Browsing by Author "Louw, Derine"

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    Cognitive training in patients with Trichotillomania (Hair-pulling Disorder)
    (Stellenbosch : Stellenbosch University, 2019-04) Louw, Derine; Lochner, Christine; Stein, Dan J.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Psychiatry.
    ENGLISH SUMMARY : Background: Hair-pulling disorder (HPD), also known as trichotillomania, is a psychiatric condition characterized by recurrent pulling of hair, resulting in hair loss. Patients report repeated but unsuccessful attempts to reduce or stop the behaviour, leading to significant distress, and in some cases, functional impairment. HPD is characterized by impairments in executive functioning including working memory (WM), impulse control (IC) and emotional regulation (ER). Current interventions include Habit Reversal Therapy (HRT) and pharmacotherapy, but a large proportion of patients do not have access to these treatments or do not respond favourably. An easily accessible strategy in the context of scant resources would be particularly welcome. Based on the efficacy of WM training in improving executive functioning, it was hypothesized that this intervention would 1) be efficacious for reducing the symptoms of HPD, 2) improve compromised neurocognitive functions, 3) and be experienced by patients as an acceptable and feasible method of intervention. Methods: A single-blind, randomized, 5-week, 25-session cognitive working memory training (CWMT) program versus a control condition was conducted in 30 participants with a primary diagnosis of HPD. The primary outcome measure was the Massachusetts General Hospital Hair-Pulling Scale (MGH-HPS). The control condition required puzzle building, i.e. the Jigsaw Puzzles program available on the Internet, following the same 5-week protocol as the CWMT, commercially known as the Cogmed Working Memory Training. Assessments at baseline, immediate post-intervention, and at 3-month follow-up, provided information on clinical and neurocognitive data. Both quantitative and qualitative methods were employed. The quantitative data addressed hypotheses relating to treatment intervention outcomes and were analysed using Statistica 13.3. The qualitative data investigated the experience of living with HPD and addressed the acceptability and feasibility of the intervention and were analysed using Atlas.ti 8.1.30. Statistical analysis of the primary outcome and the neurocognitive data were conducted using mixed model repeated measures analysis of variance (ANOVA). The qualitative data were analyzed using a thematic approach. Results: CWMT significantly decreased hair-pulling severity compared to the control condition at 5 weeks and 3 months. Although participants did not demonstrate notable impairments in WM compared with norms, WM improved immediately post-training. Although gains in symptoms and WM were maintained at 3 months, there was no longer a significant difference between the cognitive training and control group. There were no impairments in IC and ER at baseline, and CWMT did not have greater impact on IC and ER than the control condition. Qualitatively, participants indicated that CWMT was feasible and acceptable; furthermore, participation in the study was associated with greater openness about symptoms at home, feeling less isolated, and feeling more supported. Conclusions: This is the first study of CWMT in HPD and demonstrates not only the feasibility and acceptability of this intervention, but also its efficacy. Further work is needed to study the relevant mechanisms, and to assess the effectiveness and cost-efficiency of this intervention in larger pragmatic trials aimed at scaling-up the intervention.