Examining the Effectiveness of Dialectical Behavior Therapy on Impulsivity, Emotion Regulation, Rumination, and Self-Criticism in Individuals with Trichotillomania
Keywords:
Dialectical Behavior Therapy, Impulsivity, Emotion Regulation, Rumination, Self-Criticism, TrichotillomaniaAbstract
Trichotillomania is a mental disorder characterized by recurrent and irresistible urges to pull out hair from the body. The present study aimed to elucidate the effectiveness of dialectical behavior therapy on impulsivity, emotion regulation, rumination, and self-criticism in individuals with trichotillomania. From an objective standpoint, this study is considered applied research and, methodologically, a quasi-experimental study with a pre-test, post-test, and follow-up test design, including a control group with a 2-month follow-up period. The population of this research included all individuals with trichotillomania in districts 2 and 4 of Tehran, from whom 18 persons for each group were selected through purposive non-random sampling and were randomly assigned to either the experimental or control group. The instruments used in this research included the Massachusetts Hair Pulling Questionnaire, Williams and colleagues' (1997) Emotion Regulation Scale, Barratt and colleagues' (1990) Impulsivity Scale, Gilbert and colleagues' (2004) Self-Criticism Scale, and Nolen-Hoeksema and colleagues' (1991) Rumination Scale. The dialectical behavior therapy intervention was conducted over 8 one-hour sessions; however, the control group did not receive any intervention. The research was analyzed through mixed ANOVA (with repeated measures) and Bonferroni follow-up tests using SPSS version 22. The results of the present study indicated that dialectical behavior therapy has a significant effect on impulsivity (P<0.01), emotion regulation (P<0.01), rumination (P<0.01), and self-criticism (P<0.01), and these effects continue in the follow-up phase. It can be concluded that dialectical behavior therapy is effective in reducing impulsivity, improving emotion regulation, decreasing rumination, and reducing self-criticism, and can therefore be beneficial for individuals with trichotillomania.
Downloads
References
1. Ubukata S, Mimura T, Watanabe E, Matsumoto K,
Kawashima M, Kitsu K, et al. Bilateral Trichotillomania of
Eyelashes Triggered by Anxiety due to Nocturnal Enuresis: A
Case Report. Case Reports in Ophthalmological Medicine.
2019;2019:4650217. [PMID: 31321109] [PMCID: PMC6609362]
[DOI]
2. Lamothe H, Baleyte J-M, Mallet L, Pelissolo A.
Trichotillomania is more related to Tourette disorder than to
obsessive-compulsive disorder. Brazilian Journal of Psychiatry.
2019;42:87-104. [PMID: 31576938] [PMCID: PMC6986481]
[DOI]
3. Asplund M, Lenhard F, Andersson E, Ivanov VZ.
Internet-delivered acceptance-based behavior therapy for
trichotillomania and skin-picking disorder in a psychiatric setting:
A feasibility trial. Internet Interventions. 2022;30:100573. [PMID:
36133915] [PMCID: PMC9483632] [DOI]
4. Anwar S, Jafferany M. Trichotillomania: a
psychopathological perspective and the psychiatric comorbidity of
hair pulling. Acta Dermatovenerol Alp Pannonica Adriat.
2019;28(1):33-6. [PMID: 30901067] [DOI]
5. Cisoń H, Kuś A, Popowicz E, Szyca M, Reich A.
Trichotillomania and Trichophagia: Modern Diagnostic and
Therapeutic Methods. Dermatology and Therapy. 2018;8(3):389-
98. [PMID: 30099694] [PMCID: PMC6109030] [DOI]
6. Grant JE, Aslan IH, Chamberlain SR. Statistical
predictors of psychosocial impairment in body-focused repetitive
behaviors. CNS Spectrums. 2022;27(5):621-5. [PMID: 33926604]
[PMCID: PMC7613743] [DOI]
7. Kozak K, Lucatch AM, Lowe DJE, Balodis IM,
MacKillop J, George TP. The neurobiology of impulsivity and
substance use disorders: implications for treatment. Annals of the
New York Academy of Sciences. 2019;1451(1):71-91. [PMID:
30291624] [PMCID: PMC6450787] [DOI]
8. Winstanley CA, Dalley JW, Theobald DEH, Robbins
TW. Fractionating Impulsivity: Contrasting Effects of Central 5-
HT Depletion on Different Measures of Impulsive Behavior.
