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

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.

A brief, residential peer‐support retreat for trichotillomania: A mixed methods evaluation

“…Other activities featured in the retreat, such as the empty chair technique, journaling, and group discussions facilitated the identification, questioning and confrontation of long‐standing beliefs around the role TTM had in participants' lives. Our findings demonstrate that deep cognitive work can occur outside the traditional therapeutic settings for those with TTM and supports recent research emphasising the importance of addressing cognitions and beliefs in TTM (Keijsers et al, ; Rehm et al, ; Shareh, ). Interestingly, such intervention techniques resemble those of compassion‐focused therapy, which has shown some efficacy for treating anxiety and depression (Finlay‐Jones, ).…”

“…Such a trial would move our knowledge in this area from descriptive to directional. Our findings highlight the potential usefulness of an immersive retreat program for women with TTM, and indicates that factors thought to be important in the recovery of TTM such as emotional regulation (Shusterman, Feld, Baer, & Keuthen, 2009), maladaptive beliefs (Rehm et al, 2015), and avoidance (Slikboer, Castle, et al, 2018) can be addressed within a compassionate peer-support environment. Although the retreat was a brief experience that lead to only short-term symptom improvements, participants described outcomes critical to psychosocial recovery (Leamy et al, 2011), such as a sense of acceptance, belonging and shared experience, which they valued 12 months later.…”

“…Questions about the retreat focused on: expectations for the retreat; experiences that were not part of the retreat but influenced participants' experience of it; attitudes towards the retreat facilitators and accommodation; whether and how the retreat influenced hair pulling behaviour; most and least enjoyable and effective aspects of the retreat; and previous treatment‐seeking experiences. Questions regarding mental health reflected the quantitative measures used in the study; for example, participants were asked “what is your own estimate of TTM in terms of severity over the last week?” and prompted with “urges to pull,” “the behaviour of pulling,” and “distress related to pulling.” Participants were also asked about their experiences of depression, anxiety, and stress; whether they have received any other psychological diagnoses; how other areas of life are affected by TTM; and about thoughts and beliefs related to TTM (Rehm, Nedeljkovic, Thomas, & Moulding, ).…”

“…and prompted with "urges to pull," "the behaviour of pulling," and "distress related to pulling." Participants were also asked about their experiences of depression, anxiety, and stress; whether they have received any other psychological diagnoses; how other areas of life are affected by TTM; and about thoughts and beliefs related to TTM (Rehm, Nedeljkovic, Thomas, & Moulding, 2015).…”

How reward and punishment are viewed by individuals experiencing trichotillomania according to revised reinforcement sensitivity theory

“…Associated with the BIS are the emotions of anxiety and depression, and behaviours of risk assessment (Corr, 2008). The struggle over control over one's hair-pulling (Rehm, Nedeljkovic, Thomas, & Moulding, 2015) could be construed as an approach-avoidance conflict, which elicits depression and anxiety in TTM.…”