Comprehensive Behavioral Therapy of Trichotillomania: A Multiple-Baseline Single-Case Experimental Design

Gioia Bottesi, Allison Jane Ouimet, Silvia Cerea, Umberto Granziol, Eleonora Carraro, Claudio Sica, Marta Ghisi, Gioia Bottesi, Allison Jane Ouimet, Silvia Cerea, Umberto Granziol, Eleonora Carraro, Claudio Sica, Marta Ghisi

Abstract

Despite rapidly increasing knowledge about Trichotillomania (TTM), no gold-standard evidence-based psychological intervention has been identified. In the current study, we evaluated the potential efficacy of an eight-session psychological intervention for TTM, namely the Comprehensive Behavioral Model (ComB) treatment, using a multiple-baseline single-case experimental design with three Italian women with TTM. The study included three phases: baseline, intervention, and 3-month follow-up. We assessed the intervention using daily self-monitoring of number of hair-pulling episodes, number of pulled hairs per episode, degree of resistance to pulling urges, and degree of associated distress. We also assessed for reliable improvement in general distress from baseline to post-intervention. All participants completed treatment and showed improvements on those symptom measures that were most relevant to their individualized case conceptualization. However, no participants recovered completely or demonstrated reliable improvement in general distress. Our results provide initial evidence for the utility of the ComB treatment for TTM in an Italian clinical setting. Furthermore, they support the delivery of individualized and flexible psychological treatments when treating TTM.

Keywords: Comprehensive Behavioral Model; Trichotillomania; psychological treatment; self-monitoring; single-case experimental design.

Copyright © 2020 Bottesi, Ouimet, Cerea, Granziol, Carraro, Sica and Ghisi.

Figures

Figure 1
Figure 1
Number of hair-pulling episodes and number of pulled hairs over time (days).
Figure 2
Figure 2
Degree of resistance to pulling urges and degree of associated distress over time (days).

