Trichotillomania: What is problematic hair-pulling?

Trichotillomania: What is problematic hair-pulling?

Trichotillomania (TTM) is currently classified as an impulse-control disorder. TTM entails the phenomenon of repetitive hair pulling that results in hair loss. The diagnostic criteria for TTM include: an increased level of tension immediately before hair pulling or during attempts to avoid pulling and a feeling of relief, pleasure, or gratification in response to hair pulling. Trichotillomania must also cause the individual distress or impairment in occupational, social, or other areas of functioning. Hair is most often pulled, one hair at a time, either from the scalp, lashes, or eyebrows. Hair pulling from the pubic area is also common.

Pulling is generally executed by way of the fingers; however, tools such as tweezers, brushes, or combs may be used as well. TTM suffers will often partake in post-pulling actions that involve handling the pulled hair using the mouth, hands, or face. The hair can be chewed or ingested as well. Ingesting hair may also lead to a number of significant health issues. TTM is considered to be more common among females, although it is not certain whether this sex difference results from an actual variance in the occurrence of the disorder, represents a female treatment-seeking bias, or simply reflects higher acceptability in society of hair loss in men.  

At the Better Living Center for Behavioral Health we treat patients with trichotillomania with evidence-based treatments including Habit Reversal. Habit reversal helps the individual break down the series of actions that lead to hair pulling and engage in alternative behaviors to reduce hair pulling. If you would like to learn more about treatment of trichotillomania or other Body Focused Repetitive Behaviors (BFRBs) please contact us at 972-332-8765.

 

References:

Woods, D. W., Flessner, C., Franklin, M. E., Wetterneck, C. T., Walther, M. R., Anderson, E. R., & Cardona, D. (2006). Understanding and treating trichotillomania: What we know and what we don’t know. Psychiatric Clinics of North America, 29(2), 487-501. doi:10.1016/j.psc.2006.02.009

Differences in Early and Late Onset OCD

Differences in Early and Late Onset OCD

Pinto et al. (2006) defined OCD as “a neuropsychiatric condition characterized by recurrent intrusive thoughts (obsessions) and repetitive behaviors that the individual feels driven to perform (compulsions)” (pg.1 ).  The researchers sought to investigate predictors of remission/relapse among those treated for OCD.

Over five years, 293 adults were monitored and researchers measured their OCD symptoms. Researchers found those with early and late onset symptoms experience an increase in symptoms over time without effective treatment. Additional findings show a considerable amount of time between symptom onset and first initiation of treatment. Individuals in the study reported an average of 17 years from initial symptom experience to treatment initiation and 11 of delay from meeting diagnostic criteria for OCD until treatment initiation. Many clients reported spending a number of years misdiagnosed before initiating appropriate treatment for OCD.  

Researchers found the average onset for early onset OCD was 11-12 years old, while late onset OCD was 25-26 years-of-age. The first clinical symptom(s), obsessions and compulsions, 53% of participants indicated an obsession and 47% experiencing a compulsion. Interviews also found aggressive content obsessions, hoarding obsessions and compulsions as primary themes in distress. Contamination was shown as the most frequently reported subcategory for obsessions. Those with earlier onset symptoms also experienced higher rates of panic symptoms and disordered (Pinto et al., 2006).

Written by Perry Leynor, MA, LPC Associate supervised by Paula Maloney, LPC Supervisor.

Pinto, A., Mancebo, M. C., Eisen, J. L., Pagano, M. E., & Rasmussen, S. A. (2006). The Brown Longitudinal obsessive COMPULSIVE Study. The Journal of Clinical Psychiatry, 67(05), 703-711. https://doi:10.4088/jcp.v67n0503

Identifying and Treating Race-based Trauma

Identifying and Treating Race-based Trauma

Statistics indicate the United States of America (USA) is becoming more diverse and a nation of plurality. Despite statistics, USA has consistently struggled with its ability to respect, accept, and include diverse populations. Individuals of color experience direct and indirect health care disparities such as unequal access to material, social, and educational resources on a prevalent and consistent basis. They are often not able to afford health insurance, in addition, experience racist behaviors and discrimination amongst healthcare providers.

