Management of Trichotillomania by a Meaningful Competing Response Combined to Various Pharmacological Interventions (Al Ain Technique)

Mohammed Ahmed Allam

doi:doi:10.11648/j.ajpn.20261402.12

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Management of Trichotillomania by a Meaningful Competing Response Combined to Various Pharmacological Interventions (Al Ain Technique)

Mohammed Ahmed Allam^*

Published in American Journal of Psychiatry and Neuroscience (Volume 14, Issue 2)

Received: 11 March 2026 Accepted: 25 March 2026 Published: 13 April 2026

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Abstract

This technique includes using a tight scarf on the head and a comb plus or minus different pharmacological interventions. The tight scarf serves as a barrier for the first attempt to pull hair. If hair pulling is repeated, then head combing would be the second mechanism followed by putting the head scarf again. The hair combing is the meaningful competing response when feeling an urge to pull out hair, replacing knee squeezing and other meaningless competing responses. The overall impression by the patients and their families was that, this technique helped reducing hair pulling out and improvement was in average of 50% as per patients’ self-rated improvement and families’ observations to areas of hair loss. The fifty percent improvement included reduction in hair pulling frequency, allowing hair regrowth and reduced areas of baldness. The idea of Al Ain technique (ABT) - Al Ain is a city in UAE - stems from tailoring the behavioral intervention plan around the individualized patient’s behaviors and daily habits also tailoring the behavioral plan around the patients’ whereabouts to suit different patients with different circumstances and preferences in a meaningful way. This technique requires to be repeated in different parts of the world to hopefully replicate the results by other colleagues to have better evidence based status above case series.

Published in	American Journal of Psychiatry and Neuroscience (Volume 14, Issue 2)
DOI	10.11648/j.ajpn.20261402.12
Page(s)	41-46
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2026. Published by Science Publishing Group

Keywords

Trichotillomania, Behavioral Management of Trichotillomania, Meaningful Competing Response, Al Ain Behavioral Technique (ABT)

