Measuring the role of psychological inflexibility in trichotillomania
Open accessAbstract
Psychological Inflexibility (PI) is a construct that has gained recent attention as a critical theoretical component of Acceptance and Commitment Therapy (ACT). PI is typically measured by the Acceptance and Action Questionnaire-II (AAQ-II). However, the AAQ-II has shown questionable reliability in clinical populations with specific diagnoses, leading to the creation of content-specific versions of the AAQ-II that show stronger psychometric properties in their target populations. A growing body of the literature suggests that PI processes may contribute to hair pulling, and the current study sought to examine the psychometric properties and utility of a Trichotillomania-specific version of the AAQ-II, the AAQ-TTM. A referred sample of 90 individuals completed a battery of assessments as part of a randomized clinical trial of Acceptance-Enhanced Behavior Therapy for Trichotillomania. Results showed that the AAQ-TTM has two intercorrelated factors, adequate reliability, concurrent validity, and incremental validity over the AAQ-II. Furthermore, mediational analysis between emotional variables and hair pulling outcomes provides support for using the AAQ-TTM to measure the therapeutic process. Implications for the use of this measure will be discussed, including the need to further investigate the role of PI processes in Trichotillomania.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The AAQ-TTM is negatively correlated with trichotillomania severity, with correlations of −.37 with the NIMH-TSS and −.49 with the MGH-HPS.
“The AAQ-TTM has been found to be negative correlated with trichotillomania severity (r = −.37 with NIMH-TSS and −.49 with MGH-HPS), anxiety (r = −.36 with BAI), and depression (r = −.61 with BDI; Houghton et al., 2014).”
From The role of psychological flexibility in acceptance-enhanced behavior therapy for trichotillomania: Moderation and mediation findings (2023) · cites this paper as Houghton et al., 2014
The Results (§3.3 Validity; page unavailable) report significant correlations between AAQ-TTM scores and both the NIMH-TSS and MGH-HPS. The Methods (§2.2.1; page unavailable) say higher AAQ-TTM scores indicate greater psychological flexibility, consistent with an inverse relationship to severity. The passages in our copy do not give the claimed coefficients of −.37 and −.49, so those exact values are not verified. (LLM, conf=0.79)
Experimental — accuracy not yet measuredThe AAQ-TTM is negatively correlated with depression, with a correlation of −.61 with the BDI.
“The AAQ-TTM has been found to be negative correlated with trichotillomania severity (r = −.37 with NIMH-TSS and −.49 with MGH-HPS), anxiety (r = −.36 with BAI), and depression (r = −.61 with BDI; Houghton et al., 2014).”
From The role of psychological flexibility in acceptance-enhanced behavior therapy for trichotillomania: Moderation and mediation findings (2023) · cites this paper as Houghton et al., 2014
Results §3.3 (page unavailable) reports that the AAQ-TTM was significantly correlated with the BDI, supporting the claimed association with depression. The passages in our copy do not give the correlation’s direction or the specific value of −.61, so those details are not verified. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe AAQ-TTM is negatively correlated with anxiety, with a correlation of −.36 with the BAI.
“The AAQ-TTM has been found to be negative correlated with trichotillomania severity (r = −.37 with NIMH-TSS and −.49 with MGH-HPS), anxiety (r = −.36 with BAI), and depression (r = −.61 with BDI; Houghton et al., 2014).”
From The role of psychological flexibility in acceptance-enhanced behavior therapy for trichotillomania: Moderation and mediation findings (2023) · cites this paper as Houghton et al., 2014
The Results (§3.3 Validity; page unavailable) state that the AAQ-TTM was significantly correlated with BAI anxiety scores. The passages in our copy do not give the correlation’s direction or the claimed coefficient of −.36, so those details cannot be verified. (LLM, conf=0.83)
Experimental — accuracy not yet measuredThe Acceptance and Action Questionnaire - Trichotillomania has shown good internal consistency, concurrent validity, and incremental validity over the AAQ-II.
“It has shown good internal consistency, concurrent validity, as well as incremental validity over the AAQ-II (Houghton et al., 2014).”
From The role of psychological flexibility in acceptance-enhanced behavior therapy for trichotillomania: Moderation and mediation findings (2023) · cites this paper as Houghton et al., 2014
Houghton et al. (2014) reported that trichotillomania-specific psychological inflexibility indirectly linked depression to hair-pulling severity.
“In trichotillomania, Houghton et al. (2014) found an indirect effect of trichotillomania-specific psychological inflexibility on the relationship between depression and hair-pulling severity, consistent with hypotheses about the emotional regulation function of pulling behavior.”
From The role of psychological flexibility in acceptance-enhanced behavior therapy for trichotillomania: Moderation and mediation findings (2023) · cites this paper as Houghton et al., 2014
The findings support the relevance of psychological flexibility, especially when specifically related to trichotillomania symptoms, to the treatment of trichotillomania.
“In general, our findings support the relevance of psychological flexibility—especially when specifically related to trichotillomania symptoms—to the treatment of trichotillomania, consistent with findings from previous studies (Houghton et al., 2014; Woods et al., 2006).”