Racial and ethnic discrimination can cause negative psychological consequences that cause race-related stress and could eventually cause race-based trauma (Hemmings & Evans 2018). These psychological issues encompass feelings of helplessness, paranoia, anxiety, fear, medical health issues, numbing to their emotions, denigration of one’s sociocultural in-groups, and the onset of PTSD.

One solution is improving the health of individuals of color. Healthcare professionals would need to make better efforts to address racism when working with minorities. Research shows facilitating multiculturally competent care would require awareness of race, racism, discrimination, and how these factors contribute to subpar healthcare practices (Hemming & Evans 2018). Multicultural training within the mental health field also needs to be improved. A solution would be more effective training and treatment models for counselors to be better prepared to establish a therapeutic relationship with a person of color.

Written by Victoria Fontenot – Behavior Therapist. To seek care with us – please call 972-332-8765.

Hemmings, C & Evans, A. M. (2018). Identifying and treating race-based trauma in counseling. Journal of Multicultural Counseling and Development, (4), 20-37. https://doi:10.1002/jmcd.12090

Offering Your Anxious Clients the Standard of Care

Offering Your Anxious Clients the Standard of Care

                              Offering Your Anxious Clients the ‘Gold Standard’ of Care

         Exposure therapy has long been supported as the ‘gold standard’ treatment for anxiety disorders. Despite strong empirical support for the effectiveness of exposure therapy, many therapists underutilize exposure therapy in the treatment of anxiety and related disorders.

Studies examining why clinicians tend to underutilize exposure therapy indicate several important factors.

These factors include:

  • Lack of appropriate training or supervision to learn these methods.
  • Holding negative or inaccurate perceptions about exposure therapy and when it is contraindicated.
  • Clinician belief that clients will reject the treatment, drop out of treatment, or that exposure therapy may cause harm to clients by asking them to engage with aversive experiences.

In summary, clinicians tend to underutilize the ‘gold standard’ of treatments for anxiety and related disorders because they tend to have little training or experience with it. A key factor in alleviating these issues is offering more training and consultation on utilization of exposure-based treatments.

If you would like to learn more about using exposure therapy in your practice:

  • Sign up for our blog, below.
  • Contact us at 972-332-8733 to join our consultation group or to set up individual case consultation.

     by Perry Leynor, LPC Associate under the supervision of Paula Maloney, LPC-S.    

Meyer, J. M., Farrell, N. R., Kemp, J. J., Blakey, S. M., & Deacon, B. J. (2014). Why do clinicians exclude anxious clients from exposure therapy? Behaviour Research and Therapy, 54, 49-53. https://doi:10.1016/j.brat.2014.01.004

Racial Bias and Ethnic Disparities in Health Services

Racial Bias and Ethnic Disparities in Health Services

For centuries, women of color have experienced a prevailing and insidious disparity in their reproductive healthcare. Social and structural factors of minorities have been negatively impacted in the flowing ways: fewer neighborhood health services are available, less insurance coverage, decreased access to educational and economic attainment, and racial bias and stereotyping at the practitioner level. This phenomenon of a racial-ethnic gap has been deemed a human rights issue, as declared by The Center for Reproductive Rights.

One such disparity are barriers to proper access to contraceptives. Women of color are less likely to afford birth control medication due to the high cost of adequate health insurance. Disparities in maternal mortality have been a prevalent and well-documented opposition, due to clinician-level biases and racism, has contributed to delayed or absent care leading to death. Statistics have revealed that African American, Native American, and Native Alaskan women were 2.5 to 3.3 times more likely to die from pregnancy-related complications than White women. Disparities surrounding HIV prevention and treatment management for Black and Latina women have also not been properly addressed. 75 percent of new HIV diagnosis are within these demographics. The following recommendations need to be taken to decrease the percentages above: addressing disproportionate poverty, emphasizing equal access to educational and career opportunities, increased reproductive healthcare opportunities, and increased access to biomedical prevention treatment. Data shows pre-exposure prophylaxis has not been afforded to Black women as an option for HIV prevention as opposed to White women and men.

