Researchers compared two self-help interventions that can reduce trichotillomania (TTM): progressive muscle relaxation, and “decoupling.”
The investigators recruited 105 study participants with trichotillomania, or compulsive hair-pulling. Each was randomly assigned to either a progressive muscle relaxation group, or a decoupling group. After four weeks, the participants using both techniques showed a comparable and significant reduction in TTM symptoms.
Progressive muscle relaxation is a fairly well-known method of calming the body. Individuals release muscle tension by tensing and then relaxing groups of muscles (e.g. shoulder muscles, thigh muscles).
Decoupling is a less well-known technique that works by short-circuiting habitual TTM behaviors.
Habits and Decoupling
Habits are fixed, automatic patterns of behavior that do not require conscious control. Some habits are helpful, such as the automated behaviors we use when driving a car. Others, such as hair-pulling, can cause mental and emotional distress and interfere with daily functioning.
All habits are tough to abandon, they seem to have a mind of their own, and trying to suppress them does not work. Decoupling is an alternative strategy that helps the body gradually unlearn a habit. It does this by directing the unwanted behavior into a “dead end street.”
Decoupling, for TTM, starts by copying the movement of the hair-pulling habit (fingers moving toward the hair) and then diverts the movement into a different, harmless action. The harmless action, such as touching the ear, is the “dead end street,” and hitting a dead end alters the habit.
Essentially, the hair-pulling movement (reaching for the hair) is decoupled from its usual conclusion. No hair is pulled—the hand massages the neck, touches the nose, or ear instead.
Making Decoupling Work
For decoupling to work:
- It must be practiced mindfully several times throughout the day, particularly in triggering situations.
- The altered movement needs to be repeated five times successively, for at least two to three minutes, each time decoupling is practiced.
- Replacement actions, such as touching the ear, must be conducted with some tension or acceleration to block the old behavior’s reappearance.
Decoupling is considered a TTM intervention that can be self-taught, though working with a counselor familiar with the technique may prove more helpful for some individuals.
Sources: Clinical Neuropsychology/Manual for reducing nail biting and hair pulling ; Psychiatry Advisor
Photo credit: AndresRodriguez
