Should you try alternative therapies for trich?

The reason alternative therapies are called “alternative” is that they do not have the support of the medical community or approval by the Food and Drug Administration. Does that mean they don’t work? No, it just means they have not been subjected to rigorous research, which would determine if it works as intended or does not work as intended. Before you try an alternative therapy, consider some of the following tips and suggestions.

Limited research

Trichotillomania is a condition that does not have a strong research foundation. There are several reasons for this. First, because trich affects less than 5% of the population, the need is not very great in the grand scheme of things. The people who struggle with this condition would beg to differ, however. The prevalence of the disorder is likely much higher because most people with trich do not talk about it or seek treatment. The downside to hiding the disorder is that there is no demand for treatment nor is there much of a population from which to get research participants, so the studies that do occur have small sample sizes, which makes it difficult to generalize the results.

In addition to small sample sizes, there is little replication in trich research. For example, Jon E. Grant, one of the foremost researchers of trich and related disorders, conducted a study in 2011 about the impact of Dronibinol on hair-pulling. Dronibinol is a cannabinoid agonist that contains THC approved by the FDA for treating anorexia in AIDS patients and vomiting from chemotherapy. This 2011 study was the closest I could find that involved a cannabis-related substance and trichotillomania. There were 14 women in this study with an average age of 33 who received a graduated dose to a maximum of 15mg of Dronibinol per day. Then they were evaluated for pulling behaviors throughout the study. Results indicate that 64.3% of the participants experienced a significant improvement in pulling behaviors with an average of a 50% decrease in behaviors.

The good news about that study is that it showed there may be a link between the cannabinoid receptors in the brain and trich and that Dronibinol may help some people. The drug was chosen because it showed effectiveness in people with Tourette’s, which is an impulse control disorder. Therefore, in people who manifest trich behaviors similar to an impulse control disorder rather than a compulsive disorder, this form of cannabis-related drug may help.

Important points about this research:

• 64.3% of 14 participants is 8 people.
• The study was done with adult women in the Midwest.
• The cannabis-related products available on the market today are different from the Dronibinol in the research.
• The study was never replicated as far as I can tell.

These points raise questions about the validity of the research. Is it enough that it worked for 8 people? What about the other 6? If it helped over half the adult women, would it work on men, children, or teenagers? Are there differences in trich based on which part of the country someone lives? What are the contents of Dronibinol, and how did the THC impact the results? Also, to achieve “gold-star” status, research needs to be replicated properly using the same methods as the original study to ensure that the first study was not just a one-off result. If the results can be replicated and yield similar results, then it is likely that the findings are sound.

Continuing with this example, like many alternative therapies, cannabidiol products remain mostly unregulated by the FDA except for Epidiolex, which is approved for epilepsy. This means that despite their claims, cannabidiol products may or may not have THC in it, the concentration of the cannabidiol varies, and it may or may not be a derivative of cannabis and not cannabidiol.

The verdict on alternative treatments

In a perfect world, it would be delightful to say that something is for sure recommended or not, but given the challenges with research and individual differences, it is difficult to say. Some people with trich swear by alternative treatments like yoga, acupuncture, diet, probiotics, and CBD oil. While they may not be backed by research, I believe them when they say it works for them, but it may not work the same for everyone.

Before jumping on the alternative treatment bandwagon, ask yourself some questions:

• Have you had your trich thoroughly assessed by a BFRB specialist?
• Do you know your triggers?
• Are you engaged in a therapy program that can help you objectively assess the effect of a new behavior or alternative treatment?
• What are your reasons for trying an alternative treatment?
• Does the alternative treatment promise a “quick fix” or “immediate relief”? If so, be skeptical.
• Have you researched the treatment from sources other than the person, organization, or company selling it?
• What expectations do you have for it?
• How will you know if it’s helping you?

Suggestions

• Research the alternative treatment you are interested in trying. Consult with your therapist or supportive other.
• Explore and write down your expectations of the alternative treatment. Are you hoping it will decrease triggers or pulling behaviors? How much change do you need to notice to keep using it?
• Give alternative treatment time and try one at a time so you can evaluate their effectiveness properly without confounding results with multiple therapies.
• Keep a journal while you take it and write down your feelings, pulling behaviors, what you’re taking, and whether you notice any changes.
• Keep in mind some of the alternative treatments like exercise, meditation, mindfulness, yoga, healthy eating, and other supplements may be good for your overall health. Some of them may not yield results that directly relate to pulling behaviors but pay attention to how you feel overall. Are you sleeping better? Less stressed? This is why journaling about your experience is so important.
• Evaluate the results with your therapist or supportive other to ensure you’re not subjecting yourself to confirmation bias. Is it worth continuing? If so, why or why not? Share your results with others on the Trichstop.com forums.

Ultimately, you know yourself best, and you know when something works or not. When considering alternative treatments, make sure you make an informed decision, keep your expectations realistic, objectively keep track of the impact, and share what you learn.

Resources for Alternative Treatments

Trichstop.com blog articles about alternative treatments

• NAC
• Naltrexone
• Mindful Running
• Emotional Freedom Technique
• Body Talk
• Prohibere
• Natural treatments
• Exercise
• Homeopathic treatments
• Viviscal supplements
• Neuro-linguistic programming
• NeuroReplete
• 3D Printing
• Reflexology
• Inositol
• Hypnosis

TrichStop.com Forums where users share what works for them

Lesley, Trichotillomania Blogger on multiple Trich Products

Support groups, both in-person and online connected through the TLC Foundation

Dr. James Greenblatt on probiotics