the urge and leads to that intense need for release). When we surf it or allow it to be there (the urge), we are not longer struggling with it nor are we controlling it. Thus it helps us not feel the urge to immediately engage in it or have that stronger response afterwards when we are trying to control it or suppress it.

  4. Dr. Anna Urbaniak says:

    Correct :)