Neuropsychopharmacology. 2004;29(7):1331-43. [PMID:
15054475] [DOI]
9. Costanza A, Rothen S, Achab S, Thorens G, Baertschi
M, Weber K, et al. Impulsivity and Impulsivity-Related
Endophenotypes in Suicidal Patients with Substance Use
Disorders: an Exploratory Study. International Journal of Mental
Health and Addiction. 2021;19(5):1729-44. [DOI]
10. Carter K, Olshan-Perlmutter M. Impulsivity and
Stillness: NADA, Pharmaceuticals, and Psychotherapy in
Substance Use and Other DSM 5 Disorders. Behavioral Sciences.
2015;5(4):537-46. [PMID: 26703743] [PMCID: PMC4695777]
[DOI]
11. Flessner CA, Knopik VS, McGeary J. Hair pulling
disorder (trichotillomania): Genes, neurobiology, and a model for
understanding impulsivity and compulsivity. Psychiatry Research.
2012;199(3):151-8. [PMID: 22537722] [DOI]
12. Crowe E, Staiger PK, Bowe SJ, Rehm I, Moulding R,
Herrick C, Hallford DJ. The association between trichotillomania
symptoms and emotion regulation difficulties: A systematic
review and meta-analysis. Journal of Affective Disorders.
2024;346:88-99. [PMID: 37940058] [DOI]
13. Behjame F, Gharayagh Zandi H, Khabiri M. The Role
of Cognitive Emotion Regulation Strategies on Predicting
Aggression and Competitive Anger among Athletic Students.
International Journal of Motor Control and Learning.
2021;3(4):19-26. [DOI]
14. Nathania M, Satiadarma MP, Wati L, editors.
Adolescent Emotion Regulation Who were Raised with
Authoritarian Parenting Style. 2022. Atlantis Press.
15. Cyders MA, Smith GT, Spillane NS, Fischer S, Annus
AM, Peterson C. Integration of impulsivity and positive mood to
predict risky behavior: Development and validation of a measure
of positive urgency. Psychological Assessment. 2007;19(1):107-
18. [PMID: 17371126] [DOI]
16. Watkins ER, Roberts H. Reflecting on rumination:
Consequences, causes, mechanisms and treatment of rumination.
Behaviour Research and Therapy. 2020;127:103573. [PMID:
32087393] [DOI]
17. Ye B, Zhou X, Im H, Liu M, Wang XQ, Yang Q.
Epidemic Rumination and Resilience on College Students'
Depressive Symptoms During the COVID-19 Pandemic: The
Mediating Role of Fatigue. Frontiers in Public Health. 2020;8.
[PMID: 33363075] [PMCID: PMC7755644] [DOI]
18. Miceli M, Castelfranchi C. Reconsidering the
differences between shame and guilt. Europe's journal of
psychology. 2018;14(3):710. [PMID: 30263080] [PMCID:
PMC6143989] [DOI]
19. Andel SA, Pindek S, Spector PE, Crowe RP, Cash RE,
Panchal A. Adding fuel to the fire: The exacerbating effects of
calling intensity on the relationship between emotionally
disturbing work and employee health. Journal of Occupational
Health Psychology. 2022;27(5):488-502. [PMID: 35588382]
[DOI]
20. Amighi H, Ebrahimi Moghadam H, Kashani Vahid L.
Comparison the effectiveness of dialectical behavior therapy and
cognitive-behavioral therapy on anxiety and aggression in people
with obsessive-compulsive disorder. Shenakht Journal of
Psychology and Psychiatry. 2023;10(5):87-102. [DOI]
21. Sobhi Gharamaleki N, Pourabdol S, Saravani R,
Saravani S. The Effectiveness of Dialectical Behavior Therapy in
Decreasing High Risk Behaviors Among Students Suffering From
Attention Deficit / Hyperactivity Disorder. Zahedan J Res Med
Sci. 2017;19(1):e5703. [DOI]
22. Telch CF, Agras WS, Linehan MM. Dialectical
behavior therapy for binge eating disorder. Journal of Consulting
and Clinical Psychology. 2001;69(6):1061-5. [PMID: 11777110]
[DOI]
23. Stiglmayr C, Stecher-Mohr J, Wagner T, Meiβner J,
Spretz D, Steffens C, et al. Effectiveness of dialectic behavioral
therapy in routine outpatient care: the Berlin Borderline Study.
Borderline Personality Disorder and Emotion Dysregulation.
