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Treating Trichotillomania
Cognitive-Behavioral Therapy for Hairpulling and Related Problems
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Main description:

The first and perhaps most important step in writing a treatment manual for use in clinical practice is to clearly explicate the logic of how the treatment, and hence the book, should be organized. Accordingly, our goal in this section is to lay out the structure of cognitive-behavioral therapy (CBT) for trichotillomania (TTM) and other body-focused impulse control disorders, clearly explaining critical decisions such as the chosen sequence of techniques or whether a given technique is considered a core component or a module to be used in some but not all cases. The structure of this particular book is influenced by the work of experts who have gone before us in pioneering CBT for TTM, and is also informed by over a decade of our own clinical work and research on TTM across the developmental spectrum. We are indebted to those who developed this approach to treatment and also to those who built the extant literature on the psychopathology of TTM and related disorders. These clinicians and researchers did so in order to help alle- ate the suffering of those afflicted with these conditions, and we endeavor to f- low in their footsteps in continuing this important work.


Includes assessment measures and analysis, as well as core elements of treatment

Special chapter on frequently asked questions about body-focused impulse control disorders and CBT

Describes the nature of these disorders, distinguishing them from the OCD spectrum of disorders

The first comprehensive, clinical, and empirically-based volume to address these disorders

Relevant to both child and adult clinicians and researchers

Back cover:

Trichotillomania has been described in the literature for at least a hundred years, but has only in the past decade received serious clinical attention. Although now a "higher profile" disorder, there is still scant clinical information on trichotillomania. A full-length cognitive-behavioral treatment manual, Treating Trichotillomania (TTM) fills that need. Designing the book for maximum usefulness, authors Franklin and Tolin share their considerable expertise in treating body-focused repetitive behavior disorders (not only hair-pulling but skin-picking and nail-biting as well) in an accessible, clinically valid reference.

Treating Trichotillomania carefully defines TTM, differentiating the disorder from other conditions such as OCD, reviewing the varied clinical forms it can take, and setting out its diagnostic criteria. Treatment chapters are not one-size-fits-all, but offer an evidence-based framework to help practitioners in designing the most appropriate course of treatment across the developmental spectrum, from toddlers to elders. The authors give the reader:

  • Comprehensive discussion of assessment and treatment methods.

  • Key elements of treatment, including awareness training, habit reversal, and maintenance techniques.

  • Helpful ideas for treating clients with other disorders in addition to TTM.

  • "What Do We Need to Know?" chapter, addressing clients’ and families’ frequently asked questions.

  • Adjunctive cognitive-behavioral strategies, including family and group interventions.

  • Resources for clinicians, clients, and families.

With the increasing recognition of body-focused repetitive behavior disorders and their negative impact upon the lives of sufferers, the clinical psychologist, psychiatrist, social worker, counselor, or school practitioner needs the broadest understanding of the problem, which can be found in this reader-friendly volume.



Chapter 1: TRICHOTILLO-WHAT? Definition, epidemiology, impairment

Chapter 2: PUTTING IT TOGETHER: Biopsychosocial theory of TTM

Chapter 3: WHAT IT IS AND WHAT IT ISN’T: Diagnostics, differential diagnosis, measures

Chapter 4: DOING THE DETECTIVE WORK: Comprehensive assessment/functional analysis

Chapter 5: WHAT SHOULD BE DONE? Presentation of treatment alternatives (including CBT)

Chapter 6: WHAT DO WE NEED TO KNOW? Frequently and infrequently asked questions


Chapter 7: YOU CAN'T FIGHT WHAT YOU CAN'T SEE: Awareness Training and Self-Monitoring

Chapter 8: SPEED BUMPS: Stimulus Control

Chapter 9: ACTIVE STRATEGIES FOR ACTIVE HANDS: Habit Reversal/Competing Response

Chapter 10: HOLDING THE LEAD: Maintenance


Introduction to Section: What are these for? How do you know if you need them?

Chapter 11 – I’M NOT SURE IF I’M READY: Module 1: motivational enhancement

Chapter 12 – CALMING DOWN: Module 2: relaxation/deep breathing

Chapter 13 – CHANGING YOUR THINKING: Module 3: cognitive restructuring

Chapter 14 – WHEN OTHER PROBLEMS ARE ALSO PRESENT: Module 4: clinical management of comorbidity

Chapter 15 – ATTENDING TO THE CONTEXT: Module 5: family assessment and family-based interventions

Chapter 16 – GETTING SUPPORT: Module 6: group based interventions


- Comprehensive list of professional and informational sources for clinicians, patients and families

- Literature cited


ISBN-13: 9780387708836
Publisher: Springer (Springer New York)
Publication date: September, 2007
Pages: 223

Subcategories: Psychology, Psychotherapy


Martin E. Franklin, Ph.D., Associate Professor of Clinical Psychology in Psychiatry and Clinical Director of the Center for the Treatment and Study of Anxiety at the University of Pennsylvania School of Medicine, received his Ph.D. in clinical psychology from the University of Rhode Island in 1993. Dr. Franklin joined the Center's faculty in 1992 upon completion of his clinical internship at the Medical College of Pennsylvania/Eastern Pennsylvania Psychiatric Institute. His scholarly publications include scientific articles and book chapters on the treatment of adult and pediatric OCD, social phobia, trichotillomania, PTSD, and readiness for behavior change. He was a member of the Expert Consensus Panel for Obsessive Compulsive Disorder that assisted with the development of treatment guidelines for adult and pediatric OCD. Dr. Franklin is a co-investigator and clinical supervisor on the Center's ongoing NIMH-funded randomized controlled trials in pediatric OCD, adult OCD, and social phobia.

David F. Tolin, Ph.D., is the founder and Director of the Anxiety Disorders Center at The Institute of Living. He is also Assistant Professor of Psychiatry at the University of Connecticut School of Medicine. Dr. Tolin received his Ph.D. from the University of Arkansas, and completed a predoctoral internship at Tufts University School of Medicine/VA Medical Center, Boston. Dr. Tolin's research and clinical interests include cognitive-behavioral therapy for anxiety disorders in adults and children, and cognitive processes that underlie anxiety disorders, particularly obsessive-compulsive disorder, posttraumatic stress disorder, and panic disorder. He is the recipient of the award for Distinguished Contribution to the Science of Psychology from the Connecticut Psychological Association, and an Early Career Award from the Anxiety Disorders Special Interest Group of the Association for Advancement of Behavior Therapy. He is a Fellow of the Council for Scientific Medicine and Mental Health.

Dr. Tolin is the author of over 90 journal articles and book chapters, and over 140 research presentations to national and international organizations. Dr. Tolin is principal investigator on the National Institute of Mental Health (NIMH)-funded studies "Stepped Care for Obsessive-Compulsive Disorder" and "Neural Mechanisms of Compulsive Hoarding," and co-investigator on the NIMH-funded studies "Psychopathology of Compulsive Hoarding" (principal investigator: R. Frost), "Treatment of Compulsive Hoarding" (principal investigator: G. Steketee), and "Screening for GAD among Frail Elderly" (principal investigator: G. Diefenbach). He has served as principal investigator on several industry-sponsored clinical trials of experimental medications. Dr. Tolin has been interviewed for The New York Times and the Associated Press, and has been a recurrent guest on The Today Show, Good Morning America  and The Oprah Winfrey Show.