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The Role of Cognitions and Beliefs in Trichotillomania: A Qualitative Study Using Interpretative Phenomenological Analysis

Published online by Cambridge University Press:  12 August 2015

Imogen C. Rehm ,
Maja Nedeljkovic ,
Anna Thomas  and
Richard Moulding
Imogen C. Rehm*
Affiliation:
Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Victoria, Australia
Maja Nedeljkovic
Affiliation:
Brain and Psychological Sciences Research Centre, Swinburne University of Technology, Melbourne, Victoria, Australia
Anna Thomas
Affiliation:
Brain and Psychological Sciences Research Centre, Swinburne University of Technology, Melbourne, Victoria, Australia Australian Gambling Research Centre, Australian Institute of Family Studies, Melbourne, Victoria, Australia
Richard Moulding
Affiliation:
Centre for Mental Health and Wellbeing Research, Deakin University, Melbourne, Victoria, Australia
*
Address for correspondence: Imogen Rehm, Faculty of Health, Arts and Design, Swinburne University of Technology, PO.Box 218, Hawthorn, VIC 3122, Australia. Email: irehm@swin.edu.au
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Abstract

Trichotillomania (TTM) is characterised by the removal of one's hair, causing hair loss. Phenomenological research on TTM has investigated its associated behavioural and affective factors. Few studies have investigated the possible role of cognitions and beliefs, despite emerging support for cognitive therapies in treating this disorder. This study aimed to explore and describe the cognitions and beliefs that contribute to the onset and maintenance of hairpulling in TTM. Eight women with TTM participated in semi-structured, in-depth interviews to explore their experience of cognitions and beliefs before, during and after typical hairpulling episodes. Interviews were analysed using the qualitative method of Interpretative Phenomenological Analysis. Six superordinate themes of beliefs were identified as important: negative self-beliefs, control beliefs, beliefs about coping, beliefs about negative emotions, permission-giving beliefs, and perfectionism. These preliminary findings suggest that cognitions may play an important role in TTM phenomenology. Future quantitative research on the role of cognitions and beliefs in TTM in larger samples has the potential to advance cognitive-behavioural models and treatments of this poorly understood disorder.

Keywords

trichotillomaniahair pulling disorderbeliefscognitionsinterpretative phenomenological analysisqualitative
Type
Standard Papers
Information
Behaviour Change , Volume 32 , Issue 4 , December 2015 , pp. 209 - 230
Copyright
Copyright © The Author(s) 2015 

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References

American Psychiatric Association (APA). (1987). Diagnostic and statistical manual of mental disorders (3rd ed., text rev.). Washington, DC: Author.Google ScholarPubMed
American Psychiatric Association (APA). (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.Google ScholarPubMed
American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.Google ScholarPubMed
Azrin, N.H., & Nunn, R.G. (1973). Habit-reversal: A method of eliminating nervous habits and tics. Behaviour Research and Therapy, 11, 619–628.CrossRefGoogle ScholarPubMed
Beck, A.T., Wright, F.D., Newman, C.F., & Liese, B.S. (1993). Cognitive therapy of substance abuse. New York: The Guilford Press.Google Scholar
Beck, A.T., Rush, A.J., Shaw, B.F., & Emery, G. (1979). Cognitive therapy of depression. New York: The Guilford Press.Google Scholar
