Styles of pulling in trichotillomania: exploring differences in symptom severity, phenomenology, and functional impact

Previous research has examined possible phenomenological differences between “focused” (i.e., with a compulsive quality) and “automatic” (i.e., with decreased awareness) pulling associated with trichotillomania (TTM), but these constructs have not been assessed using psychometrically sound measures. In the current study, differences in TTM severity, phenomenology, comorbid psychiatric symptoms, and functional impact were examined across individuals with varying combinations of “focused” and “automatic” pulling styles. Participants aged 18 and older were recruited via an internet-based survey. Those meeting inclusion criteria and completing the Milwaukee Inventory for Subtypes of Trichotillomania-Adult Version (MIST-A; n=1545) were classified as either high- or low-focused and either high- or low-automatic based on scores obtained from the focused and automatic scales of the MIST-A using a median split procedure. Results showed some significant differences between pulling styles. For example, “high-automatic” pullers reported more severe TTM and greater stress than “low-automatic” pullers, and “high-focused” pullers reported more severe TTM, greater stress and depression, and greater functional impact than “low-focused” pullers. Subsequent analyses suggest that, in comparison to individuals experiencing low levels of both automatic and focused pulling, those experiencing high levels of each pulling style reported greater severity, psychological impact, and functional impact. Clinical and research implications, study limitations, and future areas of research are discussed.     

Styles of pulling in youths with trichotillomania: exploring differences in symptom severity, phenomenology, and comorbid psychiatric symptoms

To date, no studies have examined possible phenomenological differences between the automatic and focused styles of pulling in youths with TTM. The aims of the current study were to examine differences in TTM severity, phenomenology, comorbid psychiatric symptoms, and functional impact across youths with varying degrees of these pulling styles. Youths between the ages of 10 and 17 years (and their parent) were recruited via an Internet-based survey. A total of 186 youths with chronic hair pulling was classified as “high-focused” or “low-focused” and either “high-automatic” or “low-automatic” based upon scores obtained on the Milwaukee Inventory for Styles of Trichotillomania-Child Version (MIST-C) using a median-split procedure. Results demonstrated significant differences between pulling styles. More specifically, “high-focused” pullers reported more severe TTM and greater symptoms of anxiety and depression than “low-focused” pullers, and “high-automatic” pullers reported greater symptoms of depression than “low-automatic” pullers. Subsequent analyses suggest that, in comparison to youths with low levels of both automatic and focused pulling, those experiencing high levels of focused pulling but low levels of automatic pulling reported phenomenological differences and were more likely to engage in additional repetitive behaviors (i.e., skin picking, lip/cheek biting). Clinical and research implications, study limitations, and future areas of research are discussed.     

A focused attention intervention for coping with ostracism

Ostracism—being excluded and ignored—thwarts satisfaction of four fundamental needs: belonging, self-esteem, control, and meaningful existence. The current study investigated whether training participants to focus their attention on the here-and-now (i.e., focused attention) reduces distress from an ostracism experience. Participants were first trained in either focused or unfocused attention, and then played Cyberball, an online ball-tossing game for which half the participants were included or ostracized. Participants reported their levels of need satisfaction during the game, and after a short delay. Whereas both training groups experienced the same degree of need-threat in the immediate measure, participants who were trained in focused attention showed more recovery for the delayed measure. We reason that focused attention would not reduce the distress during the ostracism experience, but it aided in recovery by preventing participants from reliving the ostracism experience after it concludes.     

What to Say to an Online Support‐Seeker? The Influence of Others' Responses and Support‐Seekers' Replies

Research on online support forums has largely overlooked the quality of support provision. The present experiment examined how others' responses and a support-seeker's reply can influence action‐focused supportiveness, emotion‐focused supportiveness, and politeness of readers' support messages. Results showed that the supportiveness of others' comments was associated with subsequent readers' perceptions of public opinion toward the support‐seeker and readers' liking of the support‐seeker, which in turn influenced the quality of readers' support messages.     