References

[1]	Soundarya S, Jayakar T. Trichotillomania: A case report and review of the literature. Our Dermatol Online. 2024; 15(3): 261-264. https://doi.org/10.7241/ourd.20243.9
[2]	S. Gupta, V. Loniker, S. Mazzon and A. De^.‘Keep your hair on!’ A historical narration of trichotillomania. British Journal of Dermatology Volume 185, Issue S1 p. 166. 06 July 2021 https://doi.org/10.1111/bjd.20345
[3]	Diefenbach GJ, Mouton-Odum S, Stanley MA (November 2002). "Affective correlates of trichotillomania". Behaviour Research and Therapy. 40(11): 1305–1315. https://doi.org/10.1016/S0005-7967(02)00006-2
[4]	American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
[5]	Swedo SE, Leonard HL, Rapoport JL, Lenane MC, Goldberger EL, Cheslow DL. A double-blind comparison of clomipramine and desipramine in the treatment of trichotillomania (hair pulling). N Engl J Med. 1989 Aug 24; 321(8): 497-501. https://doi.org/10.1056/NEJM198908243210803
[6]	Soriano JL, O'Sullivan RL, Baer L, Phillips KA, McNally RJ, Jenike MA. Trichotillomania and self-esteem: a survey of 62 female hai r pullers. J Clin Psychiatry. 1996 Feb; 57(2): 77-82.
[7]	Melo DF, Lima CDS, Piraccini BM, Tosti A. Trichotillomania: What Do We Know So Far? Skin Appendage Disord. 2022 Jan; 8(1): 1-7. https://doi.org/10.1159/000518191 Epub 2021 Sep 1.
[8]	França K, Kumar A, Castillo D, Jafferany M, Hyczy da Costa Neto M, Damevska K, et al. Trichotillomania (hair-pulling disorder): clinical characteristics, psychosocial aspects, treatment approaches, and ethical considerations. Dermatol Ther. 2019; Jul; 32((4)): e12622. https://doi.org/10.1111/dth.12622
[9]	Sarah Anwar and Mohammad Jafferany. Trichotillomania: a psychopathological perspective and the psychiatric comorbidity of hair pulling Alpina, Acta Dermatovenerologica. 2019; 28: 33-36 https://doi.org/10.15570/actaapa.2019.7
[10]	Mackay, Clare. (2023). Trichotillomania: a perspective synthesized from neuroscience and lived experience. BMJ Ment Health. 26. https://doi.org/10.1136/bmjment-2023-300795
[11]	Tay YK, Levy ML, Metry DW (May 2004). "Trichotillomania in childhood: case series and review". Pediatrics. 113(5): e494–e498. https://doi.org/10.1542/peds.113.5.e494
[12]	Walther MR, Ricketts EJ, Conelea CA, Woods DW. Recent Advances in the Understanding and Treatment of Trichotillomania. J Cogn Psychother. 2010 Feb 1; 24(1): 46-64. https://doi.org/10.1891/0889-8391.24.1.46
[13]	Chamberlain SR, Menzies LA, Fineberg NA, et al. Grey matter abnormalities in trichotillomania: morphometric magnetic resonance imaging study. British Journal of Psychiatry. 2008; 193(3): 216-221. https://doi.org/10.1192/bjp.bp.107.048314
[14]	Grant JE, Odlaug BL, Kim SW. N-Acetylcysteine, a glutamate modulator, in the treatment of trichotillomania: A double-blind, placebo-controlled study. Archives of General Psychiatry. 2009; 66: 756–763. https://doi.org/10.1001/archgenpsychiatry.2009.60
[15]	Dan J, Ben van Heerden, Charmaine H, Jeanine van Kradenburg, James W, Nompumelelo Z, and Soraya S. Functional brain imaging and pharmacotherapy in trichotillomania Single photon emission computed tomography before and after treatment with the selective serotonin reuptake inhibitor citalopram. Progress in Neuro-Psychopharmacology & Biological Psychiatry 26 (2002) 885 – 890.
[16]	Grant JE, Peris TS, Ricketts EJ, Bethlehem RAI, Chamberlain SR, O'Neill J, Scharf JM, Dougherty DD, Deckersbach T, Woods DW, Piacentini J, Keuthen NJ. Reward processing in trichotillomania and skin picking disorder. Brain Imaging Behav. 2022 Apr; 16(2): 547-556. https://doi.org/10.1007/s11682-021-00533-5 Epub 2021 Aug 19.
[17]	Pongsatorn P and Mario N. Trichotillomania as a Manifestation of Dementia. Case reports in Psychiatry. October 2016(6): 1-5. https://doi.org/10.1155/2016/9782702
[18]	Rege S and Vicki A. An open label flexible dose study of olanzapine in treatment of Trichotillomania. J clinical psychiatry 2003; 64: 49-52.
[19]	Jon E. Grant, Ibrahim H. Aslan, Samuel R. Chamberlain. Statistical Predictors of Psychosocial Impairment in BodyFocused Repetitive Behaviors. CNS Spectr. 2022 October; 27(5): 621–625. https://doi.org/10.1017/S1092852921000468

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APA Style

Allam, M. A. (2026). Management of Trichotillomania by a Meaningful Competing Response Combined to Various Pharmacological Interventions (Al Ain Technique). American Journal of Psychiatry and Neuroscience, 14(2), 41-46. https://doi.org/10.11648/j.ajpn.20261402.12

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ACS Style

Allam, M. A. Management of Trichotillomania by a Meaningful Competing Response Combined to Various Pharmacological Interventions (Al Ain Technique). Am. J. Psychiatry Neurosci. 2026, 14(2), 41-46. doi: 10.11648/j.ajpn.20261402.12

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AMA Style

Allam MA. Management of Trichotillomania by a Meaningful Competing Response Combined to Various Pharmacological Interventions (Al Ain Technique). Am J Psychiatry Neurosci. 2026;14(2):41-46. doi: 10.11648/j.ajpn.20261402.12