From The role of psychological flexibility in acceptance-enhanced behavior therapy for trichotillomania: Moderation and mediation findings (2023) · cites this paper as Houghton et al., 2014
Because Houghton et al. (2014) and Norberg et al. (2007) relied on cross-sectional data, causal or temporal ordering cannot be inferred confidently.
“However, these studies used cross-sectional data, making it difficult to make inferences about temporal precedence or causality.”
From The role of psychological flexibility in acceptance-enhanced behavior therapy for trichotillomania: Moderation and mediation findings (2023) · cites this paper as Houghton et al., 2014
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
Baron, R. M., & Kenny, D. A. (1986) · Journal of Personality and Social Psychology · doi:10.1037//0022-3514.51.6.1173 · Cited by 91,542 · see citing works
Baron, R. M., & Kenny, D. A. (1986) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.51.6.1173 · Cited by 91,532 · see citing works
Diagnostic and Statistical Manual of Mental Disorders
(2012) · Springer eBooks · doi:10.1007/springerreference_121117 · Cited by 20,769 · see citing works
Diagnostic and Statistical Manual of Mental Disorders.
Widiger, T. A. (2000) · Oxford University Press eBooks · doi:10.1037/10518-009 · Cited by 19,767 · see citing works
An inventory for measuring clinical anxiety: Psychometric properties.
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.56.6.893 · Cited by 14,407 · see citing works
Psychometric theory (2nd ed.).
Sitgreaves, R. (1979) · Contemporary Psychology · doi:10.1037/018882 · Cited by 14,384 · see citing works
Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation
Beck, A. T., Steer, R. A., & Carbin, M. G. (1988) · Clinical Psychology Review · doi:10.1016/0272-7358(88)90050-5 · Cited by 11,696 · see citing works
A Rationale and Test for the Number of Factors in Factor Analysis
Horn, J. L. (1965) · Psychometrika · doi:10.1007/bf02289447 · Cited by 8,965 · see citing works
Gratz, K. L., & Roemer, L. (2004) · Journal of Psychopathology and Behavioral Assessment · doi:10.1023/b:joba.0000007455.08539.94 · Cited by 8,942 · cited 3× · see citing works
“Furthermore, these studies might also consider conducting additional criterion-related validation of the AAQ-TTM by performing comparisons to measures of distress tolerance, such as the Difficulty in Emotion Regulation Scale (Gratz and Roemer, 2004), the Generalized Expectancy for Negative Mood Regulation Scale (Catan…”
Method(1976) · Medical Entomology and Zoology · Cited by 8,899 · see citing works
Acceptance and commitment therapy: model, processes and outcomes
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2005.06.006 · Cited by 6,587 · cited 4× · see citing works
“…with cognitive flexibility (which involves the ability to shift attentional focus and does not appear to be dysfunctional in TTM; see Chamberlain et al. (2006)), PI involves problems in resisting maladaptive behaviors that are triggered by aversive cognitions and emotions (Hayes et al., 2006).”
BackgroundInfluential(1999) · Cited by 5,934 · see citing works
Factor analysis in the development and refinement of clinical assessment instruments.
Floyd, F. J., & Widaman, K. F. (1995) · Psychological Assessment · doi:10.1037/1040-3590.7.3.286 · Cited by 3,970 · see citing works
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (2011) · Behavior Therapy · doi:10.1016/j.beth.2011.03.007 · Cited by 3,950 · see citing works
Comparison of five rules for determining the number of components to retain.
Zwick, W. R., & Velicer, W. F. (1986) · Psychological Bulletin · doi:10.1037/0033-2909.99.3.432 · Cited by 3,139 · see citing works
Kirk, J., & Miller, M. L. (1986) · Sage eBooks · doi:10.4135/9781412985659.n2 · Cited by 1,376 · see citing works
Acceptance of chronic pain: component analysis and a revised assessment method
McCracken, L. M., Vowles, K. E., & Eccleston, C. (2004) · Pain · doi:10.1016/j.pain.2003.10.012 · Cited by 1,101 · see citing works
Reliability and validity of the Beck anxiety inventory
Fydrich, T., Dowdall, D., & Chambless, D. L. (1992) · Journal of Anxiety Disorders · doi:10.1016/0887-6185(92)90026-4 · Cited by 776 · see citing works
Exploratory Factor Analysis: A Users’Guide
Ferguson, E., & Cox, T. (1993) · International Journal of Selection and Assessment · doi:10.1111/j.1468-2389.1993.tb00092.x · Cited by 724 · see citing works
Gregg, J. A., Callaghan, G. M., Hayes, S. C., & Glenn-Lawson, J. L. (2007) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.75.2.336 · Cited by 695 · cited 2× · see citing works
“Thus, specific versions based on the AAQ-II have been created for diabetes (Gregg et al., 2007), epilepsy (Lundgren et al.”