The Patient Protection and Affordable Care Act (ACA) is an example of a social-structural-policy–level intervention that was supposed to help establish more health care access to previously uninsured and underinsured individuals. Due to federal and state rulings, continuously diminishing portions of the ACA, inefficient reproductive healthcare access and services, an all-encompassing national health insurance reform strategy needs to break down barriers and fortify access.

There are systematic and positive change solutions that would ensure more opportunity for women of color. Entailing the deterioration of social and structural barricades for underprivileged minority women would increase access to adequate reproductive health services without clinical racial bias. Women of color need to be heard with empathy and compassion to ensure care and treatment management will be appropriate. Change requires a more racial and ethnically diverse workforce, full clinical training pertaining to anti-racism education, and increased utilization of doulas and other patient advocates in maternal care.

By Victoria Fontenot – Behavior Therapist with Better Living Center for Behavioral Health

Sutton, M. Y., Anachebe, N. F., Lee, R., & Skanes, H. (2021). Racial and ethnic disparities in reproductive health services and Outcomes, 2020. Obstetrics & Gynecology, 137(2), 225-233.

 

Postpartum OCD

Postpartum OCD

When we hear “postpartum” it is usually followed by “depression”. While the postpartum period IS often associated with depression, other disorders are overlooked. Outside the scope of obsessions harming infants, the effects of Obsessive-Compulsive Disorder (OCD) have limited investigation into pregnancy and the postpartum period. This is concerning for two reasons. One, research shows that obsessive compulsive symptoms (OCSs) can be as severely debilitating as other disorders, including schizophrenia. Two, clinical research reflects psychological disorders, commonly depression, cause poor infant outcomes. It is alarming OCD is often overlooked due to the potential impact on infant outcomes. Pregnancy and parenthood constitute major events that create major life obstacles. Studies show these periods can create a greater risk of causing and increasing the severity of OCSs. OCSs are associated with the overall well-being of the infant (House et al., 2015).

House et al. (2015) examined if preexisting OCSs increased throughout the perinatal period. Researchers followed 56 women diagnosed with OCD over a period of 52 weeks postpartum. The study relied on assessment measures for OCD and follow-up with clinicians. Researchers found the severity of OCSs did not increase or fluctuate throughout the pregnancy and postpartum period, unlike other disorders. Maternity age and delivery method were both associated with predictors of increased OCSs. Women who gave birth having a cesarean section showed an increase in OCSs postpartum, and younger woman were associated more with OCSs. Future studies would replicate this data and include comorbid disorders.

By Perry Leynor, MA, LPC-A – Behavior Therapist with Better Living Center for Behavioral Health

House SJ., Tripathi SP., Knight BT., Morris N., Newport DJ., Stowe ZN. (2015). Obsessive-compulsive disorder in pregnancy and the postpartum period: Course of illness and obstetrical outcome. https://pubmed.ncbi.nlm.nih.gov/26173597/

Can mindfulness help with anxiety and depression?

Can mindfulness help with anxiety and depression?

According to Google Trends, “Mindfulness” has become an increasingly popular search term over the past decade, and a variety of resources are available to date, including books, blogs, videos, and courses. In addition to its popularity, mindfulness has been studied empirically and become an evidence-based treatment for common problems such as anxiety and depression. Generally speaking, mindfulness involves bringing intentional focus to the present moment and observing the things you are experiencing at that moment for what they are, without judgment. Your observations may involve noticing thoughts, feelings, or bodily sensations. Mindfulness interventions are commonly carried out in person, but this form of intervention is difficult for people who live in rural areas and has become particularly challenging due to the COVID-19 pandemic which has restricted social interactions. Fortunately, a group of researchers found that the positive effects of mindfulness could also be achieved via an online platform.