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@article{10.11648/j.ajpn.20261402.12,
  author = {Mohammed Ahmed Allam},
  title = {Management of Trichotillomania by a Meaningful Competing Response Combined to Various Pharmacological Interventions (Al Ain Technique)},
  journal = {American Journal of Psychiatry and Neuroscience},
  volume = {14},
  number = {2},
  pages = {41-46},
  doi = {10.11648/j.ajpn.20261402.12},
  url = {https://doi.org/10.11648/j.ajpn.20261402.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajpn.20261402.12},
  abstract = {This technique includes using a tight scarf on the head and a comb plus or minus different pharmacological interventions. The tight scarf serves as a barrier for the first attempt to pull hair. If hair pulling is repeated, then head combing would be the second mechanism followed by putting the head scarf again. The hair combing is the meaningful competing response when feeling an urge to pull out hair, replacing knee squeezing and other meaningless competing responses. The overall impression by the patients and their families was that, this technique helped reducing hair pulling out and improvement was in average of 50% as per patients’ self-rated improvement and families’ observations to areas of hair loss. The fifty percent improvement included reduction in hair pulling frequency, allowing hair regrowth and reduced areas of baldness. The idea of Al Ain technique (ABT) - Al Ain is a city in UAE - stems from tailoring the behavioral intervention plan around the individualized patient’s behaviors and daily habits also tailoring the behavioral plan around the patients’ whereabouts to suit different patients with different circumstances and preferences in a meaningful way. This technique requires to be repeated in different parts of the world to hopefully replicate the results by other colleagues to have better evidence based status above case series.},
 year = {2026}
}

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TY  - JOUR
T1  - Management of Trichotillomania by a Meaningful Competing Response Combined to Various Pharmacological Interventions (Al Ain Technique)
AU  - Mohammed Ahmed Allam
Y1  - 2026/04/13
PY  - 2026
N1  - https://doi.org/10.11648/j.ajpn.20261402.12
DO  - 10.11648/j.ajpn.20261402.12
T2  - American Journal of Psychiatry and Neuroscience
JF  - American Journal of Psychiatry and Neuroscience
JO  - American Journal of Psychiatry and Neuroscience
SP  - 41
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PB  - Science Publishing Group
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AB  - This technique includes using a tight scarf on the head and a comb plus or minus different pharmacological interventions. The tight scarf serves as a barrier for the first attempt to pull hair. If hair pulling is repeated, then head combing would be the second mechanism followed by putting the head scarf again. The hair combing is the meaningful competing response when feeling an urge to pull out hair, replacing knee squeezing and other meaningless competing responses. The overall impression by the patients and their families was that, this technique helped reducing hair pulling out and improvement was in average of 50% as per patients’ self-rated improvement and families’ observations to areas of hair loss. The fifty percent improvement included reduction in hair pulling frequency, allowing hair regrowth and reduced areas of baldness. The idea of Al Ain technique (ABT) - Al Ain is a city in UAE - stems from tailoring the behavioral intervention plan around the individualized patient’s behaviors and daily habits also tailoring the behavioral plan around the patients’ whereabouts to suit different patients with different circumstances and preferences in a meaningful way. This technique requires to be repeated in different parts of the world to hopefully replicate the results by other colleagues to have better evidence based status above case series.
VL  - 14
IS  - 2
ER  -

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Author Information

Mohammed Ahmed Allam

Department of Psychiatry, Al Ain Hospital, Al Ain City, United Arab Emirates (UAE)

Contact Email

http://orcid.org/0000-0002-7041-0211

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Plain Text BibTeX RIS

APA Style

Allam, M. A. (2026). Management of Trichotillomania by a Meaningful Competing Response Combined to Various Pharmacological Interventions (Al Ain Technique). American Journal of Psychiatry and Neuroscience, 14(2), 41-46. https://doi.org/10.11648/j.ajpn.20261402.12

