17
New Help For Alopecia

This loss of hair is neither life threatening nor physically painful, but the good news abruptly stops there. For most people, the loss is limited to one or two areas of the head, and the hair reappears in a year or two as mysteriously as it departed. Nails may develop pits or grooves and become fragile. The symptoms may be limited to areas of loss (alopecia areata) or worsen to loss of all scalp hair (alopecia totalis) or all body hair (alopecia universalis). At any level of severity, hair may regrow, and that regrowth may be permanent or temporary.

The emotional impact is major, heightened by the unpredictability of the disorder. Earlier onset, the absence of periodic regrowth, and more loss above the ears and at the nape of the neck all point to a less optimistic outcome.

The cause of alopecia is unknown, but recent research focuses on the role of the immune system. Alopecia may be an autoimmune disorder in which the immune system mistakenly reacts to the hair follicle as if it were a foreign intruder.

There is no definitive medical treatment. Cortisone, anthralin, chemically induced allergic reactions, and PUVA (psoralen and ultraviolet A light) each have their successes and complications. Medications to affect the immune system directly and minoxidil (better known for its use for male pattern baldness) show promise.

Feelings of shame are common; many people become preoccupied with finding the right wig to conceal their condition and live in fear of exposure. It was an act of true courage when a Rhode Island news anchorman with alopecia took off his wig on camera one night.

The National Alopecia Areata Foundation is a major resource. It may well have a support group in your area. When I spoke to the Boston chapter, I was impressed with the warm, supportive atmosphere, its ability to integrate the needs of both child and adult members, and the quality of organization and information. The organization publishes its own newsletter and information sheets, including medical information, coping strategies, and cosmetic approaches.

Emotional stress frequently triggers alopecia. Traumatic loss is the most frequently cited source of the stress. So here we have a problem with a clear emotional trigger in which the emotionally responsive immune system plays a major role, with often devastating emotional consequences. You'd expect to now hear all about the effectiveness of the various psychological techniques. At the time of the first edition, there were only two reports of treatment, which I didn't bother detailing. An optimist would have called them "promising," a pessimist "inconclusive."

Cohen and Lichtenberg gave rich descriptions of two patients in psychoanalytic psychotherapy who developed alopecia as the other problems that had brought them into treatment resolved. The approaching end of the therapeutic relationship seemed to rekindle earlier issues of loss and emotional focus on hair. The alopecia seemed to be a signal that more treatment was needed.

Stowe and Goldenberg reported the successful treatment of a twenty-year-old male prison inmate. He used a relaxation tape on his own and worked for eight one-hour sessions with the therapist. He learned to relax while imagining progressively more anxiety-provoking situations. His hot spots were heterosexual relationships, "overconcern with neatness and precision," and "autonomic distress," but he received steroid treatment as well. Since his recovery was dramatic and otherwise untypical of steroid results, the authors concluded that his psychological treatment may have been a critical factor in his recovery.

There are no reports of the unsuccessful use of psychological techniques with alopecia.

My own experience has been minimal. I've treated only two people. One was doing very well but then vanished, so I have no follow-up, and the other began treatment but soon left the area.

The small number of people treated and special circumstances both added up to a very thin case. Had so little been done because the problem is quite rare? One person in a hundred is affected at some time in his or her life, so this isn't the explanation.

Then Susan R. Eppley decided to do her doctoral dissertation at the University of Cincinnati's Department of School Psychology and Counseling on "Relaxation and Visual Imagery: Treatment for Alopecia Areata." This little-known paper is a masterful and convincing description of what to do and how well it can work.

Eppley worked with ten adults (three men and seven women), all with a medically confirmed diagnosis of alopecia areata partialis. These volunteers' alopecia began after age sixteen, and they were not currently receiving medical or psychological treatment. Research technique was better than usual. There was a control group, and seven therapists, and hair growth was judged independently by six dermatology residents.

The results are even more impressive because the practicalities of this sort of research made the treatment less than ideal in several key ways. Each person received nearly identical treatment. (In clinical practice, the approach is constantly fine-tuned to the individual's pacing and style.) The treatment was strictly limited to four forty-five to sixty-minute sessions, plus initial and follow-up interviews.

People were not systematically taught or urged to practice on their own but were told, "That is up to you. Some patients practice at home, others do not." The therapists were primarily students, and their hypnotic training had been a single course.

Yet with all of this stacked against them, the researchers were able to document a measurable increase in hair growth and a significant reduction in the anxiety that is typically a major part of the illness.

Here are the contents of the four sessions:



Session One:  After a general introduction and time for rapport building, the therapist teaches a relaxation technique and hypnotic imaging. Progressive Relaxation is produced by a slow, progressive tensing and then relaxation of 16 major muscle groups. People were invited to carefully observe and appreciate the experiences of tension and relaxation.

Visualization training invites the person to sit with eyes closed and vividly imagine and experience being in a cabin in the mountains. Rich and elaborate descriptions of physical, sensory, and emotional details of the scene promote a vivid experience.

Discussion after the experiences focuses on any modifications or roadblocks that need to be addressed.


Session Two:  Progressive Relaxation sets the stage as in the first session. This time, the extended imagery is set on a beach:  "The sun shines upon you, upon your body and your scalp. You feel cool, relaxed, the sun warms your head. It feels good, healthy. The warmth opens the pores on your scalp and the fresh warm air bathes your scalp inside and out. Inside your scalp, the blood supply increases with the warmth. Along with increased blood supply come the healing bodies in your blood. The healing bodies nurture your scalp, bathe the hair follicles with health and warmth."


Session Three:  The same format, starting again with the Progressive Relaxation. The hypnotic image is walking barefoot in a hot, flat surrealistic landscape then jumping into cool, fresh water.


Session Four:  The imagery again focuses on relaxation and especially warmth and increased blood flow in the scalp. There is no external setting, but the "healing bodies" are imaged in more detail, wrapping around the hair follicles.


The approach is short, sweet, and painless and involves variations on techniques that should now be very familiar to readers of this book. The results from this brief program were small but significant. If you're an ardent do-it-yourselfer, try that route. If you'd like the help and support of a mental health professional, contact one. He or she need not be a "super specialist." Anyone with whom you feel rapport and who has some familiarity with relaxation and imaging techniques should be up to the job.

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