Begotka, A.M., Woods, D.W., & Wetterneck, C.T. (2004). The relationships between experiential avoidance and the severity of trichotillomania in a nonreferred sample. Journal of Behavior Therapy and Experimental Psychiatry, 35, 17–24. doi:10.1016/j.jbtep.2004.02.001CrossRefGoogle Scholar
Bloch, M.H., Landeros-Weisenberger, A., Dombrowski, P., Kelmendi, B., Wegner, R., Nudel, J., . . . Coric, V. (2007). Systematic review: Pharmacological and behavioural treatment for trichotillomania. Biological Psychiatry, 62, 839–846. doi:10.1016/j.biopsych.2007.05.019CrossRefGoogle Scholar
Buhlmann, U., Teachman, B.A., Naumann, E., Fehlinger, T., & Rief, W. (2009). The meaning of beauty: Implicit and explicit self-esteem and attractiveness beliefs in body dysmorphic disorder. Journal of Anxiety Disorders, 23, 694–702. doi:10.1016/j.janxdis.2009.02.008.CrossRefGoogle ScholarPubMed
Casati, J., Toner, B.B., & Yu, B. (2000). Psychosocial issues for women with trichotillomania. Comprehensive Psychiatry, 41, 344–351. doi:10.1053/comp.2000.9012.CrossRefGoogle Scholar
Christenson, G.A., Mackenzie, T.B., & Mitchell, J.E. (1991). Characteristics of 60 adult chronic hair pullers. American Journal of Psychiatry, 148, 365–370.Google Scholar
Clark, D.A. (2004). Cognitive-behavioral therapy for OCD. New York: Guilford.Google Scholar
Crosby, J.M., Dehlin, J.P., Mitchell, P.R., & Twohig, M.P. (2012). Acceptance and commitment therapy and habit reversal training for the treatment of trichotillomania. Cognitive and Behavioral Practice, 19, 595–605. doi:10.1016/j.cbpra.2012.02.002CrossRefGoogle Scholar
Cunningham, E.M., Timmes, J., Holloway, G., & Radford, S.A. (2011). Women and firesetting: A qualitative analysis of context, meaning, and development. Psychology and Psychotherapy: Theory, Research and Practice, 84, 128–140. doi:10.1348/147608310×499422CrossRefGoogle ScholarPubMed
Diefenbach, G.J., Mouton-Odum, S., & Stanley, M.A. (2002). Affective correlates of trichotillomania. Behaviour Research and Therapy, 40, 1305–1315. doi:10.1016/S0005-7967(02)00006-2CrossRefGoogle ScholarPubMed
Diefenbach, G.J., Tolin, D.F., Hannan, S., Crocetto, J., & Worhunsky, P. (2005). Trichotillomania: Impact on psychosocial functioning and quality of life. Behaviour Research and Therapy, 43, 869–884. doi:10.1016/j.brat.2004.06.010CrossRefGoogle Scholar
Diefenbach, G.J., Tolin, D.F., Hannan, S., Matby, N., & Crocetto, J. (2006). Group treatment for trichotillomania: Behavior therapy versus supportive therapy. Behavior Therapy, 37, 353–363. doi:10.1016/j.beth.2006.01.006CrossRefGoogle ScholarPubMed
Doron, G., Kyrios, M., Moulding, R., Nedeljkovic, M., & Bhar, S. (2007). ‘We do not see things as they are, we see them as we are’: A multidimensional worldview model of obsessive-compulsive disorder. Journal of Cognitive Psychotherapy, 21, 217–231. doi:10.1891/088983907781494555CrossRefGoogle Scholar
Duke, D.C., Bodzin, D.K., Tavares, P., Geffken, G.R., & Storch, E.A. (2009). The phenomenology of hairpulling in a community sample. Journal of Anxiety Disorders, 23, 1118–1125. doi:10.1016/j.janxdis.2009.07.015CrossRefGoogle Scholar
du Toit, P.L., van Kradenburg, J., Niehaus, D.J. H., & Stein, D.J. (2001). Characteristics and phenomenology or hair-pulling: An exploration of subtypes. Comprehensive Psychiatry, 43, 247–256. doi:10.1053/comp.2001.23134CrossRefGoogle Scholar
Egan, S.J., Wade, T.D., & Shafran, R. (2011). Perfectionism as a transdiagnostic process: A clinical review. Clinical Psychology Review, 31, 203–212. doi:10.1016/j.cpr.2010.04.009CrossRefGoogle ScholarPubMed
Eisen, J.L., Phillips, K.A., Baer, L., Beer, D.A., Atala, K.D., & Rasmussen, S.A. (1998). The Brown assessment of beliefs scale: Reliability and validity. American Journal of Psychiatry, 155, 102–108.CrossRefGoogle Scholar
