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Barber KE, Woods DW, Deckersbach T, Bauer CC, Compton SN, Twohig MP, Ricketts EJ, Robinson J, Saunders SM, Franklin ME. Neurocognitive functioning in adults with trichotillomania: Predictors of treatment response and symptom severity in a randomized control trial. Behav Res Ther 2024; 179:104556. [PMID: 38761558 DOI: 10.1016/j.brat.2024.104556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 05/20/2024]
Abstract
Trichotillomania (TTM) is associated with impairments in response inhibition and cognitive flexibility, but it is unclear how such impairments relate to treatment outcome. The present study examined pre-treatment response inhibition and cognitive flexibility as predictors of treatment outcome, change in these domains from pre-to post-treatment, and associations with TTM severity. Participants were drawn from a randomized controlled trial comparing acceptance-enhanced behavior therapy (AEBT) to psychoeducation and supportive therapy (PST) for TTM. Adults completed assessments at pre-treatment (n = 88) and following 12 weeks of treatment (n = 68). Response inhibition and cognitive flexibility were assessed using the Stop Signal Task and Object Alternation Task, respectively. Participants completed the MGH-Hairpulling Scale. Independent evaluators administered the NIMH-Trichotillomania Severity Scale and Clinical Global Impressions-Improvement Scale. Higher pre-treatment TTM severity was associated with poorer pre-treatment cognitive flexibility, but not response inhibition. Better pre-treatment response inhibition performance predicted positive treatment response and lower post-treatment TTM symptom severity, irrespective of treatment assignment. Cognitive flexibility did not predict treatment response. After controlling for age, neither neurocognitive variable changed during treatment. Response inhibition and cognitive flexibility appear uniquely related to hair pulling severity and treatment response in adults with TTM. Implications for treatment delivery and development are discussed.
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Affiliation(s)
- Kathryn E Barber
- Department of Psychology, Marquette University, 317 604 N. 16th St. Milwaukee, WI, 53233, USA.
| | - Douglas W Woods
- Department of Psychology, Marquette University, 317 604 N. 16th St. Milwaukee, WI, 53233, USA
| | - Thilo Deckersbach
- University of Applied Sciences, DIPLOMA Hochschule, Am Hegeberg 2, 37242 Bad Sooden-Allendorf, Germany
| | - Christopher C Bauer
- Medical College of Wisconsin, Health Resource Center, 8701 Watertown Plank Rd., 5th Floor, Milwaukee, WI, 53226, USA
| | - Scott N Compton
- Department of Psychiatry and Behavioral Sciences, Duke University, Duke Child and Family Study Center, 2608 Erwin Road Durham, NC, 27705, USA
| | - Michael P Twohig
- Utah State University, Department of Psychology, 2810 Old Main Hill, Logan, UT, 84322, USA
| | - Emily J Ricketts
- Department of Neuroscience, UCLA Semel Institute, 1506 Gonda Center Los Angeles, California, 90095, USA
| | - Jordan Robinson
- JSR Neuropsychological Services, 3209 W 76th St, Edina, MN, 55435, USA
| | - Stephen M Saunders
- Department of Psychology, Marquette University, 317 604 N. 16th St. Milwaukee, WI, 53233, USA
| | - Martin E Franklin
- Rogers Behavioral Health, 1 Winding Drive, Suite 106, Philadelphia, PA, 19131, USA
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Ong CW, Woods DW, Franklin ME, Saunders SM, Neal-Barnett AM, Compton SN, Twohig MP. The role of psychological flexibility in acceptance-enhanced behavior therapy for trichotillomania: Moderation and mediation findings. Behav Res Ther 2023; 164:104302. [PMID: 37030243 PMCID: PMC10115155 DOI: 10.1016/j.brat.2023.104302] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/16/2023] [Accepted: 03/18/2023] [Indexed: 04/07/2023]
Abstract
Trichotillomania is characterized by recurrent pulling out of one's hair, leading to significant hair loss and accompanied by clinically significant distress and/or functional impairment. The current study used data from a randomized controlled trial comparing the effectiveness of acceptance-enhanced behavior therapy (AEBT) to psychoeducation plus supportive therapy (PST; active control) for trichotillomania in an adult sample. The objectives were to examine the moderating and mediating influence of trichotillomania-specific psychological flexibility in treatment for trichotillomania. Participants with lower baseline flexibility performed better in AEBT than PST in terms of greater symptom reduction and quality of life. Lower baseline flexibility also predicted higher likelihood of disorder recovery in AEBT relative to PST. In addition, relative to PST, symptom reduction in AEBT was mediated by psychological flexibility, controlling for anxiety and depression. These findings suggest that psychological flexibility is a relevant process of change in the treatment of trichotillomania. Clinical implications and directions for future research are discussed.