2014;1(1):20. [PMID: 26401303] [PMCID: PMC4579507] [DOI]
24. Mark J, Williams G, Swales M. The Use of
Mindfulness-Based Approaches for Suicidal Patients. Archives of
Suicide Research. 2004;8(4):315-29. [PMID: 16081399] [DOI]
25. Hoffman PD, Fruzzetti AE, Buteau E, Neiditch ER,
Penney D, Bruce ML, et al. Family Connections: A Program for
Relatives of Persons With Borderline Personality Disorder.
Family Process. 2005;44(2):217
-25.
[PMID: 16013747]
[DOI]
26. Lammers MW, Vroling MS, Crosby RD, van Strien T.
Dialectical behavior therapy compared to cognitive behavior
therapy in binge
-eating disorder: An effectiveness study with 6
-
month follow
-up. International Journal of Eating Disorders.
2022;55(7):902
-13.
[PMID: 35665526] [PMCID: PMC9328197]
[DOI]
27. Shamsudeen S, Kannekanti P. Dialectical Behaviour
Therapy Enhanced Habit Reversal Training: A Clinical Case of
Childhood
-Onset Trichotillomania in an Adult With Impulsive
Personality Features. Clinical Case Studies. 2023;22(5):468
-83.
[DOI
]
28. Ghadimi Bavil Olyayi N, Khanjani Z, Hashemi T.
Comparing the Level of Risk
-Taking, Sensation
–Seeking and
Impulsivity of Adolescent Girls and Boys Based on the Level of
Influence of Peers. Journal of Research in Behavioural Sciences.
2023;20(4):622
-33.
[DOI]
29. Alavi MS, Jabal Ameli S. The Effectiveness of
Cognitive
-Behavioral Therapy on Emotional Control of MS
Patients in the City of Isfahan. Jorjani Biomedicine Journal.
2018;6(1):44
-54.
[DOI]
30. Mosavi SZ, Syyad Tabaei SR. Prediction of obsessive
compulsive disorder based on rumination and distress tolerance in
the corona epidemic. Rooyesh
-
e
-Ravanshenasi Journal (RRJ).
2023;12(4):159
-66.
31. Ochghaz MG, Mohammadkhani P, Hatami M,
Mohammadrezaei R. Compare Compassion
-Based Therapy and
Mindfulness
-Based Cognitive Therapy to Reduce Fear of
Compassion and Self-Criticism in People with Heart Failure.
Contemporary Psychology. 2020;15(1):123
-36.
32. Linehan MM, Korslund KE, Harned MS, Gallop RJ,
Lungu A, Neacsiu AD, et al. Dialectical Behavior Therapy for
High Suicide Risk in Individuals With Borderline Personality
Disorder: A Randomized Clinical Trial and Component Analysis.
JAMA Psychiatry. 2015;72(5):475
-82.
[PMID: 25806661]
[DOI]
33. Amini A, Shariatmadar A. The effectiveness of group
dialectic behavioral therapy on catastrophizing & ruminations of
mothers with mental retarded children. Counseling Culture and
Psycotherapy. 2018;9(34):171
-90.
34. Jones BDM, Umer M, Kittur ME, Finkelstein O, Xue S,
Dimick MK, et al. A systematic review on the effectiveness of
dialectical behavior therapy for improving mood symptoms in
bipolar disorders. International Journal of Bipolar Disorders.
2023;11(1):6.
[PMID: 36739574] [PMCID: PMC9899872]
[DOI]
35. Roshan Chesli R, Ashori A, Mahdikhanloo M, Parsi
Nejad Z. The Effectiveness of Dialectic Behavior Therapy on
Bearing Distress and Pain Anxiety in the People with Irritable
Bowel Syndrome. Medical journal of mashhad university of
medical sciences. 2020;63(2):2436
-45.
36. Safari A, Aftab R. The Effectiveness of Online
Dialectical Behavior Therapy on the Emotion Regulation
Difficulties, Guilt Feeling and Dissociative Symptoms in
Depressed People. Applied Psychology. 2021;15(4):206
-179.
[DOI]
37. Kothgassner OD, Goreis A, Robinson K, Huscsava
MM, Schmahl C, Plener PL. Efficacy of dialectical behavior
therapy for adolescent self-harm and suicidal ideation: a
systematic review and meta
-analysis. Psychological Medicine.
2021;51(7):1057
-67.
[PMID: 33875025] [PMCID: PMC8188531]
[DOI]
Downloads
Additional Files
Published
License
Copyright (c) 2024 Shahrbano Karimi Imam Vardikhan (Author); Ramezan Hassanzadeh (Corresponding Author); Seyedeh Olia Emadian (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
