The Effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) on Cognitive Regulation and Improving the Quality of Life of Women with Trichotillomania

Jokar, Pegah; Rahmanian, Mahdieh

doi:10.30473/hpj.2025.72172.6102

Document Type : Scientific Research

Authors

Pegah Jokar ¹
Mahdieh Rahmanian ²

¹ M.Sc. Student, Department of Psychology, Payame noor University, Tehran, Iran.

² Associate Professor, Department of Psychology, Payame noor University, Tehran, Iran

10.30473/hpj.2025.72172.6102

Abstract

Objective: The present study aims to investigate the effectiveness of mindfulness-based cognitive therapy (MBCT) in improving cognitive regulation and enhancing the quality of life among women diagnosed with trichotillomania. Trichotillomania, a type of obsessive-compulsive disorder characterized by the irresistible urge to pull out one's own hair, significantly affects the emotional, psychological, and social functioning of those affected. Given the chronic nature of the disorder and its negative impacts, this study explores the potential benefits of MBCT, a therapeutic approach that integrates mindfulness meditation with cognitive-behavioral strategies, to help individuals with trichotillomania better manage their thoughts, emotions, and overall well-being. Method: The research employed a quasi-experimental design with a pre-test/post-test structure and a 4-month follow-up, alongside a control group, to evaluate the impact of MBCT on women with trichotillomania. The study's sample included 30 women diagnosed with trichotillomania who sought counseling services at centers in Dorud County during the last quarter of 2023. These individuals were assessed by two clinical psychologists and diagnosed based on the criteria outlined in the DSM-5. The participants were then administered several psychological assessments, including the Massachusetts General Hospital Hairpulling Scale (1980) to measure the severity of hair-pulling behaviors, the World Health Organization Quality of Life (WHOQOL) questionnaire (1990) to evaluate overall life satisfaction, and the Cognitive Emotion Regulation Questionnaire (CERQ) (Garnefski et al., 2001) to assess cognitive strategies for emotion regulation. The participants were purposefully selected and randomly assigned to either the experimental group (n=15) or the control group (n=15) using random assignment software. The experimental group received eight sessions of MBCT, based on the protocol developed by Segal et al. (2013), while the control group did not receive any specific intervention. The MBCT sessions focused on cultivating mindfulness, cognitive restructuring, and acceptance strategies to help participants manage their hair-pulling behavior, improve emotional regulation, and enhance their overall quality of life. Data were analyzed using Repeated Measures Analysis of Covariance (RM-ANCOVA) in SPSS version 26 to assess the significance of pre- and post-test differences in cognitive regulation and quality of life between the two groups. Results: The results of the study revealed that MBCT was significantly effective in improving cognitive regulation and enhancing the quality of life of women with trichotillomania. Statistical analysis demonstrated that the experimental group showed marked improvements in their ability to regulate emotions and manage distressing thoughts, as well as higher levels of overall life satisfaction when compared to the control group (p < 0.01). Participants in the experimental group exhibited a reduction in hair-pulling behaviors, better emotional regulation, and an improved sense of well-being. Moreover, the positive effects were maintained at the 4-month follow-up, suggesting that the benefits of MBCT were not only immediate but also sustained over time. Conclusion: This study underscores the potential of mindfulness-based cognitive therapy as an effective intervention for women with trichotillomania. The findings suggest that MBCT can significantly improve cognitive regulation, reduce hair-pulling behaviors, and enhance the overall quality of life for individuals affected by this disorder. Given its focus on mindfulness and cognitive restructuring, MBCT offers a promising therapeutic approach for managing the complex emotional and behavioral challenges associated with trichotillomania. These results have important implications for both clinical practice and future research, as they support the use of MBCT as a viable and beneficial treatment option for individuals struggling with trichotillomania.

Keywords

Main Subjects

stress

References

Aghighi, A., Mohammadi, N., Rahimi, C., & Imani, M. (2021). Effectiveness of the Emotion-regulation Group Therapy on Symptom Recovery and Quality of Life of Panic Disordered Patients. Journal of Clinical Psychology, 13(3), 19-32.

https://doi.org/10.22075/jcp.2021.20147.1858 (in persian).

Alibakshi, H., Eslami, J., Shahrokhi, S., Mirzabeigi, H., Naimi, E., & Mirshoja, M. S. (2024). Effects of Perceptual-motor Exercises Based on Multi-sensory Therapy on Sensory Processing of Older Adults. Iranian Journal of Ageing, 19(3), 410-423.

http://dx.doi.org/10.32598/sija.2023.2789.6 (in persian).