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Affiliation(s)
- Clarissa W Ong
- Department of Psychology, University of Toledo, Toledo, OH, USA.
| | - Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, WI, USA
| | | | | | | | - Scott N Compton
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
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Monoamine Oxidase Inhibitors for Trichotillomania: A Case Series. J Clin Psychopharmacol 2023; 43:149-151. [PMID: 36700727 DOI: 10.1097/jcp.0000000000001654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE/BACKGROUND Despite several decades of research, there are no US Food and Drug Administration-approved medications for trichotillomania or medications generally approved in other geographical jurisdictions. Monoamine oxidase inhibitors show efficacy in the treatment of depression and some possible promise for obsessive compulsive disorder. METHODS/PROCEDURES We present new data from a case series collected in a specialty clinical practice over a 4-year period. FINDINGS/RESULTS In 5 treatment-resistant patients whose trichotillomania had not improved with at least 1 course of cognitive behavior therapy and trials of n -acetyl cysteine, an antipsychotic, and a serotonin selective reuptake inhibitor, 2 had marked clinical improvement (>40% improvement) on phenelzine, 1 improved on tranylcypromine, and 2 showed no improvement (<10%) on phenelzine. In 2 of the 3 patients who experienced improvement, there was co-occurring depression. IMPLICATIONS/CONCLUSIONS Monoamine oxidase inhibitors in trichotillomania may deserve large-scale randomized controlled trials, particularly in specialist settings where first-line interventions have proven inadequate to manage severe symptoms.
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Pirdoğan Aydin E, Güler Kenar J, Altunay İK, Deniz F, Özer ÖA, Karamustafalioğlu KO. Massachusetts General Hospital Hairpulling Scale: Validity and Reliability Study of the Turkish Form. TURK PSIKIYATRI DERGISI = TURKISH JOURNAL OF PSYCHIATRY 2023; 34:2-10. [PMID: 36970956 PMCID: PMC10552164 DOI: 10.5080/u25864] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study is to analyze the validity and reliability of the Turkish form of Massachusetts General Hospital Hairpulling Scale (MGH-HPS), which is used to measure the severity of Trichotillomania (TTM). METHODS Fifty patients diagnosed with TTM according to the DSM-5 diagnostic criteria and fifty healthy controls participated in the study. The participants were asked to complete a sociodemographic questionnaire, the MGH-HPS-TR, the Clinical Global Impression (CGI), the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI) and the Barratt Impulsiveness Scale (BIS-11). The construct validity and the criterion validity of the MGH-HPS-TR were determined by means of exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), respectively. The reliability analysis of the MGH-HPS-TR was assessed by calculating the Cronbach's α coefficient and the item total correlation coefficient. The values for the area under the curve (AUC), sensitivity and specificity were based on the ROC analysis. RESULTS AFA and CFA results indicated a single factor structure with 7 items explaining 82.5% of the variance. The item/factor loadings were satisfactory with the best fit indeces. Correlations were found between the scores on the MGH-HPS-TR and the other scales used for criterion validity analyses. The internal consistency and the item-total correlation coefficients of the scale were found to be satisfactory. Based on a cut of point of ≥ 9, the scale had high power for discriminating between the patient and the control groups and high sensitivity and specificity. CONCLUSION This study showed that the MGH-HPS-TR can be used as a valid and reliable psychometric tool in Turkey.