BackgroundMotor Inhibition and Cognitive Flexibility in Obsessive-Compulsive Disorder and Trichotillomania
Chamberlain, S. R., Fineberg, N. A., Blackwell, A. D., Robbins, T. W., & Sahakian, B. J. (2006) · American Journal of Psychiatry · doi:10.1176/ajp.2006.163.7.1282 · Cited by 627 · see citing works
Catanzaro, S. J., & Mearns, J. (1990) · Journal of Personality Assessment · doi:10.1080/00223891.1990.9674019 · Cited by 609 · cited 3× · see citing works
“Furthermore, these studies might also consider conducting additional criterion-related validation of the AAQ-TTM by performing comparisons to measures of distress tolerance, such as the Difficulty in Emotion Regulation Scale (Gratz and Roemer, 2004), the Generalized Expectancy for Negative Mood Regulation Scale (Catan…”
MethodCatanzaro, S., & Mearns, J. (1990) · Journal of Personality Assessment · doi:10.1207/s15327752jpa5403&4_11 · Cited by 609 · see citing works
Swedo, S. E., Leonard, H. L., Rapoport, J. L., Lenane, M. C., Goldberger, E. L., & Cheslow, D. L. (1989) · New England Journal of Medicine · doi:10.1056/nejm198908243210803 · Cited by 601 · cited 2× · see citing works
“The NIMH Trichotillomania Scale (Swedo et al., 1989) is a semi-structured clinical interview consisting of two clinical indices: the NIMH Trichotillomania Severity Scale (NIMH-TSS) and the NIMH Trichotillomania Impairment Scale (NIMH-TIS).”
BackgroundMethodAcceptance-based treatment for smoking cessation
Gifford, E. V., Kohlenberg, B. S., Hayes, S. C., Antonuccio, D. O., Piasecki, M. M., Rasmussen-Hall, M. L., & Palm, K. M. (2004) · Behavior Therapy · doi:10.1016/s0005-7894(04)80015-7 · Cited by 499 · see citing works
The Massachusetts General Hospital (MGH) Hairpulling Scale: 1. Development and Factor Analyses
Keuthen, N. J., O’Sullivan, R. L., Ricciardi, J. N., Shera, D., Savage, C. R., Borgmann, A. S., Jenike, M. A., & Baer, L. (2010) · Psychotherapy and Psychosomatics · doi:10.1159/000289003 · Cited by 444 · cited 2× · see citing works
“The Massachusetts General Hospital Hairpulling Scale (MGH-HPS; Keuthen et al., 1995; O’Sullivan et al., 1995) is the most widely used self-report outcome measure of TTM, and demonstrates satisfactory psychometric properties (Keuthen et al., 1995, 2007; O’Sullivan et al., 1995; Diefenbach et al.,…”
Method(1991) · PubMed · Cited by 398 · see citing works
Assessment of body image flexibility: The Body Image-Acceptance and Action Questionnaire
Sandoz, E. K., Wilson, K. G., Merwin, R. M., & Kate Kellum, K. (2013) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2013.03.002 · Cited by 396 · see citing works
Woods, D. W., Wetterneck, C. T., & Flessner, C. A. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2005.05.006 · Cited by 381 · cited 6× · see citing works
“ACT has been found generally effective for a variety of mental health issues (Hayes et al., 2006), and components have been successfully incorporated into HRT for TTM (Twohig and Woods, 2004; Woods et al., 2006; Flessner et al., 2008a).”
BackgroundInfluentialSelf-citationA placebo-controlled trial of cognitive-behavioral therapy and clomipramine in trichotillomania
Ninan, P. T., Rothbaum, B. O., Marsteller, F. A., Knight, B. T., & Eccard, M. B. (2000) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v61n0111 · Cited by 303 · cited 2× · see citing works
“Several preliminary studies of these treatments in TTM have been undertaken (Ninan et al., 2000; Woods et al., 2006; Keuthen et al., 2010, 2011), but all suffer from methodological shortcomings including small sample size and/or lack of a control group.”
BackgroundMethodAzrin, N. H., Nunn, R. G., & Frantz, S. E. (1980) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/0005-7916(80)90045-2 · Cited by 249 · see citing works
Lundgren, T., Dahl, J., & Hayes, S. C. (2008) · Journal of Behavioral Medicine · doi:10.1007/s10865-008-9151-x · Cited by 199 · see citing works
The Massachusetts General Hospital (MGH) hairpulling scale: 2. Reliability and validity
O’Sullivan, R. L., Keuthen, N. J., Hayday, C. F., Ricciardi, J. N., Buttolph, L., Jenike, M. A., & Baer, L. (2010) · Psychotherapy and Psychosomatics · doi:10.1159/000289004 · Cited by 191 · cited 4× · see citing works
“The Massachusetts General Hospital Hairpulling Scale (MGH-HPS; Keuthen et al., 1995; O’Sullivan et al., 1995) is the most widely used self-report outcome measure of TTM, and demonstrates satisfactory psychometric properties (Keuthen et al.”
MethodInfluentialLeon, A. C., Shear, M. K., KLERMAN, G. L., S, L. P. M., Rosenbaum, J. F., & Goldenberg, I. M. (1993) · Journal of Clinical Psychopharmacology · doi:10.1097/00004714-199310000-00005 · Cited by 145 · see citing works
(2010) · Research Online (University of Wollongong) · Cited by 143 · see citing works
Twohig, M. P., & Woods, D. W. (2004) · Behavior Therapy · doi:10.1016/s0005-7894(04)80021-2 · Cited by 141 · see citing works
Self-citationAffective correlates of trichotillomania.