Elliott, R., Fischer, C.T., & Rennie, D.L. (1999). Evolving guidelines for publication of qualitative research studies in psychology and related fields. British Journal of Clinical Psychology, 38, 215–229.CrossRefGoogle Scholar
Flessner, C.A., Conelea, C.A., Woods, D.W., Franklin, M.E., Keuthen, N.J., & Cashin, S.E. (2008). Styles of pulling in trichotillomania: Exploring differences in symptom severity, phenomenology, and functional impact. Behaviour Research and Therapy, 46, 345–357. doi:10.1016/j.brat.2007.12.009CrossRefGoogle ScholarPubMed
Flessner, C.A., Knopik, V.S., & McGeary, J. (2012). Hair pulling disorder (trichotillomania): Genes, neurobiology, and a model for understanding impulsivity and compulsivity. Psychiatry Research, 199, 151–158. doi:10.1016/j.psychres.2012.03.039CrossRefGoogle Scholar
Flessner, C.A., Woods, D.W., Franklin, M.E., Cashin, S.E., & Keuthen, N.J. (2008). The Milwaukee inventory for subtypes of trichotillomania-adult version (MIST-A): Development of an instrument for the assessment of ‘focused’ and ‘automatic’ hair pulling. Journal of Psychopathology and Behavioral Assessment, 30, 20–30. doi:10.1007/s10862-007-9073-xCrossRefGoogle Scholar
Flessner, C.A., Woods, D.W., Franklin, M.E., Keuthen, N.J., & Piacentini, J. (2009). Cross-sectional study of women with trichotillomania: A preliminary examination of pulling styles, severity, phenomenology, and functional impact. Child Psychiatry and Human Development, 40, 153–167. doi:10.1007/s10578-008-0118-5.CrossRefGoogle ScholarPubMed
Foa, E.B., Huppert, J.D., Leiberg, S., Langer, R., Kichic, R., Hajcak, G., & Salkovskis, P.M. (2002). The obsessive-compulsive inventory: Development and validation of a short version. Psychological Assessment, 14, 485–496. doi:10.1037//1040-3590.14.4.485CrossRefGoogle Scholar
Franklin, M.E., Zagrabbe, K., & Benavides, K.L. (2011). Trichotillomania and its treatment: Review and recommendations. Expert Review of Neurotherapeutics, 11, p.1165. doi:http://dx.doi.org/10.1586/ern.11.93CrossRefGoogle ScholarPubMed
Franklin, M.E., & Tolin, D.F. (2007). Treating trichotillomania: Cognitive-behavioral therapy for hairpulling. New York: Springer.CrossRefGoogle Scholar
García-Soriano, G., Clark, D.A., Belloch, A., del Palacio, A., & Castaneiras, C. (2012). Self-worth contingencies and obsessionality: A promising approach to vulnerability? Journal of Obsessive-Compulsive and Related Disorders, 1, 196–202. doi:10.1016/j.jocrd.2012.05.003CrossRefGoogle Scholar
Gluhoski, V.L. (1995). A cognitive approach for treating trichotillomania. Journal of Psychotherapy Practice and Research, 4, 277–285.Google Scholar
Grant, J.E., Odlaug, B.L., & Potenza, M.N. (2007). Addicted to hair pulling? How an alternate model of trichotillomania may improve treatment outcome. Harvard Review of Psychiatry, 15, 80–85. doi:10.1080/10673220701298407CrossRefGoogle ScholarPubMed
Harvey, A.G., Watkins, E., Mansell, W., & Shafran, R. (2004). Cognitive behavioural processes across psychological disorders: A transdiagnostic approach to research and treatment. Oxford: Oxford University Press.CrossRefGoogle Scholar
Keijsers, G.P.J., van Minnen, A., Hoogduin, C.A.L., Klaassen, B.N.W., Hendriks, M.J., & Tanis-Jacobs, J. (2006). Behavioural treatment of trichotillomania: Two-year follow-up results. Behaviour Research and Therapy, 44, 359–370. doi:10.1016/j.brat.2005.03.004CrossRefGoogle ScholarPubMed
Keuthen, N.J., O’Sullivan, R.L., Ricciardi, J.N., Shera, D., Savage, C. R, Borgmann, A.S., . . . & Baer, L. (1995). The Massachusetts General Hospital (MGH) hairpulling scale: 1. Development and factor analyses. Psychotherapy and Psychosomatics, 64, 141–145.CrossRefGoogle ScholarPubMed