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Parli GM, Gales MA, Gales BJ. “N-Acetylcysteine for Obsessive-Compulsive and Related Disorders in Children and Adolescents: A Review”. Ann Pharmacother 2022:10600280221138092. [DOI: 10.1177/10600280221138092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: To evaluate clinical data using oral n-acetylcysteine (NAC) in obsessive-compulsive and related disorders (OCDRD) treatment. Data Sources: PubMed, Ovid MEDLINE (1946-July 2022), and the Cochrane Library database were searched using the terms NAC, children, adolescent, obsessive-compulsive disorder (OCD), trichotillomania (TTM), excoriation, hoarding disorder, and body dysmorphic disorder. Bibliographies were reviewed for relevant trials and case studies. Study Selection and Data Extraction: English language, clinical trials, or case studies analyzing NAC use in patients aged 3 to 21 years old with OCDRD as determined by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Data Synthesis: Three randomized double-blind placebo-controlled trials of NAC in children and adolescents studied 121 patients with OCDRD. Trials assessed symptom severity from baseline to 10 to 12 weeks of NAC therapy. Two OCD trials identified statistically significant improvements, with only 1 trial demonstrating a clear clinically relevant difference from placebo. One trial in TTM found no difference between the NAC and placebo. Adverse effects were mild and included nausea, blurred vision, fatigue, tremor, and sweats. N-acetylcysteine titrated to 2400 or 2700 mg/day in divided doses was the most studied regimen. Relevance to Patient Care and Clinical Practice: Many OCDRD patients fail to completely respond to first-line treatment with cognitive behavioral therapy (CBT) and/or selective serotonin reuptake inhibitors (SSRIs) leaving practitioners with few additional treatment options. Preliminary efficacy and safety data are presented in this review. Conclusions: Limited evidence suggests children and adolescents with OCD refractory to SSRIs or CBT may benefit from NAC augmentation.
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Affiliation(s)
- Gabrielle M. Parli
- College of Pharmacy, Southwestern Oklahoma State University, Weatherford, OK, USA
| | - Mark A. Gales
- College of Pharmacy, Southwestern Oklahoma State University, Weatherford, OK, USA
- Department of Pharmacy Practice, College of Pharmacy, Southwestern Oklahoma State University, Weatherford, OK, USA
- Department of Pharmacy, INTEGRIS Baptist Medical Center, Oklahoma City, OK, USA
| | - Barry J. Gales
- College of Pharmacy, Southwestern Oklahoma State University, Weatherford, OK, USA
- Department of Pharmacy Practice, College of Pharmacy, Southwestern Oklahoma State University, Weatherford, OK, USA
- Department of Pharmacy, INTEGRIS Baptist Medical Center, Oklahoma City, OK, USA
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Evidence-based assessment of treatment outcomes for late-life generalized anxiety disorder using the Penn State Worry Questionnaire (PSWQ) and Penn State Worry Questionnaire - Abbreviated (PSWQ-A). Int Psychogeriatr 2022; 34:489-501. [PMID: 33818343 DOI: 10.1017/s1041610221000351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Penn State Worry Questionnaire (PSWQ) is a commonly used measure of treatment outcome for late-life generalized anxiety disorder (GAD). However, there is considerable variability in the definitions used to define treatment response and remission. This study aimed to provide empirically derived guidelines for assessing treatment response and remission among older adults with GAD using the PSWQ and the abbreviated PSWQ (PSWQ-A). DESIGN Longitudinal assessment of GAD symptoms pre- and posttreatment. PARTICIPANTS Participants were 259 older adults aged 60-86 years with a diagnosis of GAD who were assessed before and after treatment. INTERVENTION Participants were randomly assigned to cognitive behavioral therapy or control (waitlist, discussion group, or supportive therapy) conditions. MEASUREMENTS Signal-detection analyses using receiver operating characteristic (ROC) methods were used to determine optimal agreement between structured diagnostic interviews and scores on the PSWQ and PSWQ-A. RESULTS Results suggest that a score of ≤51 was optimal for defining diagnostic remission status on the PSWQ, and a score of ≤24 was optimal on the PSWQ-A. A 9% reduction or ≥4-point reduction was optimal for assessing treatment response on the PSWQ. The PSWQ-A was poor at identifying treatment response status. CONCLUSIONS Findings suggest that most of the previously used definitions have underestimated the treatment effects for late-life GAD. However overall, the PSWQ and PSWQ-A are suboptimal for assessing treatment outcome for late-life GAD. The standardization of response and remission criteria has implications for comparison between treatment trials, and for the benchmarking of outcomes in clinical practice.