Bahadori, Z., Bakhshi, A., & Mohamadi Por, M. (2022). The relationship between emotional regulation strategies and Sense of Social Security with Quality of Life of Bojnord Students. Educational researches, 17(69). https://doi.org/10.30495/educ.2022.685556 (in persian).

Bonomi, A. E., Patrick, D. L., Bushnell, D. M., & Martin, M. (2000). Validation of the United States' version of the world health organization quality of life (WHOQOL) instrument. Journal of clinical epidemiology, 53(1), 1-12.https://doi.org/10.1016/S0895-4356(99)00123-7

Bryant, R. (2024). Cognitive behavior therapy vs mindfulness in treatment of prolonged grief disorder. Jama Psychiatry, 81(7), 646. https://doi.org/10.1001/jamapsychiatry.2024.0432

Bürkle, J. J., Fendel, J. C., & Schmidt, S. (2021). Mindfulness-based and acceptance-based programmes in the treatment of obsessive–compulsive disorder: a study protocol for a systematic review and meta-analysis. BMJ open, 11(6), e050329.

https://doi.org/10.1136/bmjopen-2021-050329

Casas, J. B., Szoke, D. R., & Benuto, L. T. (2021). Concurrent treatment of intimate partner violence and trichotillomania from an emotion regulation framework: A case study. Clinical Case Studies, 20(2), 115-128.https://doi.org/10.1177/1534650120964581

Crowe, E., Staiger, P. K., Bowe, S. J., Rehm, I., Moulding, R., Herrick, C., & Hallford, D. J. (2024). The association between trichotillomania symptoms and emotion regulation difficulties: A systematic review and meta-analysis. Journal of Affective Disorders, 346, 88-99.https://doi.org/10.1016/j.jad.2023.11.010

Davoudi, R., Manshaee, G., & Golparvar, M. (2019). Comparing the effectiveness of adolescent-centered mindfulness with cognitive behavioral therapy and emotion-focused therapy on emotion regulation among adolescents girl with Nomo-Phobia. Journal of Health Promotion Management, 8(4), 16-25.http://jhpm.ir/article-1-1014-en.html(in persian).

Donahue, M. (2023). Act-enhanced behavior therapy for a hispanic adult with trichotillomania: a case report. Clinical Case Studies, 23(4), 255-266.https://doi.org/10.1177/15346501231225505

Fiddaroini, F., Yusuf, A., & Rachmawati, P. (2020). Effect of mindfulness-based cognitive therapy on symptoms of depression: a systematic review. Strada Jurnal Ilmiah Kesehatan, 9(2), 761-771. https://doi.org/10.30994/sjik.v9i2.383

Fodstad, J., Greve, K., Curtin, M., & Lagges, A. (2021). Treatment of typically developing toddlers with hair-pulling behavior and concurrent poor sleep hygiene: a case series. Journal of Developmental & Behavioral Pediatrics, 42(8), 677-681.

https://doi.org/10.1097/dbp.0000000000000946

Garnefski, N., Kraaij, V., & Spinhoven, P. (2001). Negative life events, cognitive emotion regulation and emotional problems. Personality and Individual differences, 30(8), 1311-1327. https://doi.org/10.1016/S0191-8869(00)00113-6

Ghasemi, A., Salehi Omran, A., Meschi, F., Sodagar, S., & Tajeri, B. (2024). Comparing the effectiveness of existential group psychotherapy and mindfulness group therapy on resilience and life quality in patients with hypertension. Shenakht Journal of Psychology and Psychiatry, 11(1), 152-167.http://dx.doi.org/10.32598/shenakht.11.1.152 (in persian).

Grant, J. E., Collins, M., Chesivoir, E., & Chamberlain, S. R. (2023). Hazardous alcohol use in trichotillomania. Psychiatric Quarterly, 94(3), 361-369.https://doi.org/10.1007/s11126-023-10042-x

Guo, H., Ren, Y., Huang, B., Wang, J., Yang, X., Wang, Y., & Zhao, E. (2022). Psychological status, compliance, serum brain-derived neurotrophic factor, and nerve growth factor levels of patients with depression after augmented mindfulness-based cognitive therapy. Genetics Research, 2022, e82. https://doi.org/10.1155/2022/1097982

Hadian, N., Ghodsi, P., & Sadeghi Afjeh, Z. (2023). The Comparison of the Effectiveness of Mindfulness-Based Cognitive Therapy and Spiritual Therapy on Feelings of Loneliness in Older Adults. Aging Psychology, 9(3), 222-205. https://doi.org/10.22126/jap.2023.9245.1712 (in persian).

