Does cognitive bias modification prior to standard brief cognitive behavior therapy reduce relapse rates in hair pulling disorder? A double-blind randomized controlled trial

Joyce Maas*, Ger P. J. Keijsers, Mike Rinck, Eni S. Becker

*Corresponding author for this work

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Background: 

In line with previous research in alcohol addiction, we tested whether an Approach-Avoidance Training (AAT) prior to standard six-session Cognitive Behavior Therapy (CBT) for Hair Pulling Disorder (HPD) reduced problematic relapse, commonly found in this population. 

Method: 

Prior to CBT, 54 outpatients with a primary diagnosis of HPD were randomly assigned (double-blind) to either a training condition (n = 27), learning to avoid hair-pulling-related stimuli, or to a control condition (n = 27). Symptom severity was assessed with the Massachussetts General Hospital Hairpulling Scale, Severity Urge Resistance Frequency Scale, Self-Control Cognition Questionnaire, and Alopecia Scale. 

Results: 

In line with existing research, CBT showed to be an effective treatment for HPD in the short-term. There was no significant symptom increase after one and three months, but effect sizes were reduced approximately by half at the twelve-month measurement. The AAT training prior to CBT did not result in enhanced symptom reduction or reduced relapse after CBT. 

Conclusions: 

AAT training could not resolve the substantial relapse after successful CBT. Future research should take into account the complexity of stimuli that elicit hair pulling (e.g., tactile stimuli) and consider investigating other types of biases.

Original languageEnglish
Pages (from-to)453-479
JournalJournal of Social and Clinical Psychology
Volume37
Issue number6
DOIs
Publication statusPublished - 2018

Keywords

  • Hair Pulling Disorder
  • Cognitive Bias Modification
  • Approach-Avoidance Task
  • relapse
  • implicit processes
  • AUTOMATIC ACTION-TENDENCIES
  • PLACEBO-CONTROLLED TRIAL
  • HAZARDOUS DRINKERS
  • HAIRPULLING SCALE
  • ATTENTIONAL BIAS
  • SYMPTOM SEVERITY
  • HABIT REVERSAL
  • TRICHOTILLOMANIA
  • IMPLICIT
  • ALCOHOL

Cite this

@article{83cace90b8354311a9127dba76a01d04,
title = "Does cognitive bias modification prior to standard brief cognitive behavior therapy reduce relapse rates in hair pulling disorder?: A double-blind randomized controlled trial",
abstract = "Background: In line with previous research in alcohol addiction, we tested whether an Approach-Avoidance Training (AAT) prior to standard six-session Cognitive Behavior Therapy (CBT) for Hair Pulling Disorder (HPD) reduced problematic relapse, commonly found in this population. Method: Prior to CBT, 54 outpatients with a primary diagnosis of HPD were randomly assigned (double-blind) to either a training condition (n = 27), learning to avoid hair-pulling-related stimuli, or to a control condition (n = 27). Symptom severity was assessed with the Massachussetts General Hospital Hairpulling Scale, Severity Urge Resistance Frequency Scale, Self-Control Cognition Questionnaire, and Alopecia Scale. Results: In line with existing research, CBT showed to be an effective treatment for HPD in the short-term. There was no significant symptom increase after one and three months, but effect sizes were reduced approximately by half at the twelve-month measurement. The AAT training prior to CBT did not result in enhanced symptom reduction or reduced relapse after CBT. Conclusions: AAT training could not resolve the substantial relapse after successful CBT. Future research should take into account the complexity of stimuli that elicit hair pulling (e.g., tactile stimuli) and consider investigating other types of biases.",
keywords = "Hair Pulling Disorder, Cognitive Bias Modification, Approach-Avoidance Task, relapse, implicit processes, AUTOMATIC ACTION-TENDENCIES, PLACEBO-CONTROLLED TRIAL, HAZARDOUS DRINKERS, HAIRPULLING SCALE, ATTENTIONAL BIAS, SYMPTOM SEVERITY, HABIT REVERSAL, TRICHOTILLOMANIA, IMPLICIT, ALCOHOL",
author = "Joyce Maas and Keijsers, {Ger P. J.} and Mike Rinck and Becker, {Eni S.}",
year = "2018",
doi = "10.1521/jscp.2018.37.6.453",
language = "English",
volume = "37",
pages = "453--479",
journal = "Journal of Social and Clinical Psychology",
issn = "0736-7236",
publisher = "GUILFORD PUBLICATIONS INC",
number = "6",

}

Does cognitive bias modification prior to standard brief cognitive behavior therapy reduce relapse rates in hair pulling disorder? A double-blind randomized controlled trial. / Maas, Joyce; Keijsers, Ger P. J.; Rinck, Mike; Becker, Eni S.

