The role of psychological flexibility in acceptance-enhanced behavior therapy for trichotillomania: Moderation and mediation findings

A multi-modality and multi-dyad approach to measuring flexibility in psychotherapy

INTRODUCTION

Flexibility, the ability of an individual to adapt to environmental changes in ways that facilitate goal attainment, has been proposed as a potential mechanism underlying psychopathology and psychotherapy. In psychotherapy, most findings are based on self-report measures that have important limitations. We propose a multimodal, multi-dyad approach based on a nonlinear dynamical systems framework to capture the complexity of this concept.

METHOD

A new research paradigm was designed to explore the validity of the proposed conceptual model. The paradigm includes a psychotherapy-like social interaction, during which body movement and facial expressiveness data were collected. We analyzed the data using Hankel Alternative View of Koopmann analysis to reconstruct attractors of the observed behaviors and compare them.

RESULTS

The patterns of behavior in the two cases differ, and differences in the reconstructed attractors correspond with differences in self-report measures and behavior in the interactions.

CONCLUSIONS

The case studies show that information provided by a single modality is not enough to provide the full picture, and multiple modalities are needed. These observations can serve as an initial support for our claims that a multi-modal and multi-dyad approach to flexibility can address some of the issues of measurement in the field.

A Review of Research on Acceptance and Commitment Therapy for Anxiety and Obsessive-Compulsive and Related Disorders

This article reviews acceptance and commitment therapy (ACT) for anxiety disorders, obsessive-compulsive disorder (OCD), trichotillomania, excoriation disorder, hoarding, and body dysmorphic disorder (BDD). Measurement of psychological inflexibility and its relationship to pathology is reviewed. Outcome work in all disorders listed is reviewed with results supporting ACT for anxiety disorders, OCD, and trichotillomania, but there is limited evidence for excoriation disorder, hoarding, and BDD. Future research should focus on processes of change in addition to outcomes.

Predicting response to and relapse after treatment of trichotillomania with the Comprehensive Behavioral model (ComB)

Prior studies of behavior therapy for trichotillomania (TTM) have shown that response is variable, and relapse after treatment discontinuation is common. Little information is available concerning prognostic factors capable of predicting individual differences in response or maintenance of improvement. The present study is a secondary analysis of a randomized controlled trial (N = 36) of the Comprehensive Behavioral (ComB) model of treatment for TTM (Carlson et al., 2021). We investigated age, disorder history, pre-treatment symptom severity, longest prior period of abstinence from pulling, and Emotion and Intention hair pulling styles as predictors of initial response. We studied age, disorder history, pre-treatment symptom severity, longest prior period of abstinence from pulling, and post-treatment symptom severity or hair-pulling abstinence as predictors of relapse following treatment. Older age significantly predicted lower TTM severity following treatment. Lower pre-treatment severity significantly predicted lower severity of TTM at the 3-month follow-up.