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Measuring the role of psychological inflexibility in Trichotillomania.

  • Houghton, David C1
  • Compton, Scott N2
  • Twohig, Michael P3
  • Saunders, Stephen M4
  • Franklin, Martin E5
  • Neal-Barnett, Angela M6
  • Ely, Laura7
  • Capriotti, Matthew R8
  • Woods, Douglas W9
  • 1 Department of Psychology, Texas A&M University, 4235 TAMU, College Station, TX 77843, USA.
  • 2 Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
  • 3 Department of Psychology, Utah State University, Logan, UT, USA.
  • 4 Department of Psychology, Marquette University, Milwaukee, WI, USA.
  • 5 Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
  • 6 Department of Psychology, Kent State University, Kent, OH, USA.
  • 7 Psychological Health Roanoke, Roanoke, VA, USA.
  • 8 Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.
  • 9 Department of Psychology, Texas A&M University, 4235 TAMU, College Station, TX 77843, USA. Electronic address: [email protected]
Published Article
Psychiatry research
Publication Date
Dec 15, 2014
DOI: 10.1016/j.psychres.2014.08.003
PMID: 25155941


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.

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