Diefenbach, G., Mouton-Odum, S., & Stanley, M. A. (2002) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(02)00006-2 · Cited by 139 · see citing works
The voices acceptance and action scale (VAAS): Pilot data
Shawyer, F., Ratcliff, K., Mackinnon, A., Farhall, J., Hayes, S. C., & Copolov, D. (2007) · Journal of Clinical Psychology · doi:10.1002/jclp.20366 · Cited by 136 · see citing works
Begotka, A. M., Woods, D. W., & Wetterneck, C. T. (2004) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2004.02.001 · Cited by 132 · see citing works
Substance abuse and psychological flexibility: the development of a new measure
Luoma, J., Drake, C. E., Kohlenberg, B. S., & Hayes, S. C. (2011) · Addiction Research & Theory · doi:10.3109/16066359.2010.524956 · Cited by 131 · see citing works
Is it the sound or your relationship to it? The role of acceptance in predicting tinnitus impact
Westin, V., Hayes, S. C., & Andersson, G. (2008) · Behaviour Research and Therapy · doi:10.1016/j.brat.2008.08.008 · Cited by 128 · see citing works
Flessner, C., Conelea, C. A., Woods, D. W., Franklin, M., Keuthen, N., & Cashin, S. E. (2008) · Behaviour Research and Therapy · doi:10.1016/j.brat.2007.12.009 · Cited by 127 · see citing works
Self-citationMeasuring avoidance and inflexibility in weight related problems.
Lillis, J., & Hayes, S. C. (2008) · International Journal of Behavioral Consultation and Therapy · doi:10.1037/h0100865 · Cited by 121 · see citing works
Acceptance-Enhanced Behavior Therapy (AEBT) for Trichotillomania and Chronic Skin Picking
Flessner, C. A., Busch, A. M., Heideman, P. W., & Woods, D. W. (2008) · Behavior Modification · doi:10.1177/0145445507313800 · Cited by 112 · see citing works
Self-citationAssessment of trichotillomania: A psychometric evaluation of hair-pulling scales
Diefenbach, G. J., Tolin, D. F., Crocetto, J., Maltby, N., & Hannan, S. (2005) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-005-0633-7 · Cited by 109 · see citing works
BEGOTKA, A. (2004) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/s0005-7916(04)00017-5 · Cited by 98 · see citing works
DBT-enhanced habit reversal treatment for trichotillomania: 3- and 6-month follow-up results
Keuthen, N. J., Rothbaum, B. O., Falkenstein, M. J., Meunier, S., Timpano, K. R., Jenike, M. A., & Welch, S. S. (2011) · Depression and Anxiety · doi:10.1002/da.20778 · Cited by 89 · cited 4× · see citing works
“Furthermore, these studies might also consider conducting additional criterion-related validation of the AAQ-TTM by performing comparisons to measures of distress tolerance, such as the Difficulty in Emotion Regulation Scale (Gratz and Roemer, 2004), the Generalized Expectancy for Negative Mood Regulation Scale (Catan…”
BackgroundMethodInfluentialExperiential avoidance as a mediator of relationships between cognitions and hair-pulling severity
Norberg, M. M., Wetterneck, C. T., Woods, D. W., & Conelea, C. A. (2007) · Behavior Modification · doi:10.1177/0145445506297343 · Cited by 86 · cited 2× · see citing works
“According to ACT theory, the AAQ-TTM should mediate the relationship between affect and TTM symptom severity, as people may pull, in part, to control or regulate emotions and other negative private events (Norberg et al., 2007).”
ResultSelf-citationBehavior Therapy for Pediatric Trichotillomania: A Randomized Controlled Trial
Franklin, M., Edson, A. L., Ledley, D. A., & Cahill, S. (2011) · Journal of the American Academy of Child and Adolescent Psychiatry · doi:10.1016/j.jaac.2011.05.009 · Cited by 84 · see citing works
Self-citationDahlke, F., Lohaus, A., & Gutzmann, H. (1992) · PubMed · Cited by 83 · see citing works
Pilot trial of dialectical behavior therapy-enhanced habit reversal for trichotillomania
Keuthen, N. J., Rothbaum, B. O., Welch, S. S., Taylor, C., Falkenstein, M., Heekin, M., Jordan, C. A., Timpano, K., Meunier, S., Fama, J., et al. (2010) · Depression and Anxiety · doi:10.1002/da.20732 · Cited by 81 · cited 1× · see citing works
“Several preliminary studies of these treatments in TTM have been undertaken (Ninan et al., 2000; Woods et al., 2006; Keuthen et al., 2010, 2011), but all suffer from methodological shortcomings including small sample size and/or lack of a control group.”
