Affective regulation in trichotillomania before and after self-help interventions

Steffi Weidt; Gwyneth Zai; Natalie Drabe; Aba Delsignore; Annette Beatrix Bruehl; Richard Klaghofer; Michael Rufer

doi:10.1016/j.jpsychires.2015.12.020

Affective regulation in trichotillomania before and after self-help interventions

J Psychiatr Res. 2016 Apr:75:7-13. doi: 10.1016/j.jpsychires.2015.12.020. Epub 2015 Dec 29.

Authors

Steffi Weidt¹, Gwyneth Zai², Natalie Drabe³, Aba Delsignore³, Annette Beatrix Bruehl⁴, Richard Klaghofer³, Michael Rufer³

Affiliations

¹ Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Culmannstrasse 8, 8091, Zürich, Switzerland. Electronic address: steffi.weidt@usz.ch.
² Department of Psychiatry and Institute of Medical Science, University of Toronto, Canada; Neurogenetics Section, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada; Frederick W. Thompson Anxiety Disorders Centre, Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada; Behavioural and Clinical Neuroscience Institute and Department of Psychiatry, University of Cambridge, Downing Site, Cambridge, CB2 3EB, United Kingdom.
³ Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Culmannstrasse 8, 8091, Zürich, Switzerland.
⁴ Behavioural and Clinical Neuroscience Institute and Department of Psychiatry, University of Cambridge, Downing Site, Cambridge, CB2 3EB, United Kingdom; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032, Zürich, Switzerland.

PMID: 26783728
DOI: 10.1016/j.jpsychires.2015.12.020

Abstract

Objective: Trichotillomania (TTM) is characterized by recurrent hair-pulling behaviours that cause significant distress. Deficits in affective regulation have been reported in individuals with TTM. We aimed to investigate temporal stability of affective regulation in TTM individuals.

Methods: Eighty-one TTM individuals underwent an online intervention. Affective Regulation Scale (ARS), Massachusetts General Hospital Hair-Pulling Scale (MGH-HPS), and Beck Depression Inventory (BDI) scores were obtained at baseline, post-treatment (4 weeks), and follow-up (6 months). We examined the effect of phenotypes including hair-pulling severity and depressive symptoms on absolute and relative stability of affective regulation over time, using multiple linear and hierarchical regression analyses.

Results: The ARS total-score from the present TTM sample was significantly lower than the score from non-hair pullers (p < 0.001). ARS total-scores inversely correlated with the MGH-HPS total-scores at baseline (p = 0.001) and post-treatment (p = 0.02), and with BDI total-scores at all time-points (p < 0.001). Although ARS total-scores significantly increased, all ARS sub-scores, except guilt sub-scores, did not change over time, indicating absolute stability. Baseline ARS total-, and sub-scores (except tension) were found to predict their ARS follow-up scores (all p < 0.01), confirming relative stability (i.e., the extent to which the inter-individual differences remained the same over time). The relative stability of ARS total-scores and all but two sub-scores (irritability and guilt) were independent from BDI baseline scores.

Conclusions: Individuals with TTM reported deficits in affective regulation that demonstrated mostly high relative stability and partly absolute stability. Therefore, targeting to improve affective regulation in individuals with TTM during therapy is warranted.

Keywords: Absolute stability; Affective regulation; Emotional dysregulation; Hair-pulling; Relative stability; Trichotillomania.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Analysis of Variance
Cognitive Behavioral Therapy / methods*
Double-Blind Method
Female
Humans
Male
Middle Aged
Mood Disorders / etiology*
Mood Disorders / rehabilitation*
Online Systems
Psychiatric Status Rating Scales
Severity of Illness Index
Treatment Outcome
Trichotillomania* / complications
Trichotillomania* / psychology
Trichotillomania* / rehabilitation
Young Adult