The manipulation of arousal on the intensity of urges to pull hair in a 16 year old female with trichotillomania: a single case study

Abstract

Hairpulling (trichotillomania) is often linked to stressful circumstances and may produce feelings of guilt, shame and humiliation. In a behavioural model, affective experience was identified as an important maintaining factor, as both a cue and reinforcer. Habit Reversal is one of the more successful behavioural treatment options. The present study evaluated the role of emotional arousal in the intensity of urges to pull hair in a teenaged patient with trichotillomania. Using an experimental ABCD/DCBA reversal design, the patient used imagery to increase her emotional arousal through the presentation of a manipulation script based on her own experience, after baseline and during a rumination, cognitive and a behavioural distraction phase. Subjective measures of urge intensity were collected at five time points during completion of a task, and a tally was made of an overt hair touching behaviour operationalized as a hairpulling substitute behaviour. The patient experienced more intense urges to pull whilst ruminating on the arousal script compared to either of the distraction phases. The findings support the view that the experience of negative emotional arousal can exacerbate and intensify the experience of urges to pull hair in patients with trichotillomania, and that both cognitive and behavioural distraction techniques have some effect in controlling them. Demonstrating this to the patient aided engagement in treatment.