Measuring the role of psychological inflexibility in Trichotillomania (original) (raw)
Related papers
Behaviour Research and Therapy, 2006
This randomized trial compared a combined Acceptance and Commitment Therapy/Habit Reversal Training (ACT/HRT) to a waitlist control in the treatment of adults with trichotillomania (TTM). Twentyfive participants (12 treatment and 13 waitlist) completed the trial. Results demonstrated a significant reduction in hair pulling severity, impairment ratings, and hairs pulled, along with significant reductions in experiential avoidance and both anxiety and depressive symptoms in the ACT/HRT group compared to the waitlist control. Reductions generally were maintained at a 3-month follow-up. Decreases in experiential avoidance and greater treatment compliance were significantly correlated with reductions in TTM severity, implying that targeting experiential avoidance may be useful in the treatment of TTM. Other implications and suggestions for future research are noted. r
Reliability and validity of the Trichotillomania Dimensional Scale (TTM-D)
Journal of Obsessive-Compulsive and Related Disorders, 2018
Trichotillomania (TTM) is characterized by repetitive hair pulling resulting in hair loss. The Trichotillomania Dimensional Scale (TTM-D) is a newly developed DSM-5 scale that aims to assess the symptoms of TTM dimensionally. The aim of this current study was to examine the psychometric properties of the TTM-D in a sample of 483 participants. Principal Component Analysis indicated a single factor structure of the TTM-D. Internal consistency and test retest reliability was high (α = 0.89 and r = 0.91 respectively). The TTM-D demonstrated excellent convergent validity with the Massachusetts General Hospital Hair Pulling Scale (MGH-HPS; r s = 0.90) and divergent validity with the Depression Anxiety and Stress Scale (DASS-21; r s = 0.45). Further, the TTM-D demonstrated equivalence between online and pen-and-paper administrations (r s = 0.93). The findings suggest that the psychometric properties of TTM-D are sound and well supported within a community sample.
Factor analysis of the Milwaukee Inventory for Subtypes of Trichotillomania-Adult Version
Journal of Obsessive-Compulsive and Related Disorders, 2016
The Milwaukee Inventory for Subtypes of Trichotillomania-Adult Version (MIST-A; Flessner et al., 2008) measures the degree to which hair pulling in Trichotillomania (TTM) can be described as "automatic" (i.e., done without awareness and unrelated to affective states) and/or "focused" (i.e., done with awareness and to regulate affective states). Despite preliminary evidence in support of the psychometric properties of the MIST-A, emerging research suggests the original factor structure may not optimally capture TTM phenomenology. Using data from a treatment-seeking TTM sample, the current study examined the factor structure of the MIST-A via exploratory factor analysis. The resulting two factor solution suggested the MIST-A consists of a 5-item "awareness of pulling" factor that measures the degree to which pulling is done with awareness and an 8-item "internal-regulated pulling" factor that measures the degree to which pulling is done to regulate internal stimuli (e.g., emotions, cognitions, and urges). Correlational analyses provided preliminary evidence for the validity of these derived factors. Findings from this study challenge the notions of "automatic" and "focused" pulling styles and suggest that researchers should continue to explore TTM subtypes.
Validating indicators of treatment response: Application to trichotillomania
Psychological Assessment, 2014
Different studies of the treatment of trichotillomania (TTM) have used varying standards to determine the proportion of patients who obtain clinically meaningful benefits, but there is little information on the similarity of results yielded by these methods or on their comparative validity. Data from a stepped-care (Step 1: Web-based self-help;
Acceptance-Enhanced Behavior Therapy for Trichotillomania in Adolescents
Although several studies have examined the efficacy of Acceptance Enhanced Behavior Therapy (AEBT) for the treatment of trichotillomania (TTM) in adults, data are limited with respect to the treatment of adolescents. Our case series illustrates the use of AEBT for TTM in the treatment of two adolescents. The AEBT protocol (Woods & Twohig, 2008) is a structured treatment manual that was adapted to the individual clients' needs and clinical progress. Both clients reported clinically significant gains in treatment as determined by at least 2 weeks of abstinence from pulling, and subjective reports of decreased distress and impairment, although one required a booster session due to relapse. AEBT is worth further exploration as a treatment for adolescents with TTM.