Hasani, J. (2010). The psychometric properties of the cognitive emotion regulation questionnaire (CERQ). Journal of clinical psychology, 2(3), 73-84. https://doi.org/10.22075/jcp.2017.2031 persian).

Haugmark, T., Hagen, K., Smedslund, G., & Zangi, H. (2019). Mindfulness- and acceptance-based interventions for patients with fibromyalgia – a systematic review and meta-analyses. Plos One, 14(9), e0221897.https://doi.org/10.1371/journal.pone.0221897

Hazrati, Y., & Abdi, H. (2024). The effect of cognitive behavioral therapy based on mindfulness on social anxiety, self-efficacy and quality of life of adults with stuttering with a psycholinguistic approach. Journal of Research in Behavioural Sciences, 22(1), 16-30. http://rbs.mui.ac.ir/article-1-1750-en.html

Hedayatizafarghandi, S., Emamipour, S., & Rafiepoor, A. (2021). Evaluation of the effectiveness of mindfulness-based therapy on emotion regulation skills. medical journal of mashhad university of medical sciences, 64(1), 2374-2380. https://doi.org/10.22038/mjms.2021.18853(in persian).

Kabat-Zinn, J., & Hanh, T. N. (2009). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. Delta.

Karimlou, F., Goodarzi, K., karimi, J., & Roozbahani, M. (2024). Comparison of the Effectiveness of Schema Therapy and Cognitive Therapy Based on Mindfulness on Quality of Life and Psychological Symptoms in addicts. medical journal of mashhad university of medical sciences, 66(6),https://doi.org/10.22038/mjms.2022.64090.3767 (in persian).

Karrakchou, B., Fliti, A., Hamich, S., Ismaili, N., Benzekri, L., Meziane, M., & Senouci, K. (2023). Acquired non-scarring vertex alopecia in three women revealing trichotillomania: Diagnostic accuracy of trichoscopy. Our Dermatol Online, 14, 228-9.

Khadem, S., Fakhri, M. K., & Emadian, S. O. (2023). The effectiveness of mindfulness based cognitive therapy on rumination, perfectionism and thought-action fusion of women suffering from obsessive-compulsive disorder. Journal of Adolescent and Youth Psychological Studies (JAYPS), 4(4), 105-117.https://doi.org/10.61838/kman.jayps.4.4.11

Kumar, S., Malik, D., & Gupta, A. (2023). Relationship between automatic thoughts and mindfulness in patients with dual diagnosis: A correlational study. International Journal of Community Medicine and Public Health, 10(2), 760-765.https://doi.org/10.18203/2394-6040.ijcmph20230234

Mehri, Z. (2024). The Effectiveness of Mindfulness Training on the Quality of Life and Mental Rumination of Female Students. Journal of Psychology New Ideas, 19(23), 1-11. http://jnip.ir/article-1-1101-en.html (in persian).

Mirzaei, G. & Heydari. M. (2021). The effectiveness of mindfulness on the quality of life of patients with multiple sclerosis. Cognitive Analytical Psychology Quarterly, 12(46), 65-77. (in persian).

Moghimi, S., Montazeri, S., Behroozi, N., & Maraghi, E. (2022). The effectiveness of mindfulness based on cognitive therapy (MBCT) on quality of life and optimism of adolescent pregnant women. International Journal of Health Sciences, 1311-1321.

https://doi.org/10.53730/ijhs.v6ns7.11537

Mohammadnejad, E., Arshadi, F., & Hasani, F. (2022). Comparison of the effectiveness of exposure and response prevention (erp) with mindfulness-based cognitive-behavioral therapy (mbcbt) on obsessive-compulsive syndrome and depression in women with obsessive-compulsive disorder. The Journal of Psychological Science, 20(108), 2269-2284.https://doi.org/10.52547/jps.20.108.2269

Okumuş, H. G., Akdemir, D., Temeltürk, R. D., & Öksüzoğlu, M. E. (2024). Impulsivity in adolescent girls diagnosed with trichotillomania: an evaluation of clinical and neuropsychological characteristics. European Child & Adolescent Psychiatry, 33(2), 617-625.https://doi.org/10.1007/s00787-023-02354-x

Pan, W., Gau, M., Hsu, T., Chiao, S., & Lee, T. (2022). Applying mindfulness techniques to the management of depressive tendencies in women in taiwan in the perinatal period: a qualitative study. Asian Nursing Research, 16(3), 149-154. https://doi.org/10.1016/j.anr.2022.05.004

