Psychological Inflexibility as a Session-to-Session Process of Change in Acceptance and Commitment Therapy-Enhanced Behavior Therapy for Adults With Trichotillomania

Abstract

One potential explanation for difficulty in treating trichotillomania despite increased research on evidence-based treatments is the heterogeneity in symptom presentation. An individualized treatment approach may help increase treatment response and recovery. Additionally, understanding which processes help improve treatment outcomes in psychosocial interventions may be particularly important. This study examined how changes in trichotillomania-specific psychological inflexibility related to week-to-week levels of hair-pulling severity and distress. We also explored a potential bidirectional relationship between hair-pulling severity and trichotillomania-specific psychological inflexibility. Results indicated that trichotillomania symptom severity predicted trichotillomania-specific psychological inflexibility and vice versa, suggesting a bidirectional relationship. Additionally, trichotillomania-specific psychological inflexibility may play a more central role in trichotillomania symptom changes. Moreover, distress was strongly predicted by current trichotillomania-specific psychological inflexibility. Trichotillomania-specific psychological inflexibility appears to be a process of change in treatment for trichotillomania. Clinical implications are discussed.