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Farhat LC, Olfson E, Levine JL, Li F, Franklin ME, Lee HJ, Lewin AB, McGuire JF, Rahman O, Storch EA, Tolin DF, Zickgraf HF, Bloch MH. Measuring Treatment Response in Pediatric Trichotillomania: A Meta-Analysis of Clinical Trials. J Child Adolesc Psychopharmacol 2020; 30:306-315. [PMID: 31794677 PMCID: PMC7476376 DOI: 10.1089/cap.2019.0103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objectives: In clinical trials of pediatric trichotillomania (TTM), three instruments are typically employed to rate TTM severity: (1) the Massachusetts General Hospital Hair Pulling Scale (MGH-HPS), (2) the National Institute of Mental Health Trichotillomania Severity Scale (NIMH-TSS), and (3) the Trichotillomania Scale for Children (TSC). These instruments lack standardized definitions of treatment response, which lead researchers to determine their own definitions of response post hoc and potentially inflate results. We performed a meta-analysis to provide empirically determined accuracy measures for percentage reduction cut points in these three instruments. Methods: MEDLINE was searched for TTM clinical trials. A total of 67 studies were initially identified, but only 5 were clinical trials focused on TTM in pediatric populations and therefore were included in this meta-analysis (n = 180). A Clinical Global Impressions Improvement score ≤2 was used to define clinical response. Receiver operating characteristic principles were employed to determine accuracy measures for percentage reduction cut points on each one of the instruments. Meta-DiSc software was employed to provide pooled accuracy measures for each cut point for each instrument. The Youden Index and the distance to corner methods were used to determine the optimal cut point. Results: The optimal cut points to determine treatment response were a 45% reduction on the MGH-HPS (Youden Index 0.40, distance to corner 0.20), a 35% reduction on the NIMH-TSS (Youden Index 0.42, distance to corner 0.17), a 25% reduction on the TSC child version (TSC-C; Youden Index 0.40, distance to corner 0.18), and a 45% (distance to corner 0.30) or 50% reduction (Youden Index 0.33) on the TSC parent version (TSC-P). The TSC-C had less discriminative ability at determining response in younger children in comparison to older children; no age-related differences were observed on the TSC-P. Conclusions: This study provides empirically determined cut points of treatment response on three instruments that rate TTM severity. These data-driven cut points will benefit future research on pediatric TTM.
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Affiliation(s)
- Luis C. Farhat
- Departamento de Psiquiatria da Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil.,Funding: No funding was received for this article
| | - Emily Olfson
- Department of Psychiatry, Yale University, New Haven, Connecticut, USA.,Yale Child Study Center, New Haven, Connecticut, USA.,Funding: No funding was received for this article
| | - Jessica L.S. Levine
- Yale Child Study Center, New Haven, Connecticut, USA.,Funding: No funding was received for this article
| | - Fenghua Li
- Yale Child Study Center, New Haven, Connecticut, USA.,Funding: No funding was received for this article
| | - Martin E. Franklin
- Child and Adolescent OCD, Tic, Trich and Anxiety Group (COTTAGe), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Funding: No funding was received for this article
| | - Han-Joo Lee
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA.,Funding: No funding was received for this article
| | - Adam B. Lewin
- Department of Pediatrics, University of South Florida, Tampa, Florida, USA.,Funding: No funding was received for this article
| | - Joseph F. McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Funding: No funding was received for this article
| | - Omar Rahman
- Department of Pediatrics, University of South Florida, Tampa, Florida, USA.,Funding: No funding was received for this article
| | - Eric A. Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA.,Funding: No funding was received for this article
| | - David F. Tolin
- Institute of Living, Hartford, Connecticut, USA.,Yale University School of Medicine, New Haven, Connecticut, USA.,Funding: No funding was received for this article
| | - Hana F. Zickgraf
- Child and Adolescent OCD, Tic, Trich and Anxiety Group (COTTAGe), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA.,Funding: No funding was received for this article
| | - Michael H. Bloch
- Department of Psychiatry, Yale University, New Haven, Connecticut, USA.,Yale Child Study Center, New Haven, Connecticut, USA.,Funding: No funding was received for this article.,Address correspondence to: Michael H. Bloch, MD, MS, Yale Child Study Center, PO Box 207900, New Haven, CT 06520, USA
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Wetterneck C, Singh RS, Woods DW. Hair pulling antecedents in trichotillomania: Their relationship with experiential avoidance. Bull Menninger Clin 2020; 84:35-52. [DOI: 10.1521/bumc_2020_84_01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In this study, 285 adults who met criteria for trichotillomania (TTM) via self-report completed an online, cross-sectional survey examining antecedent phenomenological experiences pertaining to hair pulling along with measures of TTM severity and experiential avoidance (i.e., avoidance of or escape from unwanted thoughts or feelings). Results showed a heterogeneous depiction of antecedent experiences. Subsequent analyses revealed that certain antecedents were not significantly related to TTM severity but were significantly correlated with higher levels of experiential avoidance. In particular, four of five classes of antecedents (i.e., bodily sensations, physical symptoms, mental anxiety, and general uncomfortableness) were significantly related to greater experiential avoidance. The authors conclude that treatments may need to be designed to address specific private antecedents, and that this may be done through targeting experiential avoidance.
