New research into environmental causes
Credit Sue Price for Notes, TLC Conference Session
This is another email to me - with notes from the April 2002 TLC
Conference Session:
New Research into Environmental Causes
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**(If you don't already know what TLC is, it is the Trichotillomania
Learning Center - and the only Not-for Profit Association for
Trichotillomania. Their Website is www.trich.org. They have encouraged
me and others to post and distribute our notes from the TLC Retreat
sessions, in order to help as many people as possible!) I recommend that
you look through their site ... the Calendar section lists events and
Support Groups (who know they may be in your area).
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This is the second talk Dr. Woods gave at the TLC conference.
"New Research into the Environmental Causes of Body-Focused Repetitive
Behaviors" (presented at TLC Conference, April 2002)
Douglas Woods, Ph.D. University of Wisconsin-Milwaukee
Again he is discussing Body focused repetitive behaviors (BFRBs)
including hair pulling, skin picking, nail biting, and cheek/lip biting,
all of which appear more commen in women.
Excerpts from his PowerPoint handout:
Environmental Hypotheses of Cause and/or Maintenance of BFRBs (each
discussed in turn)
*** Tension-reduction
- building feeling of uncomfortable tension is reduced by doing the
BFRB
*** Environmental restriction
- uneventful or activity-restricted environments occasion
BFRB, similar to psychogenic feather plucking in birds
*** Emotional Regulation
- BFRBs calm a person when anxious or upset
- BFRBs increase arousal in a person when bored
- incorporates both tension-reduction and
environmental restriction theories
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Tension Reduction Hypothesis
*** Through surveys, anxiety found to be related to BFRBs (research done
by Dr. Woods, and by others)
*** Dr. Woods and a colleague verified role of anxiety experimentally
- 44 adults put into one of three situations: bored,
anxious, or neutral
- repetitive behaviors observed from behind a one-way mirror
- Face touching and hair manipulation occurred more often in the
"anxiety" condition.
Problems with Tension Reduction Hypothesis
*** Little directly observed, experimentally obtained evidence that a
reduction in tension actually occurs. (Self-reports suggest that tension
is reduced immediately after pulling.)
*** Many people report that BFRBs occur when they are not tense or
anxious
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Environmental Restriction Hypothesis
*** Surveys suggests that common triggers for BFRBs include: lying in
bed, waiting, reading, watching TV, being bored
*** Etiological models suggest that leaving animals in understimulating
or physically restricting environments can produce BFRBs (e.g. birds,
dogs, monkeys)
Dr. Woods et. al. did an experimental analysis. Six children who
chronically bit their nails were exposed to 8 different conditions on
three different days. Their nail biting behavior was observed and scored
without their knowledge.
5-minute conditions included
- Alone-idle
- Alone-TV
- Alone-Game
- Math problems-no break for biting
- Math problems-break for biting
- Talking with someone-no mention of biting
- Talking with someone- comment contingent on biting -Talking with
someone-discuss the biting
In all six children, the alone-idle or alone-TV conditions produced the
greatest level of nail biting.
This fits the environmental restriction hypothesis because the behavior
did not occur during the alone-game condition.
Problems with Environmental Restriction Hypothesis
* Did alone condition produce appropriate environmental restriction, or
did it just allow the behavior to occur without social consequences?
* Other functions were possible in conjunction with environmental
restriction
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Emotional Regulation Hypothesis, which incorporates both
tension-reduction and environmental restriction theories
Various studies showed:
*Adults with a BFRB were more anxious than persons without a BFRB
* Persons for whom BFRBs were a problem were as anxious as persons for
whom BFRBs were not a problem
*Persons with a BFRB were more depressed than persons without a BFRB
* Persons for whom BFRBs were a problem were more depressed than persons
for whom BFRBs were not a problem
He cited a recent study that compared 18 adults with a BFRB and 14
without a BFRB.
They were asked to watch four different videos, each with a different
emotional effect, while they were covertly observed for # of times a
BFRB occureed. The conditions evoked were anxiety, boredom, depression,
and no emotion.
Results: for the no-BFRB group, there was no difference between the
conditions. The BFRB group differed: boredom produced significantly more
BFRB than depression or neutral condition. Anxiety also increased BFRB
levels.
Emotional Regulation Hypothesis Conclusions: *Persons with BFRB
experience higher levels of negative emotions such as anxiety or
depression
* Producing boredom or anxiety increased frequency of BFRBs
* Still unclear whether BFRBs reduce such emotions - some research
suggests negative emotions increase after doing the behavior
* Studies also suggest other triggers such as skin imperfections or
coarse/discolored hair; it appears that alterations or manipulation of
the body may in itself have certain reinforcing value (looking at the
hair or skin, removing "bad" hair, etc. [he called this Product-Based
Consequences]
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Conclusions
* There is no one clear environmental cause, and it does not appear that
any one person would have only one cause
* Practitioners should assess for multiple causes including tension
reduction, environmental restriction, emotional regulation, and
product-based consequences
* NEED MORE RESEARCH USING EXPERIMENTAL DESIGNS!!!!!!!
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