In: Journal of Social and Clinical Psychology, Vol. 37, No. 6, 2018, p. 453-479.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Does cognitive bias modification prior to standard brief cognitive behavior therapy reduce relapse rates in hair pulling disorder?

T2 - A double-blind randomized controlled trial

AU - Maas, Joyce

AU - Keijsers, Ger P. J.

AU - Rinck, Mike

AU - Becker, Eni S.

PY - 2018

Y1 - 2018

N2 - Background: In line with previous research in alcohol addiction, we tested whether an Approach-Avoidance Training (AAT) prior to standard six-session Cognitive Behavior Therapy (CBT) for Hair Pulling Disorder (HPD) reduced problematic relapse, commonly found in this population. Method: Prior to CBT, 54 outpatients with a primary diagnosis of HPD were randomly assigned (double-blind) to either a training condition (n = 27), learning to avoid hair-pulling-related stimuli, or to a control condition (n = 27). Symptom severity was assessed with the Massachussetts General Hospital Hairpulling Scale, Severity Urge Resistance Frequency Scale, Self-Control Cognition Questionnaire, and Alopecia Scale. Results: In line with existing research, CBT showed to be an effective treatment for HPD in the short-term. There was no significant symptom increase after one and three months, but effect sizes were reduced approximately by half at the twelve-month measurement. The AAT training prior to CBT did not result in enhanced symptom reduction or reduced relapse after CBT. Conclusions: AAT training could not resolve the substantial relapse after successful CBT. Future research should take into account the complexity of stimuli that elicit hair pulling (e.g., tactile stimuli) and consider investigating other types of biases.

AB - Background: In line with previous research in alcohol addiction, we tested whether an Approach-Avoidance Training (AAT) prior to standard six-session Cognitive Behavior Therapy (CBT) for Hair Pulling Disorder (HPD) reduced problematic relapse, commonly found in this population. Method: Prior to CBT, 54 outpatients with a primary diagnosis of HPD were randomly assigned (double-blind) to either a training condition (n = 27), learning to avoid hair-pulling-related stimuli, or to a control condition (n = 27). Symptom severity was assessed with the Massachussetts General Hospital Hairpulling Scale, Severity Urge Resistance Frequency Scale, Self-Control Cognition Questionnaire, and Alopecia Scale. Results: In line with existing research, CBT showed to be an effective treatment for HPD in the short-term. There was no significant symptom increase after one and three months, but effect sizes were reduced approximately by half at the twelve-month measurement. The AAT training prior to CBT did not result in enhanced symptom reduction or reduced relapse after CBT. Conclusions: AAT training could not resolve the substantial relapse after successful CBT. Future research should take into account the complexity of stimuli that elicit hair pulling (e.g., tactile stimuli) and consider investigating other types of biases.

KW - Hair Pulling Disorder

KW - Cognitive Bias Modification

KW - Approach-Avoidance Task

KW - relapse

KW - implicit processes

KW - AUTOMATIC ACTION-TENDENCIES

KW - PLACEBO-CONTROLLED TRIAL

KW - HAZARDOUS DRINKERS

KW - HAIRPULLING SCALE

KW - ATTENTIONAL BIAS

KW - SYMPTOM SEVERITY

KW - HABIT REVERSAL

KW - TRICHOTILLOMANIA

KW - IMPLICIT

KW - ALCOHOL

U2 - 10.1521/jscp.2018.37.6.453

DO - 10.1521/jscp.2018.37.6.453

M3 - Article

VL - 37

SP - 453

EP - 479

JO - Journal of Social and Clinical Psychology

JF - Journal of Social and Clinical Psychology

SN - 0736-7236

IS - 6

ER -