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Affiliation(s)
| | - R. Sonia Singh
- Postdoctoral Psychology Fellow at the South Central Mental Illness Research, Education and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock
| | - Douglas W. Woods
- Department of Psychology at Marquette University, Milwaukee, Wisconsin
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Farhat LC, Olfson E, Li F, Telang S, Bloch MH. Identifying standardized definitions of treatment response in trichotillomania: A meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2019; 89:446-455. [PMID: 30336171 DOI: 10.1016/j.pnpbp.2018.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/25/2018] [Accepted: 10/14/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Symptom severity in trichotillomania clinical trials is typically rated using the Massachusetts General Hospital Hair Pulling Scale (MGH-HPS) and the National Institute of Mental Health Trichotillomania Severity Scale (NIMH-TSS). There are no universal definitions of treatment response on these scales. The absence of empirically supported definitions of treatment response hampers advances in trichotillomania treatment. METHODS PubMed and CENTRAL databases were searched for trichotillomania clinical trials. A total of 14 studies were identified and 7 provided adequate data to be included in the meta-analysis (n = 270). Meta-DiSc software was employed. The Youden index and distance to corner were used to determine the optimal cut-point. Response was defined by the Clinical Global Impressions Improvement scale score ≤ 2. RESULTS The optimal cut-points for identifying response on the MGH-HPS was a 35% percent reduction [Youden Index 0.48; distance to corner 0.37] or a seven-point reduction [Youden Index 0.43; distance to corner 0.40]. The optimal cut-points for the NIMH-TSS was a 50% reduction [Youden Index 0.57; distance to corner 0.34] or a six-point reduction [Youden Index 0.53; distance to corner 0.36]. The optimal cut-points were similar when the analysis was confined to only trichotillomania trials involving adult subjects, but the scales appeared to have improved ability to define treatment response when pediatric subjects were excluded. CONCLUSION This study provides empirically determined cut-points of treatment response on the MGH-HPS and NIMH-TSS. These data-driven cut-points will benefit future research in trichotillomania by providing definitions of treatment response that can be defined a priori in clinical trials.
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Affiliation(s)
- Luis C Farhat
- Yale Child Study Center, New Haven, CT, United States
| | - Emily Olfson
- Yale Child Study Center, New Haven, CT, United States; Department of Psychiatry, Yale University, New Haven, CT, United States
| | - Fenghua Li
- Yale Child Study Center, New Haven, CT, United States
| | - Shilpa Telang
- Yale Child Study Center, New Haven, CT, United States
| | - Michael H Bloch
- Yale Child Study Center, New Haven, CT, United States; Department of Psychiatry, Yale University, New Haven, CT, United States.
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Lee EB, Homan KJ, Morrison KL, Ong CW, Levin ME, Twohig MP. Acceptance and Commitment Therapy for Trichotillomania: A Randomized Controlled Trial of Adults and Adolescents. Behav Modif 2018; 44:70-91. [DOI: 10.1177/0145445518794366] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to examine acceptance and commitment therapy (ACT) as a standalone treatment for trichotillomania in a randomized controlled trial of adults and adolescents. Participants consisted of a community sample of treatment seeking adults and adolescents with trichotillomania. Of the eligible 39 participants randomized into treatment and waitlist groups, 25 completed treatment and were included in the final analysis. Treatment consisted of a 10-session ACT protocol. Multiple mixed models repeated measures analyses were utilized to evaluate changes in trichotillomania symptom severity, daily number of hairs pulled and urges experienced, and experiential avoidance from pretreatment to posttreatment. Findings indicated significant changes in symptom severity and daily hairs pulled, but not daily urges experienced or psychological flexibility. However, psychological flexibility saw a 24.5% decrease in the treatment group and reduced from clinical to subclinical levels on average. This study suggests that ACT alone is an effective treatment for adults and adolescents with trichotillomania. Outcomes appear to be similar to trials that combined ACT and habit reversal training (HRT).
