Mindfulness-Based Cognitive Therapy for Trichotillomania: A Bayesian Case-Control Study

Abstract

Over the last years, mindfulness-based interventions combined with habit reversal training have been demonstrated to be particularly suitable for addressing trichotillomania. However, because these studies always combined mindfulness training to habit reversal without including either a mindfulness or habit reversal condition alone, it is still unclear whether clinical benefits are the consequences of mindfulness or merely result from habit reversal training. The primary purpose of the present study was thus to examine whether a mindfulness training procedure without habit reversal could alleviate trichotillomania. Using a Bayesian probabilistic approach for single-case design, client's hair loss severity and level of mindfulness were compared to a normative sample (n = 15) before treatment, after treatment, and at six-month follow-up. Improvement in mindfulness first occurred, and that beneficial effect then transferred to hair-pulling. Indeed, as compared to the normative sample, the client exhibited, from baseline to post-treatment, an improvement in mindfulness. Although a marginal trend to improvement was already evidenced at post-treatment, the mindfulness program only had a significant beneficial effect transferred to hair-loss severity at six-month follow-up. Although it remains particularly difficult to infer generalization from one client, the data from the present case study are the first to suggest that mindfulness training per se might be a suitable clinical intervention for trichotillomania.

Keywords: Bayesian approach; Hair-pulling; Mindfulness-based interventions; Single-case; Trichotillomania.

Figure 1

Changes in Hair Loss Severity as a function of Time. Note: The broken line depicts the mean score of the normative sample; the red “X” indicates that the case exhibits a deficit as compared to the normative sample; the green “v” indicates a significant restoration of this deficit.

Figure 2

Changes in Mindfulness Facets as a function of Time. Note: The broken line depicts the mean score of the normative sample; the red “X” indicates that the case exhibits a deficit as compared to the normative sample; the green “v” indicates a significant restoration of this deficit.