Pande, S., & Salvucci, L. Effectiveness of Mindfuless Based Cognitive Therapy (MBCT) in Preventing Depression Symptoms. Indian Journal of Health Studies, 5, 89-110.https://doi.org/10.56490/ijhs.2023.5205

Ricketts, E. J., Peris, T. S., Grant, J. E., Valle, S., Cavic, E., Lerner, J. E., ... & Piacentini, J. (2024). Clinical characteristics of youth with trichotillomania (hair-pulling disorder) and excoriation (skin-picking) disorder. Child Psychiatry & Human Development, 55(4), 975-986. https://doi.org/10.1007/s10578-022-01458-w

Rodrigues, M., Campos, C., Pelucio, L., Barreto, I., Machado, S., Appolinário, J., … & Levitan, M. (2019). Patients’ comprehension of mindfulness-based cognitive behavioral therapy in an outpatient clinic for resistant depression: a cross-sectional study. Frontiers in Psychology, 10. https://doi.org/10.3389/fpsyg.2019.00271

Rouhi, M., Manzari Tavakoli, A., & Tajrobehkar, M. (2023). The Effectiveness of Cognitive Behavioral Therapy on Coherent Self-Knowledge, Emotion Regulation, and Quality of Life of Hemodialysis Patients: A Quasi-Experimental Study. Journal of Rafsanjan University of Medical Sciences, 21(10), 1055-1070. http://dx.doi.org/10.52547/jrums.21.10.1055(in persian).

Samadi, B. (2023). Comparing the efficacy of skills training based on dialectical behavior therapy (dbt-st) and mindfulness-based cognitive therapy (mbct) on distress tolerance and psychological well-being in individuals with symptoms of borderline personality disorder. JARAC, 5(5), 108-115. https://doi.org/10.61838/kman.jarac.5.5.14

Schmidt, C., Soler, J., Vega, D., & Pascual, J. C. (2024). Practice matters: The role of mindfulness skills in emotion dysregulation in borderline personality disorder. Journal of Contextual Behavioral Science, 32, 100756.https://doi.org/10.1016/j.jcbs.2024.100756

Senker, K., Fries, S., Dietrich, J., & Grund, A. (2021). Mindfulness and academic emotions: A field study during a lecture. Learning and individual differences, 92, 102079.https://doi.org/10.1016/j.lindif.2021.102079

Shabani, M., Najat, H., & Saffarian, M. R. (2019). Comparison of the effectiveness of mindfulness-based cognitive therapy and a quality of life-based therapy on rumination in patients with migraine. International Journal of Basic Science in Medicine, 4(2), 61-68.https://doi.org/10.15171/ijbsm.2019.13

Shahni Fayz, K., Yousefi Nik, A., Ghasemizahed, S., & Dohooyi Mosa, T. (2023). Effectiveness of mindfulness-based stress reduction program on emotion regulation and obsessive-compulsive symptoms of children with obsessive-compulsive disorder. Journal of Applied Family Therapy, 4(3), 79-92.https://doi.org/10.22034/AFTJ.2023.393463.2013

Singh, G. (2022). Mindfulness based interventions framework in district mental health programme in india. TJIMA, 02(02), 57-59. https://doi.org/10.52314/tjima.2022.v2i2.89

Thomson, H. A., Farhat, L. C., Olfson, E., Levine, J. L., & Bloch, M. H. (2022). Prevalence and gender distribution of trichotillomania: A systematic review and meta-analysis. Journal of Psychiatric Research, 153, 73-81. https://doi.org/10.1016/j.jpsychires.2022.06.058

Zare, H., & Sabeti, A. (2023). Predicting complicated grief based on cognitive flexibility with the mediating role of cognitive regulation of emotion in survivors of the COVID-19. Health Psychology, 12(47), 133-144. https://doi.org/10.30473/hpj.2024.66452.5705 (in persian).

zarieh, S., Naderi, F., Bakhtiarpoor, S., & askari, P. (2023). The effectiveness of Emotion-Focused Therapy in Cognitive Emotion Regulation and Ego Strength among Cardiovascular Patients with Obesity. Health Psychology, 12(47), 119-132. https://doi.org/10.30473/hpj.2024.66573.5712 (in persian)

The Effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) on Cognitive Regulation and Improving the Quality of Life of Women with Trichotillomania

References

References

Volume 14, Issue 53June 2025Pages 77-92

Volume 14, Issue 53
June 2025
Pages 77-92