Comprehensive Behavioral (ComB) Treatment of Trichotillomania: A Randomized Clinical Trial

ObjectiveThis study is the first controlled trial of comprehensive behavioral (ComB) treatment of trichotillomania (TTM). ComB provides individualized treatment based on factors triggering and maintaining hair pulling. Method: Participants (N = 36) were adults (M = 34.08 years old, SD = 12.26) meeting DSM5 criteria for TTM. A majority were female (80%) and Caucasian (75%), whereas 17% were African American and 19% Hispanic/Latinx. In a parallel-group design, participants were randomly assigned to (a) Immediate ComB (12 sessions) or (b) Minimal Attention Control (MAC), followed by delayed ComB after week 12. Follow-up continued through week 38. Primary outcomes were self-report (Massachusetts General Hospital Hair pulling Scale; MGH-HPS) and interviewer-rated (NIMH-Trichotillomania Impact Scale and Trichotillomania Severity Scale; TIS/TSS) TTM symptom severity, as well as diagnosis (Trichotillomania Diagnostic Interview).ResultsImmediate efficacy of ComB (vs. MAC) was statistically significant (p = .03) for self-reported symptoms, with an effect size d = −.78, but not significant for interviewer-rated symptoms or diagnostic status. Immediate ComB was significantly more likely than MAC (27% vs. 0%) to lead to complete abstinence from hair pulling at week 12. Follow-ups showed good maintenance of effects.ConclusionsEfficacy of ComB was established for self-reported symptoms. Future research is needed to establish whether the lack of more widespread effects stems from limitations of the model or to a need for more extensive therapist training, as secondary analyses suggested stronger results among therapists with more TTM experience.     

Trichotillomania (hair pulling) in toddlers

Although the clinical diagnosis of trichotillomania has been observed for more than a century, not until the last decade has there been a focus on this diagnosis in early childhood. This small case series focuses on the clinical evaluation of 10 toddlers, average of 26 mo., presenting at a specialty child and adolescent psychiatry clinic with hair pulling. Authors suggest that hair pulling in this age group might better be conceptualized as an anxiety disorder.     

Trichotillomania: Assessment,Diagnosis, and Treatment

This article examines the assessment, diagnosis, and treatment of trichotillomania (the recurrent desire to pull out one's hair). The authors provide a brief review both of proposed etiologies of trichotillomania and of the diagnostic and assessment issues related to this disorder, and they discuss interventions and treatments that have been shown to be most efficacious when working with clients diagnosed with trichotillomania.     

Trichotillomania: Identification and Treatment

Trichotillomania is a disorder distinguished by recurrent hair pulling resulting in hair loss ( American Psychiatric Association, 2000 ). This review of the literature provides a broad overview of the disorder so that counselors can better understand, describe, identify, and implement effective treatment for clients with trichotillomania. Phenomenology, impairment, etiology, multicultural considerations, differentiation, comorbidity, and current treatment approaches are presented.     

Polyglot aphasics and language mixing: A comment on Perecman (1984)

Perecman (1984) Brain and Language, 23, 43-63, proposes that language mixing (and especially utterance level mixing) in polyglot aphasics reflects a linguistic deficit and that spontaneous translation indicates a prelinguistic processing deficit. It is argued in this comment that both language mixing (including utterance-level mixing) and spontaneous translation are also found in normal polyglots, and that they may not therefore always be reflecting language deficit in aphasics. Only a good assessment of the patient's language and speech before and after the injury will determine if these behaviors do indeed reflect deficits.     

Assessment of Trichotillomania: A Psychometric Evaluation of Hair-Pulling Scales

Currently there is no gold standard treatment outcome measure for trichotillomania (TTM), a disorder characterized by repetitive hair pulling resulting in noticeable hair loss. The goal of the current study was to evaluate the psychometric properties of TTM measures of differing assessment methods: self-report, clinician-rated summary scales, and clinician-rated global severity scales. Data collected from 28 patients with TTM indicated mixed psychometric properties for current scales. Internal consistency was strong for self-report but not clinician-rated summary scales. One clinician-rated summary scale total and subjective ratings of hair loss demonstrated good interrater agreement. Although convergent validity was good within measurement type, self-report did not correlate with clinician-rated global severity scales, perhaps because of absence of hair loss severity assessment on the self-report measure. A multimethod assessment including one of each type of measure reviewed in this paper, along with self-monitoring and measures of hair loss severity, is recommended for a comprehensive best practice approach to TTM assessment.     