In 2013, Krusche and colleagues evaluated the effects of a web-based mindfulness course for stress, anxiety, and depression with 273 participants. The authors developed 10 online interactive sessions led by mindfulness instructors, and participants participated for at least 4 weeks, but the course was designed to follow the same sequence as an 8-week mindfulness course. Participants were also given audio and video clips for guided meditation and assigned work to complete outside of sessions, including informal practice of mindfulness (i.e., being present while doing an everyday task such as washing the dishes). After the course had ended, results showed significant decreases in scores related to stress, anxiety, and depression, and these effects maintained at a 1-month follow up. The results of this study are promising and suggest that many people experiencing emotional challenges during this time might benefit from online interventions such as telehealth and video-based mindfulness instruction and guide practice.

Krusche, A., Cyhlarova, E., & Williams, J. M. G. (2013). Mindfulness online: An evaluation of the feasibility of a web-based mindfulness course for stress, anxiety and depression. BMJ Open Science. doi:10.1136/bmjopen-2013-003498

Contamination OCD in Adolescents: Treatment with Acceptance and Commitment Therapy

Contamination OCD in Adolescents: Treatment with Acceptance and Commitment Therapy

Obsessive-Compulsive Disorder (OCD) describes a condition in which an individual has uncontrollable thoughts and/or behaviors (i.e., compulsions) that are problematic on an ongoing basis (National Institute of Mental Health), and these symptoms can be experienced by adults as well as children and adolescents. Common treatments for OCD involve exposure therapy, which is sometimes combined with a selective-serotonin reuptake inhibitor (SSRI) medication (International OCD Foundation). However, recent advances in treatment for OCD are now including Acceptance and Commitment Therapy (ACT), which is a form of therapy that encourages individuals to accept unwanted thoughts without judgment, separate themselves from their thoughts, engage in activities that move the individual toward life values, and mindfulness (see contextualscience.org/act for more information). Although there is growing evidence for ACT as a component of treatment for OCD, the majority of these studies have been conducted with adults. Therefore, Armstrong and colleagues (2013) evaluated the effects of ACT for three adolescents (ages 12-13 years old) diagnosed with OCD.

Participants in this study reported fears about contamination and dying which were linked to problematic behaviors such as excessive hand washing, frequent reassurance-seeking, and lengthy bedtime routines. Treatment occurred weekly over the course of 8 weeks and involved a variety of components. A few examples of treatment components were 1) identifying differences between obsessions and compulsions; 2) drawing activities; 3) education about and activities surrounding the futility of fighting thoughts; 4) identifying life values; 5) accepting unwanted thoughts; and 6) mindfulness. Each treatment session was 50 min and included related homework assignments. The results of this study showed that self-reported compulsions decreased by 40%, and these effects were maintained at a 3-month follow up, and treatment was rated as highly acceptable by participants as well as their parents.

Armstong, A. B., Morrison, K. L., & Twohig, M. P. (2013). A preliminary investigation of acceptance and commitment therapy for adolescent obsessive-compulsive disorder. Journal of Cognitive Psychotherapy, 27, 175-190.

 

Evidence-based Treatments for PTSD: Prolonged Exposure and Behavioral Activation

Evidence-based Treatments for PTSD: Prolonged Exposure and Behavioral Activation

Many people witness or experience some kind of traumatic event during their lifetime; however, these events affect people in different ways. It is common for people who have witnessed or experienced a traumatic event to have some difficulty adjusting and coping, but symptoms such as flashbacks and anxiety typically improve with time (Mayo Clinic). However, for some people, symptoms get worse or persist for several months or years and interfere with daily functioning, which is usually an indication of Post-Traumatic Stress Disorder (PTSD; Mayo Clinic). A common form of treatment for PTSD is exposure-based therapy which involves intentionally imagining the traumatic experience and interacting with people, places, or things that are associated with or related to the traumatic event (Gros et al., 2012). However, some individuals with PTSD also have symptoms of depression which sometimes persist after treatment for PTSD (Gros et al., 2012). Due to this concern, Gros and colleagues (2012) sought to evaluate the effects of a treatment package for individuals with PTSD and depression which included evidence-based therapies for each of these conditions.

