Trichotillomania Awareness Devices – Do They Work? by Matthew Toles

Feature Image: Wrist and neck worn sensors used in Dr. Himle's study. (Himle et al.)

With inventions like the Slightly Robot Bracelet having hit the market relatively recently, both patients and medical professionals are looking for more information on the effectiveness of these kinds of devices.

Building awareness has long been a staple of traditional therapy combatting both BFRBs and other mental conditions like anxiety, depression, and substance abuse. The logic goes that it is near impossible to do anything about a problem without being aware that it’s even happening. In the context of BFRBs this has historically meant keeping a journal of all times (or as many as possible) that you catch yourself pulling your hair. Writing other data, like session duration, pulling location, number of hairs pulled, the emotional state you were in, and what you were doing at the time can all be used to help identify patterns and triggers in your hair pulling. The act itself of journaling can help build awareness of passive hair pulling.

Awareness devices, however, add an entirely new way to approach the issue. Rather than relying on your own alertness to catch each time your start pulling, awareness devices offload this task onto a machine. In theory, this should increase awareness and decrease pulling, but sometimes psychology is complicated and the human mind does not behave as expected. This is why it is important to check peer-reviewed, reputable studies rather than relying on assumptions and hypotheses.

Fortunately for us, the folks over at the University of Michigan have been working on this problem longer than we have. While their device uses somewhat different technology to detect hair pulling, the principle and end result are the same.

University of Michigan Professor Joseph Himle’s team published a research study in January 2018 detailing their findings. This study was a follow-up to a successful pilot study published in 2008. Instead of using just accelerometers to detect hand position, as we use in our bracelet, Himle’s device uses a combination of an ultrasonic emitter worn on the neck, and sound receivers and accelerometers worn on the wrists. When wrists were near the neck, the bracelets alerted the user by vibration, just like our bracelets do.

Twenty subjects were given traditional habit reversal therapy (HRT) and then

The results of the study were positive:

“The results of the open trial revealed significant improvements in trichotillomania symptoms as measured by clinician and self-report rating scales. Most participants met study criteria for HRT completion and treatment effects were large. Participants reported that the AEMD, when operational, was effective in alerting participants to TTM-related behaviors.”

Even despite numerous technical issues with the device’s intended functions, the 20-person feasibility study showed strong results with significant improvement even persisting three months afterward.

While medical science is never fully complete, this study and virtually all current theory on the treatment of BFRBs indicates that this type of awareness device can be beneficial to many users.

Himle, Joseph A., et al. “Awareness Enhancing and Monitoring Device plus Habit Reversal in the Treatment of Trichotillomania: An Open Feasibility Trial.” Journal of Obsessive-Compulsive and Related Disorders, vol. 16, 2018, pp. 14–20., doi:10.1016/j.jocrd.2017.10.007.

Read the full article in the Journal of Obsessive-Compulsive and Related Disorders