Keuthen, N.J., Rothbaum, B.O., Fama, J., Altenburger, E., Falkenstein, M.J., Sprich, S.E., . . . Welch, S.S. (2012). DBT-enhanced cognitive-behavioral treatment for trichotillomania: A randomized controlled trial. Journal of Behavioral Addictions, 1, 106–114. doi:10.1002/da.20778CrossRefGoogle ScholarPubMed
Lecrubier, Y., Sheehan, D.V., Weiller, E., Amorim, P., Bonara, I., Sheehan, K., . . . & Dunbar, G.C. (1997). The mini international neuropsychiatric interview (MINI). A short diagnostic structured interview: Reliability and validity according to the CIDI. European Psychiatry, 12, 224–231.CrossRefGoogle Scholar
Mansueto, C.S., Stemberger, R.M., Thomas, A., & Golomb, R. (1997). Trichotillomania: A comprehensive behavioral model. Clinical Psychology Review, 17, 567–577.CrossRefGoogle ScholarPubMed
Moulding, R., Doron, G., Kyrios, M., & Nedeljkovic, M. (2008). Desire for control, sense of control and obsessive-compulsive checking: An extension to clinical samples. Journal of Anxiety Disorders, 22, 1472–1479. doi:10.1016/j.janxdis.2008.03.001CrossRefGoogle Scholar
Moulding, R., Doron, G., Kyrios, M., & Nedeljkovic, M. (2009). Mediated and direct effects of general control beliefs on obsessive compulsive symptoms. Canadian Journal of Behavioural Science, 41, 84–92. doi:10.1037/a0014840CrossRefGoogle Scholar
Moulding, R., & Kyrios, M. (2006). Anxiety disorders and control related beliefs: The exemplar of obsessive-compulsive disorder. Clinical Psychology Review, 26, 573–583. doi:10.1016/j.cpr.2006.01.009CrossRefGoogle ScholarPubMed
Norberg, M.M., Wetterneck, C.T., Woods, D.W., & Conelea, C.A. (2007). Experiential avoidance as a mediator of relationships between cognitions and hair-pulling severity. Behavior Modification, 31, 367–381. doi:10.1177/0145445506297343CrossRefGoogle ScholarPubMed
Obsessive Compulsive Cognitions Working Group. (1997). Cognitive assessment of obsessive-compulsive disorder. Behaviour Research and Therapy, 35, 667–681.CrossRefGoogle ScholarPubMed
Obsessive Compulsive Cognitions Working Group. (2001). Development and initial validation of the obsessive beliefs questionnaire and the interpretation of intrusions inventory. Behaviour Research and Therapy, 39, 987–1006. doi:10.1016/S0005-7967(00)00085-1CrossRefGoogle ScholarPubMed
Obsessive Compulsive Cognitions Working Group. (2005). Psychometric validation of the obsessive belief questionnaire and interpretation of intrusions inventory — Part 2: Factor analyses and testing of a brief version. Behaviour Research and Therapy, 43, 1527–1542. doi:10.1016.j.brat.2004.07.010CrossRefGoogle Scholar
O’Connor, K.P., Brault, M., Robillard, S., Loiselle, J., Borgeat, F., & Stip, E. (2001). Evaluation of a cognitive-behavioural program for the management of chronic tic and habit disorder. Behavior Research and Therapy, 39, 667–681. doi:10.1016/S0005-7967(00)00048-6CrossRefGoogle Scholar
O’Connor, K.P., Gareau, D., & Borgeat, F. (1997). A comparison of a behavioural and cognitive-behavioral approach to the management of chronic tic disorders. Clinical Psychology and Psychotherapy, 4, 105–117.Google Scholar
Pelissier, M., & O’Connor, K. (2004). Cognitive-behavioral treatment of trichotillomania, targeting perfectionism. Clinical Case Studies, 3, 57–69. doi:10.1177/1534650103258973CrossRefGoogle Scholar
Phillips, B., Moulding, R., Kyrios, M., Nedeljkovic, M., & Mancuso, S. (2011). The relationship between body dysmorphic disorder sysmptoms and self-construals. Clinical Psychologist, 15, 10–16. doi:10.111/j.1742-9552.2011.00004.xCrossRefGoogle Scholar
Phillips, K.A., Stein, D.J., Rauch, S.L., Hollander, E., Fallon, B.A., Barsky, A., . . . Leckman, J. (2010). Should and obsessive-compulsive spectrum grouping of disorders be included in DSM-V? Depression and Anxiety, 27, 528–555. doi:10.1002/da.20705CrossRefGoogle ScholarPubMed
