Journal Article Annotations
2024, 3rd Quarter
Annotations by J. Jewel Shim, MD, FACLP, FAPA
October, 2024
The finding:
This is a randomized controlled trial examining the neurocognitive performance of subjects with trichotillomania (TTM), comparing their pre- and post- treatment performance before and after 12 weeks of either acceptance-enhanced behavior therapy (AEBT) or a psychoeducation and supportive therapy (PST) intervention. The authors hypothesized that two factors, response-inhibition and cognitive flexibility, would predict treatment response as well as the severity of TTM symptoms. The study found that higher pre-treatment response inhibition correlated with better post-treatment responder status and lower post-treatment severity of TTM symptoms. These findings held true regardless of which intervention the subjects received. However, the degree of response inhibition did not change post-treatment. The study authors posited that those with stronger response inhibition may be more able to focus on a treatment plan and specific goals. In terms of cognitive flexibility, the findings demonstrated that this did not predict treatment response, nor did it change post-treatment in either intervention arm. Results did show that lower cognitive flexibility was associated with higher TTM symptom severity via a clinician-administered rating scale (NIMH-TSS). To explain these findings, the investigators suggested there may be a distinction between cognitive flexibility, measured by the study, and psychological flexibility, which AEBT is designed to improve, and as such cognitive flexibility may not be a key mechanism by which AEBT can effect change.
Strength and weaknesses:
This is a study that sought to further previous work in TTM and deficits in neurocognitive functioning, particularly in response and inhibition and cognitive flexibility, and in doing so, adds to this body of literature. Other strengths include moderate sample size and a randomized controlled study design. Some weaknesses include a lack of a healthy control group for comparison and that the subjects were predominantly female and Caucasian, thus limiting the generalizability of the findings.
Relevance:
This study highlights two neurocognitive functions that may serve as treatment targets for interventions for TTM, and could help clinicians tailor treatment plans more specifically based on pre-treatment performance in these domains.
This is an interesting article, psychodermatology adjacent, that discusses the observed association in the literature that there is a higher prevalence of mental health disorders and suicidal ideation in people who have four or more tattoos. Citing the experience during the pandemic when a “barbershop model” was implemented to increase the accessibility of the COVID-19 vaccine in African American communities, the authors posited that a similar model, leveraging tattoo artists/shops could be used to outreach to clients with mental health disorders and suicidal ideation. The investigators conducted a cross-sectional survey among 79 tattoo artists querying their experiences with mental health issues and suicidal ideation in their clientele, their comfort level in helping clients who expressed these issues, and the practicality and acceptability of providing suicide prevention in the tattoo shop setting.
While the authors largely found that the subjects had positive attitudes toward potentially helping their clients with mental health issues, some raised concerns regarding the necessary training to implement any sort of mental health intervention and the fear that they could potentially exacerbate rather than alleviate their clients’ problems. This study highlights the creativity in identifying novel approaches to identify mental health challenges and support people in the community whose mental health problems may otherwise go unacknowledged or unnoticed and allow for potentially meaningful intervention.