How to use Prohibere
Prohibere was designed to be applied directly to scalp when a pulling episode begins. Cooling sensation may take up to 5-10 minutes to occur.
To successfully prevent and fight pulling urges often requires a multifaceted approach including competing response training, tracking, practice, barrier methods, and CBT/DBT.
Below is the standard plan for habit reversal training for trichotillomania incorporating Prohibere as a competing response tool.
Competing response training
1. Competing Reaction Training- Subject learns the inconspicuous competing response of applying cooling Prohibere and fist clenching whenever pulling starts to occur
2. Awareness Training- Subject learns to be aware of the specific movements involved in hair pulling especially by observing themselves in mirror or using awareness bracelet.
3. Identifying Response Precursors- A common response that is a precursor to hairpulling is face-touching as is also hair straightening or playing with hair. Subject learns which are specific to his or her habit.
4. Identify Habit Prone Situations- Subject learns to identify which situations lead to hair pulling, such as watching TV, reading, studying, and driving.
5. Relaxation Training- Nervousness is a common precursor to hair puling. The subject is taught how to relax with deep breathing, mindfulness training, and postural adjustment.
6. Prevention- Practice competing reaction by applying cooling Prohibere and 3 min of clenching fists whenever nervousness or a response precursor exists, thereby preventing hair pulling.
7. Habit Interruption- Subject practices using the competing response (hair cooling prohibere and barrier methods) to interrupt hair pulling immediately
8. Positive Attention (over correction)- The subject practices positive hair care such as applying hair growth products, hair nourishing masks, or brushing hair after each episode of hair pulling is stopped.
9. Daily Practice of Competing Reaction- Subject practices the competing reaction before a mirror at home on a scheduled basis to be assured of the inconspicuousness of the competing reaction.
10. Self-recording: Subjects recorded each instance of actual hair pulling and each strong compulsion to hair pull on a recording chart to provide greater awareness and feedback for progress in hair pulling.
Tracking Apps available include QuitThat.
Additional Tools and Skills
Barrier Method: Subject also incorporates multiple barrier methods such as finger covers, band aids, acrylic nails and head covers such as hats or hair pieces to assist in preventing accidental hair pulling occurrences.
Dialectical Behavior Therapy
DBT combines standard cognitive behavioral techniques for emotion regulation and reality-testing with concepts of distress tolerance, acceptance, and mindful awareness largely derived from Buddhist meditative practice.
Mindfulness is one of the core ideas behind all elements of DBT. It is considered a foundation for the other skills taught in DBT, because it helps individuals accept and tolerate the powerful emotions they may feel when challenging their habits or exposing themselves to upsetting situations. The concept of mindfulness and the meditative exercises used to teach it are derived from traditional Buddhist practice, though the version taught in DBT does not involve any religious or metaphysical concepts. Within DBT it is the capacity to pay attention, nonjudgmentally, to the present moment; about living in the moment, experiencing one's emotions and senses fully, yet with perspective. The practice of mindfulness can also be intended to make people more aware of their environments through their 5 senses: touch, smell, sight, taste, and sound.
Acceptance and Change
An essential part of learning acceptance is to first grasp the idea of radical acceptance: radical acceptance embraces the idea that one should face situations, both positive and negative, without judgment. Acceptance also incorporates mindfulness and emotional regulation skills, which depend on the idea of radical acceptance. These skills, specifically, are what set DBT apart from other therapies.
Dialectical behavior therapy emphasizes learning to bear pain skillfully. Distress tolerance skills constitute a natural development from DBT mindfulness skills. They have to do with the ability to accept, in a non-evaluative and nonjudgmental fashion, both oneself and the current situation. Since this is a non-judgmental stance, this means that it is not one of approval or resignation. The goal is to become capable of calmly recognizing negative situations and their impact, rather than becoming overwhelmed or hiding from them.
Emotional regulation skills are based on the theory that intense emotions are a conditioned response to troublesome experiences, the conditioned stimulus, and therefore, are required to alter the patient’s conditioned response. These skills can be categorized into four modules: understanding and naming emotions, changing unwanted emotions, reducing vulnerability, and managing extreme conditions.