BackgroundHabit reversal training for trichotillomania: A group approach
Mouton, S., & Stanley, M. (1996) · Cognitive and Behavioral Practice · doi:10.1016/s1077-7229(96)80036-8 · Cited by 77 · see citing works
Rapp, J. T., Miltenberger, R. G., Long, E. S., Elliott, A. J., & Lumley, V. A. (1998) · Journal of Applied Behavior Analysis · doi:10.1901/jaba.1998.31-299 · Cited by 77 · see citing works
Group treatment for trichotillomania: behavior therapy versus supportive therapy
Diefenbach, G. J., Tolin, D. F., Hannan, S., Maltby, N., & Crocetto, J. (2006) · Behavior Therapy · doi:10.1016/j.beth.2006.01.006 · Cited by 73 · cited 1× · see citing works
“The CGI-S has good reliability (Dahlke et al., 1992), strong convergent validity (Leon et al., 1993), and has been used as a treatment outcome measure for adults with TTM (Ninan et al., 2000; Diefenbach et al., 2006).”
MethodFactor analysis of the Massachusetts General Hospital Hairpulling Scale.
Keuthen, N., Flessner, C., Woods, D. W., Franklin, M., Stein, D., & Cashin, S. E. (2007) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2006.12.003 · Cited by 70 · see citing works
Self-citationThe habit-reversal technique in treating trichotillomania
ROSENBAUM, M. S., & Ayllón, T. (1981) · Behavior Therapy · doi:10.1016/s0005-7894(81)80085-8 · Cited by 63 · see citing works
MacKenzie, M. B., & Kocovski, N. L. (2010) · International Journal of Behavioral Consultation and Therapy · doi:10.1037/h0100909 · Cited by 58 · see citing works
A modified habit reversal procedure in a recalcitrant case of trichotillomania
Tarnowski, K. J., Rosén, L. A., McGrath, M. L., & Drabman, R. S. (1987) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/0005-7916(87)90030-9 · Cited by 49 · see citing works
Clinician-Rated Measures of Hair Pulling: A Preliminary Psychometric Evaluation
Stanley, M., Breckenridge, J. K., Snyder, A. G., & Novy, D. M. (1999) · Journal of Psychopathology and Behavioral Assessment · doi:10.1023/a:1022160522908 · Cited by 44 · see citing works
Treatment of Trichotillomania by Habit Reversal
Støylen, I. J. (1996) · Scandinavian Journal of Behaviour Therapy · doi:10.1080/16506079609456020 · Cited by 5 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- Nunnally JC 1978 Psychometric theory 2 McGraw-Hill New York
- Woods DW Twohig MP 2008 Trichotillomania: An ACT-enhanced Behavior Therapy Approach, Therapist’s Guide Oxford University Press New York
Cited by
Sorted by citations
Thompson, E. M., Destree, L., Albertella, L., & Fontenelle, L. F. (2021) · Behavior Therapy · doi:10.1016/j.beth.2020.07.002 · Cited by 168 · see citing works
A review of AAQ variants and other context-specific measures of psychological flexibility
Ong, C. W., Lee, E. B., Levin, M. E., & Twohig, M. P. (2019) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2019.02.007 · Cited by 142 · see citing works
Self-citationLee, E. B., Homan, K. J., Morrison, K. L., Ong, C. W., Levin, M. E., & Twohig, M. P. (2018) · Behavior Modification · doi:10.1177/0145445518794366 · Cited by 88 · see citing works
Self-citationAcceptance-enhanced behavior therapy for trichotillomania in adults: A randomized clinical trial
Woods, D. W., Ely, L. J., Bauer, C. C., Twohig, M. P., Saunders, S. M., Compton, S. N., Espil, F. M., Neal-Barnett, A., Alexander, J. R., Walther, M. R., et al. (2022) · Behaviour Research and Therapy · doi:10.1016/j.brat.2022.104187 · Cited by 51 · see citing works
Self-citationThe Role of Experiential Avoidance in Problematic Pornography Viewing
Levin, M. E., Lee, E. B., & Twohig, M. P. (2018) · The Psychological Record · doi:10.1007/s40732-018-0302-3 · Cited by 50 · see citing works
Self-citationThe Acceptance and Action Questionnaire – II: an Item Response Theory Analysis
Ong, C. W., Pierce, B. G., Woods, D. W., Twohig, M. P., & Levin, M. E. (2018) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-018-9694-2 · Cited by 50 · see citing works
Self-citationEmotion regulation in individuals with and without trichotillomania
Arabatzoudis, T., Rehm, I. C., Nedeljkovic, M., & Moulding, R. (2017) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2017.01.003 · Cited by 48 · see citing works
Twohig, M. P., Petersen, J. M., Fruge, J. E., Ong, C. W., Barney, J. L., Krafft, J., Lee, E. B., & Levin, M. E. (2021) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2021.01.004 · Cited by 46 · see citing works
