If you find yourself restless during the night, tossing and turning, and waking up with the feeling that you are carrying the weight of the world on your shoulders, you may be stressed or feeling anxious. Such weight or feelings of anxiety you may find then lead to an irritable mood, sap you of your enthusiasm, and yes slowly wear down your physical readiness, which may even lead to lack of concentration poor judgment and yes pulling. In our work with people recovering from Trich, we have found that stress and in fact restless night can impede your progress. Indeed, your observation that those shoulders of yours seem to be getting weaker with each passing day may in fact be correct.

For people with Trichotillomania, anxiety and or stress may be old acquaintances that you may often feel you are able to contain. However, the above scenario of restless nights due to the long list of life, work commitments and guilt over resistant habits, is all too familiar with one who has worked with many experiencing stress and habit disorder related difficulties.

What then might one due to help alleviate such levels of restlessness and stress? While there are numerous approaches to controlling ones’ anxiety, the following points represent some obvious but often overlooked ways that you can use to help get your thoughts back under control and ultimately get the rest you need to stay focused on your goals to recover. Consider the following:

• Stop being so spontaneous and get predictable: Living for the moment and spontaneity can be fun, but often create uncertainty in our lives. The key to mastering stress is to organize! Yes that’s it, plan your day or week with a schedule of events that seems doable and stick to it. Write down your schedule and keep it in your journal; the few minutes you spend doing this will have an almost immediate effect on lessening your level of stress.
• Learn from the worst: There is evidence to suggest that learning from negative situations can help you cope in the future. Take the most horrendous situation you have experienced and look for the positive. Perhaps you learned what not to do in the future or perhaps you developed some positive means of coping with a disastrous bout of pulling that might be beneficial in the future.
  
• Expect the Unexpected: No matter how much you may want something to work out the right way, leave a little room for error. We have not yet found a technique for controlling pulling that has not had its disappointments.
• Don’t expect to change the past: Learn from the past and then forget about the incident. The single best technique for coping with the past is acceptance of it. Accept the fact that what has happened has happened and move on. Get over it, the time spent rethinking and playing out "what if scenarios" in your mind should be relatively short lived. You can’t change the fact that you may have pulled too much yesterday, but can work on what you do not want to do today.
• Stop saying yes: Feel free to say no to a friend or family member’s request from time to time. Just because you want to be nice, doesn’t mean that you can solve everyone’s problems or have to please everyone all of the time. If you are falling into this pattern of wanting to uphold your image with family and friends, try telling yourself, "it’s OK" if someone disapproves of my saying no to their request.
  
• Learn to do visual imagery: If you anticipate an uncomfortable situation, don’t deny it, rather face it as difficult as it may be. Try to imagine the situation beforehand, think about the bad feelings involved, and then plan how to best handle it, or tell yourself coping statements such as "even if this is an awful situation or event, I can survive or deal with the unpleasantness."

For those who are coping with recovery from Trich, stress is always present, even if it is lurking in the background. Implementing some of these strategies can be helpful on the roller coaster to recovery and helpful in getting you that much deserved restful night of sleep.

Dr. Hank Srednicki is Chief Psychologist of Upper Montclair Psychological Associates, LLC and specializes in the cognitive behavioral treatment of Trichotillomania.

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