Acceptance and Commitment Therapy and Habit Reversal Training for the Treatment of Trichotillomania
Trichotillomania is a behavioral problem, and is often referred to as a habit disorder, but it is important to consider the cognitive and emotional components of the behavior. Current treatment recommendations include a traditional behavioral approach (Habit Reversal Training; HRT) combined with an approach that addresses the cognitive and emotional components of the behavior (Acceptance and Commitment Therapy [ACT] or Dialectical Behavior Therapy [DBT]). Current evidence indicates a combination of ACT and HRT is an effective treatment for trichotillomania. The goal of this article is to replicate the effectiveness of the ACT/HRT treatment package for trichotillomania and to provide practical clinical guidance on how to deliver the treatment. This guidance is presented in the context of an empirical study in which 5 participants demonstrating high levels of pulling at pretreatment were treated with 8 sessions of a combination of ACT and HRT. Treatment resulted in an 88.87% reduction in pulling across participants from pretreatment to posttreatment, and all 5 responded to the treatment. At 3-month follow-up, 2 participants maintained the treatment gains, 2 lost half of the treatment gains, and 1 was at pretreatment levels. A discussion of the results is presented along with implications for clinical practice and future directions for research.
Pilot trial of dialectical behavior therapy-enhanced habit reversal for trichotillomania
Depression and Anxiety, 2010
Background: Not all hair pullers improve acutely with cognitive-behavioral treatment (CBT) and few maintain their gains over time. Methods: We conducted an open clinical trial of a new treatment that addresses affectively triggered pulling and emphasizes relapse prevention in addition to standard CBT approaches. Ten female participants satisfying DSM-IV criteria for trichotillomania (TTM) at two study sites received Dialectical Behavior Therapy (DBT)-enhanced CBT consisting of 11 weekly sessions and 4 maintenance sessions over the following 3 months. Independent assessors rated hair pulling impairment and global improvement at several study time points. Participants completed self-report measures of hair pulling severity and emotion regulation. Results: Significant improvement in hair pulling severity and emotion regulation, as well as hair pulling impairment and anxiety and depressive symptoms, occurred during acute treatment and were maintained during the subsequent 3 months. Significant correlations were reported between changes in emotion regulation and hair pulling severity during both the acute treatment and maintenance phases. Conclusions: This study offers preliminary evidence for the efficacy of DBT-enhanced CBT for TTM and suggests the importance of addressing emotion regulation during TTM treatment. Depression and Anxiety 0:1-7, 2010.
Behavior Therapy, 1998
The effectiveness of a cognitive behavioral treatment program for trichotillomania was examined in an uncontrolled study. Immediately following treatment, 12 of 14 treatment completers were classified as responders (>50% improvement on NIMH Trichotillomania Severity Scale). However, only 4 of 13 treated patients were classified as responders at follow-up (M = 3 years, 9 months); one posttreatment responder was lost to follow-up. Long-term symptom severity was also assessed in a subset of treatment refusers and dropouts; 4 of 10 available treatment refusers and dropouts were classified as improved at follow-up (M = 3 years, 2 months). Our findings suggest a significant risk for relapse following successful cognitive behavioral treatment of trichotillomania. Recommendations to address this problem include extending treatment length to achieve greater initial symptom reduction and expanding the focus on relapse prevention strategies.
A comprehensive model for behavioral treatment of trichotillomania
Cognitive and Behavioral Practice, 1999
7}ichotiUomania is a disorder characterized by repetitive pulling out of one's hair. In this paper, we explore the essential elements for effective treatment and propose a comprehensive model for behavioral intervention. Individualized, focused treatment proceeds through four phases: First, a functional analysis is conducted that garners information about critical antecedents, behaviors, and consequences of hair pulling. Next, this information is organized into cognitive, affective, motoric, sensory, and environmental modalities. Then, specific treatment strategies are selected and implemented to target critical maintaining factors through relevant modalities. Finally, evaluation and modifications are made as necessary. The potential advantages of this approach are discussed, as are its limitations.
Journal of Psychopathology and Behavioral Assessment, 2008
This article describes the development of the Milwaukee Inventory for Subtypes of Trichotillomania-Adult Version (MIST-A), which was designed to assess "automatic" and "focused" pulling subtypes of trichotillomania (TTM). Participants reporting symptoms of TTM (n=1,697) completed an internet survey; participants were later randomly assigned to either Exploratory (n=848) or Confirmatory (n=849) Analyses. Exploratory Analyses examined the development and psychometric properties of the MIST-A. Results of an exploratory factor analysis revealed a two-factor solution. Factor 1 ("focused" pulling scale) and 2 ("automatic" pulling scale) consisted of ten and five items respectively, with both scales demonstrating adequate internal consistency and good construct and discriminant validity. Subsequent confirmatory factor analysis demonstrated support for the scale's underlying factor structure. The MIST-A provides researchers with a reliable and valid assessment of "automatic" and "focused" pulling, although replication using a clinically ascertained sample is necessary.