Self-citationLee, E. B., Haeger, J., Levin, M. E., Ong, C. W., & Twohig, M. P. (2018) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2018.04.003 · Cited by 45 · see citing works
Self-citationJacoby, R. J., Abramowitz, J. S., Buchholz, J. L., Reuman, L., & Blakey, S. M. (2018) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2018.07.003 · Cited by 43 · see citing works
Asplund, M., Rück, C., Lenhard, F., Gunnarsson, T., Bellander, M., Delby, H., & Ivanov, V. Z. (2021) · Journal of Clinical Psychology · doi:10.1002/jclp.23147 · Cited by 42 · see citing works
Ong, C. W., Barney, J. L., Barrett, T. S., Lee, E. B., Levin, M. E., & Twohig, M. P. (2019) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2019.06.005 · Cited by 40 · see citing works
Self-citationComprehensive Behavioral Treatment of Trichotillomania
Falkenstein, M. J., Mouton‐Odum, S., Mansueto, C. S., Golomb, R. G., & Haaga, D. A. F. (2015) · Behavior Modification · doi:10.1177/0145445515616369 · Cited by 41 · see citing works
Emotion regulation deficits in persons with body-focused repetitive behavior disorders
Alexander, J. R., Houghton, D. C., Bauer, C. C., Lench, H. C., & Woods, D. W. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.11.035 · Cited by 43 · see citing works
Self-citationTrauma and trichotillomania: A tenuous relationship
Houghton, D., Mathew, A., Twohig, M., Saunders, S., Franklin, M., Compton, S., Neal-Barnett, A., & Woods, D. W. (2016) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2016.09.003 · Cited by 9 · see citing works
Self-citationBlakey, S. M., Halverson, T. F., Evans, M. K., Patel, T. A., Hair, L. P., Meyer, E. C., DeBeer, B. B., Beckham, J. C., Pugh, M. J., Calhoun, P. S., et al. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.07.033 · Cited by 31 · see citing works
Clarifying the relationship between Trichotillomania and anxiety
Alexander, J. R., Houghton, D. C., Twohig, M. P., Franklin, M. E., Saunders, S. M., Neal-Barnett, A. M., Compton, S. N., & Woods, D. W. (2017) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2017.02.004 · Cited by 31 · see citing works
Self-citationFactor analysis of the Milwaukee Inventory for Subtypes of Trichotillomania-Adult Version
Alexander, J. R., Houghton, D., Twohig, M., Franklin, M., Saunders, S., Neal-Barnett, A., Compton, S., & Woods, D. W. (2016) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2016.08.001 · Cited by 27 · see citing works
Self-citationHair pulling antecedents in trichotillomania: Their relationship with experiential avoidance
Wetterneck, C. T., Singh, R. S., & Woods, D. W. (2020) · Bulletin of the Menninger Clinic · doi:10.1521/bumc_2020_84_01 · Cited by 28 · see citing works
Self-citationMeasuring ACT in context: Challenges and future directions
Ong, C. W., Sheehan, K. G., & Haaga, D. A. F. (2023) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2023.04.005 · Cited by 28 · see citing works
Asplund, M., Lenhard, F., Andersson, E., & Ivanov, V. Z. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100573 · Cited by 25 · see citing works
Ricketts, E. J., Peris, T. S., Grant, J. E., Valle, S., Cavic, E., Lerner, J. E., Lochner, C., Stein, D. J., Dougherty, D. D., O’Neill, J., et al. (2024) · Child Psychiatry & Human Development · doi:10.1007/s10578-022-01458-w · Cited by 23 · see citing works
Self-citationCrowe, E., Staiger, P. K., Bowe, S. J., Rehm, I. C., Moulding, R., Herrick, C. A., & Hallford, D. J. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.11.010 · Cited by 28 · see citing works
Capel, L. K., Petersen, J. M., Becker, M. R., Levin, M. E., & Twohig, M. P. (2023) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2023.100800 · Cited by 20 · see citing works
Self-citationKrafft, J., Ong, C. W., Twohig, M. P., & Levin, M. E. (2019) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2018.08.003 · Cited by 18 · see citing works
Self-citationMoulding, R., Mancuso, S. G., Rehm, I. C., & Nedeljkovic, M. (2016) · Cambridge University Press eBooks · doi:10.1017/cbo9781139941297.014 · Cited by 17 · see citing works
Ong, C. W., & Eustis, E. H. (2022) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780197550076.013.7 · Cited by 16 · see citing works
Ong, C. W., Woods, D. W., Franklin, M. E., Saunders, S. M., Neal-Barnett, A. M., Compton, S. N., & Twohig, M. P. (2023) · Behaviour Research and Therapy · doi:10.1016/j.brat.2023.104302 · Cited by 15 · see citing works
“It has shown good internal consistency, concurrent validity, as well as incremental validity over the AAQ-II (Houghton et al., 2014).”