Family Business-Owning Couples: An EFT View into Their Unique Conflict Culture

This study expands the understanding of business-related tensions within business-owning couples through an interdisciplinary literature review, through a longitudinal data analysis, and through application of Emotionally Focused Therapy (EFT) to a case study. Business-owning husbands and wives in this study reported that conflicts related to work/family life balance and unfair distribution of resources (money, time, energy) between family and business systems create the greatest tensions. Low family functionality, wives' role dissatisfaction, transfer of resources from family to business, and husbands' identification of wives as major decision makers were all predictors of wives' higher tension levels. Husbands reported increased tension when wives worked more hours in the business. Three elements of EFT are applied to a family business couple.     

Parents Plus Systemic,Solution‐Focused Parent Training Programs: Description,Review of the Evidence Base,and Meta‐Analysis

Parents Plus (PP) programs are systemic, solution‐focused, group‐based interventions. They are designed for delivery in clinical and community settings as treatment programs for families with child‐focused problems, such as behavioral difficulties, disruptive behavior disorders, and emotional disorders in young people with and without developmental disabilities. PP programs have been developed for families of preschoolers, preadolescent children, and teenagers, as well as for separated or divorced families. Seventeen evaluation studies involving over 1,000 families have shown that PP programs have a significant impact on child behavior problems, goal attainment, and parental satisfaction and stress. The effect size of 0.57 (p < .001) from a meta‐analysis of 10 controlled studies for child behavior problems compares favorably with those of meta‐analyses of other well‐established parent training programs with large evidence bases. In controlled studies, PP programs yielded significant (p < .001) effect sizes for goal attainment (d = 1.51), parental satisfaction (d = 0.78), and parental stress reduction (d = 0.54). PP programs may be facilitated by trained front‐line mental health and educational professionals.     

Conceptual and Application Issues: Emotionally Focused Therapy With Gay Male Couples

Therapists working with couples are likely to see gay male couples in their practice yet there is a lack of training to prepare therapists to work with gay couples. Emotionally Focused Therapy (EFT) is an empirically supported approach to couples therapy and offers a clear structure and map for working with gay male couples. This article reviews some of the issues that are specific to EFT work with gay men. Given the range of minority stressors that gay men contend with EFT is particularly appropriate for work with gay male couples because of the focus on the attachment bond. Building a secure relationship is an important source of resilience that can buffer against prejudice and discrimination and provide a secure base for individual and couple exploration.     

Building Blocks for Older Adult Ministry

SUMMARY

The final building block is deciding what program fits ministry goals, congregational resources and skills, and the needs of the older adults who will benefit from this ministry. A final form is used to choose, from the many options gathered in the previous steps, which ministries to begin, at this time, for this group of people, with these specific resources, be they congregational resources or those from community collaboration. Choosing target dates for specific tasks and assigning those tasks to specific committee member is crucial for success. The place of attendance in declaring success or failure is discussed. Using the OAM mission statement as a basis for continuing evaluation is suggested.     

Expertise and the evolution of consciousness

This paper argues that expertise can be used as an indicator of consciousness in humans and other animals. The argument is based on the following observations: (1) expertise and skill acquisition require deliberate practice; and (2) the characteristics of deliberate practice such as performance evaluation against a more proficient model, retention of voluntary control over actions, self-monitoring, goal-setting, error-detection and correction, and the construction of hierarchically organized retrieval structures are outside of the currently understood bounds of unconscious processing. Thus, to the extent that evidence of expertise exists in an organism, evidence of conscious experience is also present. Two important implications arise from this conclusion: (1) evidence of expertise can be used as the basis for cross-species comparisons of consciousness; and (2) the evolution of human consciousness can be assessed using fossil evidence of skilled behavior as a measure of consciousness.     

The Milwaukee Inventory for Subtypes of Trichotillomania-Adult Version (MIST-A): Development of an Instrument for the Assessment of “Focused” and “Automatic” Hair Pulling

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.