References

    1. American Psychiatric Association (APA) (2013). Diagnostic and statistical manual of mental disorders. 5th Edn. Washington, DC: American Psychiatric Association.
    1. Andrews G., Creamer M., Crino R., Hunt C., Page A., Lampe L. (2003). The treatment of anxiety disorders: clinician guides and patient manuals. Cambridge University Press: Cambridge, United Kingdom.
    1. Azrin N. H., Nunn R. G. (1973). Habit reversal: a method of eliminating nervous habit and tics. Behav. Res. Ther. 11, 619–628. 10.1016/0005-7967(73)90119-8, PMID:
    1. Blampied N. M. (1999). A legacy neglected: restating the case for single-case research in cognitive-behaviour therapy. Behav. Chang. 16, 89–104. 10.1375/bech.16.2.89
    1. Borckardt J. J., Nash M. R., Murphy M. D., Moore M., Shaw D., O’Neil P. (2008). Clinical practice as natural laboratory for psychotherapy research: a guide to case-based time-series analysis. Am. Psychol. 63, 77–95. 10.1037/0003-066X.63.2.77, PMID:
    1. Bottesi G., Cerea S., Ghisi M. (2019). Tricotillomania. Diagnosi, assessment e trattamento cognitivo-comportamentale integrato. Trento, Italy: Edizioni Erikson.
    1. Bottesi G., Cerea S., Ouimet A., Sica C., Ghisi M. (2016a). Affective correlates of trichotillomania across the pulling cycle: findings from an Italian sample of self-identified hair pullers. Psychiatry Res. 246, 606–611. 10.1016/j.psychres.2016.10.080
    1. Bottesi G., Cerea S., Razzetti E., Sica C., Frost R. O., Ghisi M. (2016b). Investigation of the phenomenological and psychopathological features of trichotillomania in an Italian sample. Front. Psychol. 7:256. 10.3389/fpsyg.2016.00256, PMID:
    1. Bottesi G., Ghisi M., Altoè G., Conforti E., Melli G., Sica C. (2015). The Italian version of the depression anxiety stress scales-21: factor structure and psychometric properties on community and clinical samples. Compr. Psychiatry 60, 170–181. 10.1016/j.comppsych.2015.04.005, PMID:
    1. Cerea S., Bottesi G., Sica C., Ghisi M. (2014). Tricotillomania: aspetti fenomenologici in un gruppo clinico. Psicoter. Cogn. Comport. 14, 319–341.
    1. Duke D. C., Keeley M. L., Ricketts E. J., Geffken G. R., Storch E. A. (2010). The phenomenology of hairpulling in college students. J. Psychopathol. Behav. Assess. 32, 281–292. 10.1007/s10862-009-9150-4
    1. Falkenstein M. J., Mouton-Odum S., Mansueto C. S., Golomb R. G., Haaga D. A. (2016). Comprehensive behavioral treatment of trichotillomania: a treatment development study. Behav. Modif. 40, 414–438. 10.1177/0145445515616369, PMID:
    1. Falkenstein M. J., Rogers K., Malloy E. J., Haaga D. A. F. (2014). Predictors of relapse following treatment of trichotillomania. J. Obsessive Compuls. Relat. Disord. 3, 345–353. 10.1016/j.jocrd.2014.09.001, PMID:
    1. First M. B., Williams J. B., Benjamin L. S., Spitzer R. L. (2016). Structured clinical interview for DSM-5 personality disorders: SCID-5-PD. Arlington, VA: American Psychiatric Association Publishing.
    1. First M. B., Williams J. B. W., Karg R. S., Spitzer R. L. (2015). Structured clinical interview for DSM-5—research version (SCID-5 for DSM-5, research version; SCID-5-RV). Arlington, VA: American Psychiatric Association Publishing.
    1. Franklin M. E., Edson A. L., Ledley D. A., Cahill S. P. (2011). Behavior therapy for pediatric trichotillomania: a randomized controlled trial. J. Am. Acad. Child Adolesc. Psychiatry 50, 763–771. 10.1016/j.jaac.2011.05.009, PMID:
    1. Franklin M. E., Flessner C. A., Woods D. W., Keuthen N. J., Piacentini J. C., Moore P., et al. . (2008). The child and adolescent trichotillomania impact project: descriptive psychopathology, comorbidity, functional impairment, and treatment utilization. J. Dev. Behav. Pediatr. 29, 493–500. 10.1097/DBP.0b013e31818d4328, PMID:
    1. Franklin M. E., Tolin D. F. (2007). Treating trichotillomania: cognitive-behavioral therapy for hairpulling and related problems. Springer Science & Business Media: Berlin, Germany.
    1. Ghisi M., Bottesi G., Sica C., Ouimet A. J., Sanavio E. (2013). Prevalence, phenomenology and diagnostic criteria of hair-pulling in an Italian non-clinical sample: a preliminary study. J. Obsessive Compuls. Relat. Disord. 2, 22–29. 10.1016/j.jocrd.2012.09.003