InfluentialSelf-citationNeal-Barnett, A. M., Woods, D. W., Espil, F. M., Davis, M., Alexander, J. R., Compton, S. N., Walther, M. R., Twohig, M. P., Saunders, S. M., Cahill, S. P., et al. (2019) · Bulletin of the Menninger Clinic · doi:10.1521/bumc_2019_83_04 · Cited by 15 · see citing works
Self-citationThe Beliefs in Trichotillomania Scale (Bi TS ): Factor analyses and preliminary validation
Rehm, I. C., Nedeljkovic, M., Moulding, R., & Thomas, A. C. (2019) · British Journal of Clinical Psychology · doi:10.1111/bjc.12219 · Cited by 11 · see citing works
Petersen, J. M., Capel, L. K., Levin, M. E., & Twohig, M. P. (2022) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2022.100757 · Cited by 10 · see citing works
Self-citationWetterneck, C. T., Lee, E. B., Flessner, C. A., Leonard, R. C., & Woods, D. W. (2015) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2015.12.003 · Cited by 10 · see citing works
Self-citationSlikboer, R., Castle, D., Nedeljkovic, M., & Rossell, S. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2017.12.056 · Cited by 9 · see citing works
Gregory, V. L. (2019) · Springer eBooks · doi:10.1007/978-981-13-0440-8_5-1 · Cited by 9 · see citing works
Thompson, E. M., Albertella, L., Viskovich, S., Pakenham, K. I., & Fontenelle, L. F. (2024) · Behaviour Research and Therapy · doi:10.1016/j.brat.2024.104595 · Cited by 8 · see citing works
Soltani, E., Ghanizadeh, A., Dastgheib, S. A., Wong, Q. J. J., & Jaafari, N. (2020) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2020.100582 · Cited by 7 · see citing works
Psychosocial Treatment of Trichotillomania: A Review
Capel, L., Woolley, M. G., & Twohig, M. (2024) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2024.05.003 · Cited by 9 · see citing works
Self-citationAcceptance and Action Questionnaire-Adult Hearing Loss (AAQ-AHL): validation with hearing aid users
Miguel, G. G. S., Muñoz, K. F., Barrett, T. S., & Twohig, M. P. (2022) · International Journal of Audiology · doi:10.1080/14992027.2022.2142161 · Cited by 6 · see citing works
Self-citationCapel, L. K., Petersen, J. M., Levin, M. E., & Twohig, M. P. (2023) · Cognitive Therapy and Research · doi:10.1007/s10608-023-10418-0 · Cited by 5 · see citing works
Self-citationBowers, E. M., Capel, L. K., Woolley, M. G., Barnes, A., Twohig, M. P., & Levin, M. E. (2024) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2024.100909 · Cited by 5 · see citing works
Self-citationCapel, L. K., Bowers, E. M., Becker, M. R., Davis, M. P., Levin, M. E., & Twohig, M. P. (2024) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2024.100908 · Cited by 4 · see citing works
Self-citationPsychological flexibility in mild traumatic brain injury: an evaluation of measures
Faulkner, J. W., Snell, D. L., Theadom, A., Mahon, S., Barker-Collo, S., & Skirrow, P. (2021) · Brain Injury · doi:10.1080/02699052.2021.1959062 · Cited by 4 · see citing works
Twohig, M. P., & Capel, L. K. (2025) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2025.02.011 · Cited by 4 · see citing works
Self-citationTrichotillomania: Therapist Guide
Twohig, M. P., & Woods, D. W. (2023) · doi:10.1093/med-psych/9780197670309.001.0001 · Cited by 4 · see citing works
Self-citationGregory, V. L. (2020) · Springer eBooks · doi:10.1007/978-981-13-6975-9_5 · Cited by 4 · see citing works
Swisher, V. S., Ricketts, E. J., Peris, T. S., Jones, G. M., Dunning, E. E., Valle, S., Cavic, E., Löchner, C., Stein, D. J., Dougherty, D. D., et al. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.10.037 · Cited by 3 · see citing works
Self-citationIs ACT-Informed Exposure a Viable Treatment for Excoriation Disorder? A Multiple Baseline Study
Thompson, B. L. (2022) · Behavior Modification · doi:10.1177/01454455221091778 · Cited by 3 · see citing works
Phenomenology of Trichotillomania
Houghton, D., & Woods, D. W. (2017) · doi:10.1002/9781118890233.ch46 · Cited by 1 · see citing works
Self-citationACT-Enhanced Behavior Therapy for a Hispanic Adult with Trichotillomania: A Case Report
Donahue, M. L., & Twohig, M. P. (2024) · Clinical Case Studies · doi:10.1177/15346501231225505 · Cited by 3 · see citing works
Self-citationUntroubled Pullers: An Examination of Nonclinical Hair-Pulling
Flannery, M. K., Falkenstein, M. J., Boyd, M., & Haaga, D. (2023) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2023.100821 · Cited by 2 · see citing works
Rehm, I. C., Moulding, R., & Nedeljkovic, M. (2024) · Australian Psychologist · doi:10.1080/00050067.2024.2376881 · Cited by 2 · see citing works
Capel, L. K., Bowers, E. M., Woolley, M. G., Petersen, J. M., Muñoz, K. F., & Twohig, M. P. (2025) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2025.100896 · Cited by 2 · see citing works
Self-citationVillanueva‐Blasco, V. J., Martínez, A. C., Eslava, D., & Valdivia‐Salas, S. (2018) · INFORMACIO PSICOLOGICA · doi:10.14635/ipsic.2018.115.7 · Cited by 2 · see citing works
Mouton-Odum, S., & Houghton, D. (2018) · Bulletin of the Menninger Clinic · doi:10.1521/bumc.2018.82.4.288 · Cited by 1 · see citing works
Self-citationObsessive Compulsive and Related Disorders
Lee, E. B., Arendtson, M., & Wall, A. (2022) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780197550076.013.16 · Cited by 2 · see citing works
Acceptance-Enhanced Behavior Therapy for Trichotillomania in Youth
Petersen, J. (2024) · Journal of Cognitive Psychotherapy · doi:10.1891/jcp-2023-0012 · Cited by 1 · see citing works
Development of a measure of cognitions and beliefs in trichotillomania
Rehm, I. C. (2016) · Swinburne figshare (Swinburne University of Technology) · doi:10.25916/sut.26269711 · Cited by 1 · see citing works
Body-Focused Repetitive Behavior Disorders
Stein, D., & Lochner, C. (2018) · The Cambridge Handbook of Anxiety and Related Disorders · doi:10.1017/9781108140416.025 · Cited by 2 · see citing works
Spanish version of the hearing loss acceptance and action questionnaires
Miguel, G. G. S., & Muñoz, K. F. (2024) · International Journal of Audiology · doi:10.1080/14992027.2024.2353270 · Cited by 1 · see citing works
Acceptance and Commitment Model of Borderline Personality Disorder
Salavati, M., & Selby, E. A. (2024) · Springer eBooks · doi:10.1007/978-3-031-75503-3_11 · Cited by 1 · see citing works
Capel, L. K., Bowers, E. M., Woolley, M. G., Soileau, K. J., Thomas, G., Levin, M. E., & Twohig, M. P. (2025) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2025.08.001 · Cited by 1 · see citing works
Self-citationDiaz, A., & Miteva, M. (2019) · Alopecia · doi:10.1016/b978-0-323-54825-0.00007-7
Mechanisms of Treatments for Trichotillomania (Hair Pulling Disorder)
Brennan, E., Francazio, S., Murphy, Y. E., & Flessner, C. (2017) · doi:10.1002/9781118877142.ch20 · Cited by 1 · see citing works
Acceptance and Commitment Therapy for OC‐Spectrum Disorders
Morrison, K. L., Smith, B. M., Lee, E. B., & Twohig, M. P. (2017) · Wiley eBooks · doi:10.1002/9781118890233.ch65
Self-citationSession 8: Practicing Acceptance and Commitment Therapy (ACT)
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0008
Self-citationClient Forms, Graphs, and Worksheets
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.005.0002
Self-citationModifications for Working with Adolescents
Petersen, J. M. (2023) · doi:10.1093/med-psych/9780197670309.003.0011
Session 4: Can Pulling-Related Inner Experiences Be Controlled?
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0005
Self-citationWoods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0002
Self-citationWoods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.005.0004
Self-citationSession 2: Habit Reversal Training (HRT) and Trigger Reduction Strategies
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0003
Self-citationWoods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.005.0001
Self-citationSession 5: Acceptance of Pulling-Related Inner Experiences
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0006
Self-citationSessions 6 and 7: Defusion from Your Inner Experiences: You Are Not Your Urges to Pull
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0007
Self-citationSession 9: Practicing Acceptance and Commitment Therapy (ACT) and Review of Treatment
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0009
Self-citationWoods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.005.0003
Self-citationSession 10: Review and Relapse Prevention
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0010
Self-citationSession 3: Increasing Motivation for Treatment Through Values
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0004
Self-citationHummelen, B., Brovold, F., Moen, E. M., Meland, K. J., Andersen, A., Johnsen, D. S., Dammen, T., Woods, D. W., & Grøtte, T. (2025) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2025.100972
Self-citationCapel, L. K., Woolley, M. G., Bowers, E. M., Soileau, K. J., Thomas, G., Levin, M. E., & Twohig, M. P. (2025) · Journal of Cognitive Psychotherapy · doi:10.1891/jcp-2025-0021
Self-citation
- Authors
- Houghton, D. C., Compton, S. N., Twohig, M. P., Saunders, S. M., Franklin, M. E., Neal-Barnett, A. M., Ely, L., Capriotti, M. R., & Woods, D. W.
- Affiliations
- Texas A&M University (US)
- Duke University (US)
- Utah State University (US)
- Marquette University (US)
- University of Pennsylvania (US)
- Kent State University (US)
- University of Wisconsin–Milwaukee (US)
- Corresponding author
- Woods, Douglas W.
- ORCID
- Venue
- Psychiatry Research
- Publisher
- Elsevier BV
- Published
- 2014-12
- Volume
- 220
- Issue
- 1-2
- Pages
- 356-361
- ISSN
- 0165-1781 (ISSN-L)
- PMC
- PMC4254146
- OpenAlex
- W2083072238
- Cited by
- 84
- References
- 59
- Citations by year
- 2025: 6 · 2024: 8 · 2023: 26 · 2022: 8 · 2021: 4 · 2020: 4 · 2019: 5 · 2018: 10 · 2017: 7 · 2016: 4 · 2015: 2
- FWCI
- 5.11
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychiatry Research (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Digital Commons - USU (Utah State University) (submittedVersion)
- Funders
- National Institutes of Health (R01MH080966)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- psychological inflexibility, trichotillomania, Acceptance and Action Questionnaire-II, psychometric properties, incremental validity, concurrent validity, hair pulling, therapeutic process, emotional factors
- MeSH terms
- Adult, Behavior Therapy, Cross-Sectional Studies, Female, Humans, Male, Psychometrics, Surveys and Questionnaires, Trichotillomania, Reproducibility of Results, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