INTERPRETING THE RESULTS OF META-ANALYTIC RESEARCH: A COMMENT ON SCHMITT, GOODING, NOE, AND KIRSCH (1984)

This comment shows that the conclusion of Schmitt, Gooding, Noe, and Kirsch (1984) that their meta-analytic findings are inconsistent with earlier validity generalization work is in error. The findings in their study that less variance than previously reported was due to sampling error are a result of their larger average sample sizes. Their claim that, after sampling error variance was accounted for, much unexplained variance remained, is incorrect. This error is demonstrated to be a result of their exclusive concentration on percentages and consequent failure to examine amount of observed and residual variance.     

StopPulling.com: An Interactive, Self-Help Program for Trichotillomania

Despite the widespread nature and significant impact of trichotillomania (TTM), relatively few controlled studies have evaluated treatment options for people with this disorder. Pharmacological treatment and behavior therapy are the two most widely accepted approaches to treating TTM, but few mental health professionals with appropriate expertise are available to provide care. The cost of treatment also is prohibitive in some cases. A number of self-help books are available for people with TTM, but no empirical data have documented associated outcomes. This paper describes the development and two phases of program evaluation for an alternative, Internet-based self-help treatment strategy for repetitive hair pulling. StopPulling.com is an on-line, interactive self-help approach derived from evidence-based cognitive behavioral models of treatment for TTM. Following program development, an initial test phase elicited feedback from individuals with repetitive hair pulling and professionals with expertise in the treatment of TTM or Web site development. StopPulling.com was modified in accordance with feedback from this initial test phase, and a revised version was made available to the public in January 2003. Preliminary data from 265 users of the program during the first year of public availability suggested significant improvement in symptoms, with some evidence that duration of program use accounted for reductions in symptom severity. Response rates were comparable to long-term follow-up after more intense cognitive behavioral treatment. StopPulling.com may provide a potentially useful self-help alternative or adjunctive strategy for repetitive hair pulling.     

THE POLITICS OF INTIMACY: (RE)THINKING 1984

The year 1984 is deeply ingrained in the collective Sikh memory. The attack on the Sri Harmandir Sahib and the subsequent pogrom in Delhi fundamentally challenged the manner in which the Sikh population in India and the diaspora engaged with the state. Indeed, these two events represented the culmination of a first phase of a war that began in the 1970s and continued well into the 1990s with the clearest effect on the Sikhs in Punjab. Nevertheless, 1984 continues to evoke a series of questions that are addressed in this paper. It examines how lives become precarious and grievable as well as how societies descend into barbarism. Finally, it seeks to understand how we memorialise grievable lives.     

Hand inversion in sinistrals and lateral preference: Comments on Searleman, Porac, and Coren (1984)

A reanalysis of data from left-handers presented by A. Searleman, C. Porac, and S. Coren, (1984, Brain and Cognition, 3, 86–93) cautions against premature conclusions that an inverted handwriting posture is more prevalent for sinistral men with leftward lateral preferences and for women with rightward or mixed lateral preferences. Although this may eventually prove to be true, the findings of Searleman et al. (1984) are insufficient for supporting this inference.     

Form perception at birth: Cohen and Younger (1984) revisited

Cohen (1988; Cohen & Younger, 1984) has suggested that there is a shift in the perception of form sometime after 6 weeks of age. Prior to this age infants can remember the specific orientations of line segments, but cannot process and remember the angular relations that line segments can make. Experiment 1 used simple line stimuli with newborn infants to test this suggestion. Following habituation to a simple two-line angle the newborns dishabituated to a change of orientation but not to a change in angle, confirming Cohen and Younger's suggestion that orientation is a powerful cue in early shape perception. In Experiments 2 and 3 newborns were familiarized either to an acute or to an obtuse angle that changed its orientation over trials. On subsequent test trials the babies gave strong novelty preferences to a different angle. Alternative interpretations of the results are discussed, but these experimental findings are compatible with the suggestion that newborns can quickly learn to process angular relations, and that rudimentary form perception may not be dependent on a lengthy period of learning and/or maturation for its development.     