Roberts, S., O’Connor, K., & Bélanger, C. (2013). Emotion regulation and other psychological models for body-focused repetitive behaviors. Clinical Psychology Review, 33, 745–762. doi:10.1016/j.cpr.2013.05.004CrossRefGoogle ScholarPubMed
Sheehan, D.V., Lecrubier, Y., Sheehan, K., Amorim, P., Janavs, J., Weiller, E., . . . Dunbar, G.C. (1998). The mini-international neuropsychiatric interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 22–33.Google ScholarPubMed
Sheehan, D.V., Lecrubier, Y., Sheehan, K., Janavs, J., Weiller, E., Keskiner, A., . . . Dunbar, G.C. (1997). The validity of the mini international neuropsychiatric interview (MINI) according to the SCID-P and its reliability. European Psychiatry, 12, 232–241.CrossRefGoogle Scholar
Shusterman, A., Feld, L., Baer, L., & Keuthen, N. (2009). Affective regulation in trichotillomania: Evidence from a large-scale internet survey. Behaviour Research and Therapy, 47, 637–644. doi:10.1016/j.brat.2009.04.004CrossRefGoogle ScholarPubMed
Smith, J.A. (1996). Beyond the divide between cognition and discourse: Using interpretative phenomenological analysis in health psychology. Psychology and Health, 11, 261–271.CrossRefGoogle Scholar
Smith, J.A., & Osborn, M. (2008). Interpretative phenomenological analysis. In Smith, J.A. (Ed.), Qualitative psychology: A practical guide to research methods (pp. 53–80). London: Sage.Google Scholar
Stanley, M.A., Prather, R.C., Wagner, A.L., Davis, M.L., & Swann, A.C. (1993). Can the Yale-Brown obsessive-compulsive scale be used to assess trichotillomania? A preliminary report. Behaviour Research and Therapy, 31, 171–177.CrossRefGoogle ScholarPubMed
Stevanovic, D. (2011). Quality of life enjoyment and satisfaction questionnaire — Short form for quality of life assessments in clinical practice: A psychometric study. Journal of Psychiatric and Mental Health Nursing, 18, 744–750. doi:10.1111/j.1365-2850.2011.01735.xCrossRefGoogle ScholarPubMed
Twohig, M.P., & Woods, D.W. (2004). A preliminary investigation of acceptance and commitment therapy and habit reversal as a treatment for trichotillomania. Behavior Therapy, 35, 803–820. doi:10.1016/S0005-7894(04)80021-2CrossRefGoogle Scholar
Veale, D., & Neziroglu, F.A. (2010). Body dysmorphic disorder: A treatment manual. Malden, MA: Wiley-Blackwell.CrossRefGoogle Scholar
Wilhelm, S., Berman, N.C., Keshaviah, A., Schwartz, , & Steketee, G. (2015). Mechanisms of change in cognitive therapy for obsessive compulsive disorder: Role of maladaptive beliefs and schemas. Behaviour Research and Therapy, 65, 5–10. doi:10.1016/j.brat.2014.12.006CrossRefGoogle ScholarPubMed
Winchel, R.M., Jones, S., Molcho, A., Parsons, B., Stanley, B., & Stanley, M. (1992). The Psychiatric Institute trichotillomania scale (PITS). Psychopharmacology Bulletin, 28, 463–476.Google Scholar
Wood, H., Cupitt, C., & Lavender, T. (2015). The experience of cognitive impairment in people with psychosis. Clinical Psychology and Psychotherapy, 22, 193–207. doi:10.1002/cpp.1878CrossRefGoogle ScholarPubMed
Woods, D.W., Flessner, C.A., Franklin, M.E., Keuthen, N.J., Goodwin, R.D., Stein, D.J., & Walther, M.R. (2006). The trichotillomania impact project (TIP): Exploring phenomenology, functional impairment, and treatment utilization. Journal of Clinical Psychiatry, 67, 1877–1888.CrossRefGoogle Scholar
Woods, D.W., Wetterneck, C.T., & Flessner, C.A. (2006). A controlled evaluation of acceptance and commitment therapy plus habit reversal for trichotillomania. Behaviour Research and Therapy, 44, 639–656. doi:10.1016/j.brat.2005.05.006CrossRefGoogle ScholarPubMed