Measuring the role of psychological inflexibility in Trichotillomania

Abstract

Psychological Inflexibility (PI) is a construct that has gained recent attention as a critical theoretical component of Acceptance and Commitment Therapy (ACT). PI is typically measured by the Acceptance and Action Questionnaire-II (AAQ-II). However, the AAQ-II has shown questionable reliability in clinical populations with specific diagnoses, leading to the creation of content-specific versions of the AAQ-II that show stronger psychometric properties in their target populations. A growing body of literature suggests that PI processes may contribute to hair pulling, and the current study sought to examine the psychometric properties and utility of a Trichotillomania-specific version of the AAQ-II, the AAQ-TTM. A referred sample of 90 individuals completed a battery of assessments as part of a randomized clinical trial of Acceptance-Enhanced Behavior Therapy for Trichotillomania. Results showed that the AAQ-TTM has two intercorrelated factors, adequate reliability, concurrent validity, and incremental validity over the AAQ-II. Furthermore, mediational analysis between emotional variables and hair pulling outcomes provides support for using the AAQ-TTM to measure therapeutic process. Implications for the use of this measure will be discussed, including the need to further investigate the role of PI processes in Trichotillomania.

Factor analysis of the Milwaukee Inventory for Subtypes of Trichotillomania-Adult Version

“…Previous research suggests that the degree to which pulling functions to regulate internal experiences is positively related to negative affect (Duke, Keeley, Geffken et al, 2010; Duke, Keeley, & Ricketts, 2010; Shusterman et al, 2009), experiential avoidance (i.e., the tendency to avoid unpleasant, internal experiences via maladaptive practices; Begotka et al, 2004; Houghton et al, 2014), and disorder severity (Begotka et al, 2004; Houghton et al, 2014; Norberg, Wetterneck, Woods, & Conelea, 2007; Shusterman et al, 2009). Consequently, we hypothesized that the “internal-regulated pulling” subscale would be positively related to anxiety, depression, experiential avoidance, and TTM severity.…”

“…The Acceptance and Action Questionnaire- Trichotillomania (AAQ-TTM; Houghton et al, 2014) is a nine-item self-report measure of experiential avoidance (also referred to as psychological inflexibility) specific to TTM. Items are rated on a 1 (“never true”) to 7 (“always true”) scale.…”

“…Lower scores are indicative of greater TTM-specific experiential avoidance. The AAQ-TTM has demonstrated adequate reliability and validity in a TTM sample (Houghton et al, 2014). In the current sample, the AAQ-TTM demonstrated acceptable internal consistency (α = .84).…”

Clarifying the relationship between Trichotillomania and anxiety

“…TTM research has predominantly treated anxiety as a unidimensional construct (e.g., Diefenbach, Mouton-Odum, & Stanley, 2002; Diefenbach, Tolin, Hannan, Crocetto, & Worhunsky, 2005; Diefenbach, Tolin, Meunier, & Worhunsky, 2008; Duke, Bodzin, Tavers, Geffken, & Storch, 2009; Houghton et al, 2014; Shusterman, Feld, Baer, & Keuthen, 2009; Stanley et al, 1994). However, anxiety researchers recognize anxiety as a multidimensional construct consisting of cognitive (sometimes referred to as subjective anxiety; e.g., fear and worry) and somatic (e.g., physiological arousal and panic) dimensions (Clark & Watson, 1991; Nitschke, Heller, Imig, McDonald, & Miller, 2001; Ree, French, MacLeod, & Locke, 2008).…”

“…To this end, a growing body of research focuses on the role of psychological inflexibility (i.e., one’s propensity to prioritize the mitigation of undesirable private experiences over the continuation of adaptive goal pursuits; Bond et al, 2011). For example, studies have found that psychological inflexibility mediates the relationship between hair pulling severity and both unidimensional measures of anxiety (Houghton et al, 2014) as well as some of the cognitive aspects of anxiety (i.e., apprehension/anxious thoughts about being negatively evaluated by others; Norberg et al, 2007). However, it is unclear whether psychological inflexibility mediates the relationship between TTM severity and the broader cognitive anxiety dimension.…”