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ACS Style

Allam, M. A. Management of Trichotillomania by a Meaningful Competing Response Combined to Various Pharmacological Interventions (Al Ain Technique). Am. J. Psychiatry Neurosci. 2026, 14(2), 41-46. doi: 10.11648/j.ajpn.20261402.12

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AMA Style

Allam MA. Management of Trichotillomania by a Meaningful Competing Response Combined to Various Pharmacological Interventions (Al Ain Technique). Am J Psychiatry Neurosci. 2026;14(2):41-46. doi: 10.11648/j.ajpn.20261402.12

Copy | Download

@article{10.11648/j.ajpn.20261402.12,
  author = {Mohammed Ahmed Allam},
  title = {Management of Trichotillomania by a Meaningful Competing Response Combined to Various Pharmacological Interventions (Al Ain Technique)},
  journal = {American Journal of Psychiatry and Neuroscience},
  volume = {14},
  number = {2},
  pages = {41-46},
  doi = {10.11648/j.ajpn.20261402.12},
  url = {https://doi.org/10.11648/j.ajpn.20261402.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajpn.20261402.12},
  abstract = {This technique includes using a tight scarf on the head and a comb plus or minus different pharmacological interventions. The tight scarf serves as a barrier for the first attempt to pull hair. If hair pulling is repeated, then head combing would be the second mechanism followed by putting the head scarf again. The hair combing is the meaningful competing response when feeling an urge to pull out hair, replacing knee squeezing and other meaningless competing responses. The overall impression by the patients and their families was that, this technique helped reducing hair pulling out and improvement was in average of 50% as per patients’ self-rated improvement and families’ observations to areas of hair loss. The fifty percent improvement included reduction in hair pulling frequency, allowing hair regrowth and reduced areas of baldness. The idea of Al Ain technique (ABT) - Al Ain is a city in UAE - stems from tailoring the behavioral intervention plan around the individualized patient’s behaviors and daily habits also tailoring the behavioral plan around the patients’ whereabouts to suit different patients with different circumstances and preferences in a meaningful way. This technique requires to be repeated in different parts of the world to hopefully replicate the results by other colleagues to have better evidence based status above case series.},
 year = {2026}
}

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TY  - JOUR
T1  - Management of Trichotillomania by a Meaningful Competing Response Combined to Various Pharmacological Interventions (Al Ain Technique)
AU  - Mohammed Ahmed Allam
Y1  - 2026/04/13
PY  - 2026
N1  - https://doi.org/10.11648/j.ajpn.20261402.12
DO  - 10.11648/j.ajpn.20261402.12
T2  - American Journal of Psychiatry and Neuroscience
JF  - American Journal of Psychiatry and Neuroscience
JO  - American Journal of Psychiatry and Neuroscience
SP  - 41
EP  - 46
PB  - Science Publishing Group
SN  - 2330-426X
UR  - https://doi.org/10.11648/j.ajpn.20261402.12
AB  - This technique includes using a tight scarf on the head and a comb plus or minus different pharmacological interventions. The tight scarf serves as a barrier for the first attempt to pull hair. If hair pulling is repeated, then head combing would be the second mechanism followed by putting the head scarf again. The hair combing is the meaningful competing response when feeling an urge to pull out hair, replacing knee squeezing and other meaningless competing responses. The overall impression by the patients and their families was that, this technique helped reducing hair pulling out and improvement was in average of 50% as per patients’ self-rated improvement and families’ observations to areas of hair loss. The fifty percent improvement included reduction in hair pulling frequency, allowing hair regrowth and reduced areas of baldness. The idea of Al Ain technique (ABT) - Al Ain is a city in UAE - stems from tailoring the behavioral intervention plan around the individualized patient’s behaviors and daily habits also tailoring the behavioral plan around the patients’ whereabouts to suit different patients with different circumstances and preferences in a meaningful way. This technique requires to be repeated in different parts of the world to hopefully replicate the results by other colleagues to have better evidence based status above case series.
VL  - 14
IS  - 2
ER  -

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