Eighty-two combat veterans completed participation in the current study which incorporated exposure therapy and behavioral activation (BA)—an evidence-based treatment for depression involving planning activities that are aligned with personal values. Each treatment session was 90 minutes, and participants completed eight treatment sessions. Treatment consisted of encouraging participants to plan activities consistent with personal values—some of which involved exposure to feared situations such as shopping in a crowded mall—and writing or speaking about the traumatic event (i.e., imaginal exposure). In this way, participants used behavioral activation combined with exposure therapy. Throughout the study, participants completed a variety of questionnaires designed to assess the severity of symptoms of PTSD and depression. Overall, researchers observed improvements in PTSD and overlapping symptoms of PTSD and depression; however, similar effects were not observed for nonoverlapping symptoms of depression. The authors concluded that more research is needed to determine the effects of specific treatment components on specific symptoms of PTSD and depression, and which additional treatment components may enhance treatment effects.

Scrupulosity: When religion and morality become impairing

Scrupulosity: When religion and morality become impairing

Although most people are familiar with Obsessive Compulsive Disorder (OCD)—or at least have a general idea and may even feel that they personally have some OCD tendencies—a lesser known form of OCD exists called scrupulosity. Scrupulosity involves obsessions related to religious or moral ideals which cause an individual to be overly concerned that their actions are sinful or are violating religious or moral doctrine (International OCD Foundation, 2010). This concern is so great that it often leads to excessive praying or trips to confession, repeating rituals involving cleansing and purifying, and avoiding situations where some religious or moral error may occur (IOCDF, 2010). One effective and recommended treatment for scrupulosity is Exposure and Response Prevention (ERP); however, another form of treatment, Acceptance and Commitment Therapy (ACT) was shown to be another effective form of treatment in a recent study by Dehlin, Morrison, and Twohig (2013). Acceptance and Commitment Therapy traditionally involves accepting undesirable thoughts and feelings, reducing the meaning of and attachment to these thoughts and feelings, and working toward acting in a way that fulfills one’s values in life and has been used in the treatment of OCD.

Dehlin and colleagues (2013) evaluated the effects of ACT on scrupulosity with five adults (three females and two males) across eight treatment sessions. In order to measure the effects of treatment, researchers tracked the participants’ compulsive behaviors as well as engagement with valued activities. In addition, researchers had participants complete assessment questionnaires. Treatment sessions were 1-1.5 hours each week and consisted of activities that helped the participants incorporate the core processes of ACT. Participants also completed weekly homework assignments. Throughout treatment, participants learned to accept unwanted thoughts, separate themselves from obsessive thoughts, view the self as a context in which thoughts occur, contact the present moment, and commit to actions in alignment with values. Results of the study showed a 74% reduction in compulsions and a 79% reduction in avoided valued behaviors, and these reductions were maintained during a 3-month follow up. In addition, participants reported high levels of treatment acceptability which, combined with the positive results of treatment, makes this a promising treatment for individuals with scrupulosity.

Dehlin, J. P., Morrison, K. L., & Twohig, M. P. (2013). Acceptance and commitment therapy as a treatment for scrupulosity in obsessive compulsive disorder. Behavior Modification. DOI: 10.1177/0145445512475134

International Obsessive-Compulsive Disorder Foundation (2010). Retrieved from https://iocdf.org/wp-content/uploads/2014/10/IOCDF-Scrupulosity-Fact-Sheet.pdf