The myth of "ecological dyslexia": a reply to Pontius (1984)

Ways in which Pontius' rejoinder to the criticisms raised earlier about her 1982 study of white and Aboriginal Australians fall short of success are enumerated.     

Task-Specific Dynamics and the Study of Perception and Action: A reaction to von Hofsten (1989)

In a recent discussion of motor development, von Hofsten (1989) distinguished two approaches which he called the perception-action and dynamic systems ap- proaches, respectively. In this reaction, we suggest that the proposed distinction is inappropriate. We argue that research on perception and action in terms of task-specific dynamics is uniquely suited to the characterization of problems inherent to the coupling of perception and action. The problems discussed include the problem of stability and transitions in behavior; the problem of perceptual information about physical properties of the action system; and the role of the brain in the context of the degrees of freedom problem, the problem of multiple scales of analysis, and the heterogeneity of the components of the human action system including the brain.     

A reaction time paradigm to assess (implicit) complaint-specific dysfunctional beliefs

We investigated whether an implicit association test (IAT) can be used to assess dysfunctional beliefs in the realm of psychopathology. As a first exploration we therefore constructed a IAT that was designed to differentiate between high and low social anxious individuals. Social situation and neutral words were the targets (e.g. date vs hall), and positive and negative outcomes (e.g. compliment vs rejection) the associated attributes. High social anxious women (N=32) showed the predicted deterioration of task performance if the required responses switched from compatible to incompatible with the idea that social situations are related to negative outcomes and vice versa, whereas the opposite was true for low anxious women (N=32). Thus a modified IAT seems a useful and highly flexible tool to implicitly assess complaint-specific dysfunctional associations and may be a valuable addition to the usual (explicit) self-report measures of patients' beliefs.     

1984: A Love Letter

Dear Kris, I know you will read this letter if it ever manages to get to you. You like reading. I’m not sure what you’ll think of it though. I just know I had to make this attempt to talk to you about the summer of 1984. There are some things you and I come to know in the summer of 1984 that will take us 35 years to learn to talk about. They were not an easy 35 years. And I want to help change that.     

Trichotillomania: impact on psychosocial functioning and quality of life

This study explored the impact of hair pulling on psychosocial functioning for patients diagnosed with trichotillomania (TTM; n = 28). TTM patients were compared to age and gender-matched groups of psychiatric patients without TTM (n = 28) and nonpsychiatric control volunteers (NC, n = 28) on measures of psychological distress, functioning/quality of life, and self-esteem. Results indicated that TTM patients reported more severe psychosocial impairments than did NC volunteers; however, these differences were mediated by differences in level of depression. Regression analyses indicated significant relationships between some measures of psychosocial functioning and severity of hair pulling, independent of level of depression. Finally, an interview of the impact of hair pulling on 6 domains of daily functioning (negative affect/negative self-evaluations, grooming, recreational activities, social interaction, work/housework productivity, and physical health) indicated common and wide-ranging impairments for both lifetime and current (i.e., past week) ratings. These results highlight the importance of promoting and improving resources for the clinical care of TTM patients, and provide some directions for clinicians to enhance assessment of interference caused by TTM.     

Context,goal, utility,and relevance: A reply to Evans (2002) considering Oaksford (2002)

Yama (2001) argued that the matching bias effect was an amalgam of a genuine matching effect and a set size effect. However, Evans (2002) pointed out some problems with Yama's argument. One was on the matching index used in Yama (2001). The others concerned a gap between Yama's (2001) interpretation of matching bias and Evans' (1998) recent discussions that had placed emphasis on the problem of implicit negation. I reply to these claims taking Oaksford (2002) into consideration. Further, I propose a framework connecting context, goal, utility, and relevance, and including a hierarchical structure of goals. I argue that theories of reasoning can be developed and extended with the framework.