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Lecture 5

PSYCH 127A Lecture Notes - Lecture 5: Dialectical Behavior Therapy, Borderline Personality Disorder, Cognitive Restructuring

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Repetti Rena

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General notes:
Trichotillomania (TTM) - compulsive pulling of hair often associated with
significant distress or impairment
1. Scalp is the most common target but can occur on any area of the
2. Form of OCD
3. Includes recurrent thoughts, urges, and impulses to engage in
pulling followed by recurrent and uncontrollable episodes of hair
pulling behavior
4. Associated with distress arising from shame, embarrassment, and
frustration over hair loss and perceived lack of control
5. Impairment - reluctance to participate in activities that may reveal
hair loss problems or social withdrawal due to embarrassment
Patient: 21yo high functioning college student, 5 years of TTM with
unsuccessful psychotherapy and med management
1. Developed problematic patch of hair --> has to do her hair in a
certain, avoid certain activities such as swimming to prevent others
from finding out
CBT used includes relaxation, self monitoring, habit reversal training
(HRT), reinforcement/punishment, contingencies, thought monitoring and
cognitive restructuring
Client showed 72% decrease after HRT alone and complete elimination
after cognitive restructuring
Maintained at 5 year follow up
Successful treatment models include: HRT, comprehensive behavioral
model for TTM (comB), and dialectical behavior therapy (DBT)
1. DBT initially developed for borderline personality disorder but can
improve outcomes for TTM
A form of CBT
CBT can be tailored to specific client needs
HRT encourages clients to develop awareness of when the problem
behavior occurs then use alternative/competing responses as a way to
prevent that behavior from occurring
1. Awareness training
2. Competing response (CR) practice
3. Habit control motivation
4. Generalization training
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