    1. Grant J. E. (2015). Review of psychopharmacological approaches for trichotillomania and other body-focused behaviors. Curr. Treat. Options Psychiatry 2, 422–431. 10.1007/s40501-015-0058-1
    1. Jacobson E. (1977). The origins and development of progressive relaxation. J. Behav. Ther. Exp. Psychiatry 8, 119–123. 10.1016/0005-7916(77)90031-3
    1. Kazdin A. E. (2011). Single-case research designs: Methods for clinical and applied settings. Oxford University Press: Oxford, United Kingdom.
    1. Keijsers G. P., Maas J., van Opdorp A., van Minnen A. (2016). Addressing self-control cognitions in the treatment of trichotillomania: a randomized controlled trial comparing cognitive therapy to behaviour therapy. Cogn. Ther. Res. 40, 522–531. 10.1007/s10608-016-9754-4, PMID:
    1. Keuthen N. J., Rothbaum B. O., Fama J., Altenburger E., Falkenstein M. J., Sprich S. E., et al. . (2012). DBT-enhanced cognitive-behavioral treatment for trichotillomania: a randomized controlled trial. J. Behav. Addict. 1, 106–114. 10.1556/JBA.1.2012.003, PMID:
    1. Lee E. B., Haeger J. A., Levin M. E., Ong C. W., Twohig M. P. (2018). Telepsychotherapy for trichotillomania: a randomized controlled trial of ACT enhanced behavior therapy. J. Obsessive Compuls. Relat. Disord. 18, 106–115. 10.1016/j.jocrd.2018.04.003
    1. Lootens C. M., Nelson-Gray R. O. (2016). Treating trichotillomania: successful application of manualized cognitive-behavioral therapy. Clin. Case Stud. 15, 376–391. 10.1177/1534650116649438
    1. Mansueto C. S., Golomb R. G., Thomas A. M., Townsley-Stemberger R. M. (1999). A comprehensive model for behavioral treatment of trichotillomania. Cogn. Behav. Pract. 6, 23–43. 10.1016/S1077-7229(99)80038-8
    1. Mansueto C. S., Townsley-Stemberger R. M., McCombs-Thomas A. M., Goldfinger-Golomb R. G. (1997). Trichotillomania: a comprehensive behavioral model. Clin. Psychol. Rev. 17, 567–577. 10.1016/S0272-7358(97)00028-7, PMID:
    1. Minichiello W. E., O’Sullivan R. L., Osgood-Hynes D., Baer L. (1994). Trichotillomania: clinical aspects and treatment strategies. Harv. Rev. Psychiatry 1, 336–344. 10.3109/10673229409017100, PMID:
    1. Morely S., Dowzer C. N. (2014). Manual for the leeds reliable change indicator: simple excel® applications for the analysis of individual patient and group data. Leeds, UK: University of Leeds.
    1. O’Connor K. (2002). A cognitive-behavioral/psychophysiological model of tic disorders. Behav. Res. Ther. 40, 1113–1142. 10.1016/S0005-7967(02)00048-7, PMID:
    1. Osman A., Wong J. L., Bagge C. L., Freedenthal S., Gutierrez P. M., Lozano G. (2012). The depression anxiety stress scales—21 (DASS-21): further examination of dimensions, scale reliability, and correlates. J. Clin. Psychol. 68, 1322–1338. 10.1002/jclp.21908, PMID:
    1. Parker R. I., Vannest K. J., Davis J. L., Sauber S. B. (2011). Combining non-overlap and trend for single-case research: tau‐ U. Behav. Ther. 42, 284–299. 10.1016/j.beth.2010.08.006, PMID:
    1. Rehm I., Moulding R., Nedeljkovic M. (2015a). Psychological treatments for trichotillomania: update and future directions. Australas. Psychiatry 23, 365–368. 10.1177/1039856215590029, PMID:
    1. Rehm I. C., Nedeljkovic M., Thomas A., Moulding R. (2015b). The role of cognitions and beliefs in trichotillomania: a qualitative study using interpretative phenomenological analysis. Behav. Chang. 32, 209–230. 10.1017/bec.2015.11
    1. Roberts S., O’Connor K., Bélanger C. (2013). Emotion regulation and other psychological models for body-focused repetitive behaviors. Clin. Psychol. Rev. 33, 745–762. 10.1016/j.cpr.2013.05.004, PMID:
    1. Shareh H. (2018). A preliminary investigation of metacognitive therapy and habit reversal as a treatment for trichotillomania. Behav. Cogn. Psychother. 46, 1–20. 10.1017/S1352465817000546, PMID:
    1. Stolzenburg S., Freitag S., Evans-Lacko S., Speerforck S., Schmidt S., Schomerus G. (2019). Individuals with currently untreated mental illness: causal beliefs and readiness to seek help. Epidemiol. Psychiatr. Sci. 28, 446–457. 10.1017/S2045796017000828, PMID:
    1. Woods D. W., Wetterneck C. T., Flessner C. A. (2006). A controlled evaluation of acceptance and commitment therapy plus habit reversal for trichotillomania. Behav. Res. Ther. 44, 639–656. 10.1016/j.brat.2005.05.006, PMID:

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj