Clarifying the Relationship between Trichotillomania and Anxiety

Due to the differences in treatment focus for different subtypes of anxiety in trichotillomania (e.g., deep breathing for somatic anxiety; cognitive restructuring for cognitive anxiety), the authors of this study aimed to see whether TTM severity was related to either cognitive anxiety (anxious thoughts/worries) or somatic anxiety(anxious sensations), predicting a relationship between TTM severity and cognitive anxiety but not somatic anxiety. Psychological inflexibility, or the prioritization of short-term self-soothing over striving to meet longterm adaptive goals, is thought to mediate TTM severity and anxiety in general, so the authors hypothesized that it would also mediate the hypothesized relationship between TTM severity and cognitive anxiety. A sample of 91 adults from a previous randomized trial of TTM treatment (92% female, 84% white, mean age about 35 years) was given measures of anxiety, TTM severity, and TTM-specific psychological inflexibility. As expected, cognitive anxiety was significantly correlated with TTM severity, but somatic anxiety was not, such that people with more serious cognitive anxiety tend to have more severe TTM but not necessarily people with more physical symptoms of anxiety. Furthermore, the relationship between TTM severity and cognitive anxiety was fully mediated by psychological inflexibility, meaning that people who are less accepting of their urges are more likely to pull their hair when faced with anxious thoughts or worries. This study supports cognition-focused TTM therapies, such as CBT and ACT, more than techniques like deep breathing or Progressive Muscle Relaxation.