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Slikboer R, Castle DJ, Nedeljkovic M, Rossell SL. Types of avoidance in hair-pulling disorder (trichotillomania): An exploratory and confirmatory analysis. Psychiatry Res 2018; 261:154-160. [PMID: 29306818 DOI: 10.1016/j.psychres.2017.12.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/27/2017] [Accepted: 12/20/2017] [Indexed: 01/16/2023]
Abstract
Hair-pulling disorder (HPD) or Trichotillomania is a complex disorder with frequent relapses. Avoidance has been highlighted as an important behavioural feature in HPD. To improve our understanding of avoidance, two studies were conducted to identify the types of avoidance that may be experienced by those who pull hair. Internet questionnaires were used to collect data. Data from study one was split into two subsets. An exploratory factor analysis was conducted to identify the different types of avoidance experienced by those reporting symptoms of hair pulling (subset one, n = 278), followed by a confirmatory factor analysis (subset two, n = 295). In study two a MANOVA was conducted (n = 300) to examine whether levels of avoidance differed between controls and those with hair pulling symptoms. Participants with hair pulling symptoms had greater levels of avoidance on each of the five types: 'Avoidance of non-social goals', 'Self-concealment', 'Behavioural social avoidance', 'Avoidance of relationship problem solving' and 'Avoidance of thinking about the future'. These data expand on the current literature, which has predominantly focused on experiential avoidance. Future research will need to validate these findings in a clinical group.
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Affiliation(s)
- Reneta Slikboer
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.
| | - David J Castle
- Monash Alfred Psychiatry Research Centre, The Alfred Hospital and Monash University Central Clinical School, Melbourne, VIC, Australia
| | - Maja Nedeljkovic
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia; Monash Alfred Psychiatry Research Centre, Melbourne, Australia; Monash Alfred Psychiatry Research Centre, The Alfred Hospital and Monash University Central Clinical School, Melbourne, VIC, Australia
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Abstract
Trichotillomania is a functionally impairing, often overlooked disorder with no Food and Drug Administration-approved medications indicated for its treatment. The ability of clinical trials to detect the beneficial effects of pharmacologic treatment in trichotillomania has been hampered by the high placebo response rate. Very little is known about baseline demographic and clinical characteristics that may be predictive of placebo response in such patients. Overall, 104 participants assigned to placebo were pooled from five double-blind trials conducted at three sites in the USA and Canada. Participants were classified as placebo responders or nonresponders on the basis of a cutoff of a 35% reduction in symptom severity on the Massachusetts General Hospital Hair Pulling Scale. Baseline group differences were characterized using t-tests and equivalent nonparametric tests as appropriate. Thirty-one percent of individuals assigned to placebo treatment showed a significant clinical response to placebo. Placebo responders (n=32) and nonresponders (n=72) did not differ significantly on any demographic or clinical variable. Predictors of placebo response for trichotillomania remain elusive and do not appear to be similar to those reported for other mental health disorders.
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Obinwa O, Cooper D, Khan F, O’Riordan JM. Rapunzel syndrome is not just a mere surgical problem: A case report and review of current management. World J Clin Cases 2017; 5:50-55. [PMID: 28255548 PMCID: PMC5314261 DOI: 10.12998/wjcc.v5.i2.50] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/07/2016] [Accepted: 12/28/2016] [Indexed: 02/05/2023] Open
Abstract
Recurrent Rapunzel syndrome (RRS) is a rare clinical presentation with fewer than six cases reported in the PubMed literature. A report of RRS and literature review is presented. A 25-year-old female was admitted to hospital with a 4-wk history of epigastric pain and swelling. She had a known history of trichophagia with a previous admission for Rapunzel syndrome requiring a laparotomy nine years earlier, aged 16. Psychological treatment had been successfully achieved for nine years with outpatient hypnotherapy sessions only, but she defaulted on her last session due to stressors at home. The abdominal examination demonstrated an epigastric mass. Computer tomography scan revealed a large gastric bezoar and features of aspiration pneumonia. The patient underwent emergency open surgical laparotomy for removal as the bezoar could not be removed endoscopically. The bezoar was cast in a shape that mimicked the contours of the stomach and proximal small bowel, hence the diagnosis of RRS. The patient was seen by a psychiatrist and was commenced on Quetiapine before discharge. She continues to attend follow-up.
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