Background: In line with previous research in alcohol addiction, we tested whether an Approach-Avoidance Training (AAT) prior to standard six-session Cognitive Behavior Therapy (CBT) for Hair Pulling Disorder (HPD) reduced problematic relapse, commonly found in this population. Method: Prior to CBT, 54 outpatients with a primary diagnosis of HPD were randomly assigned (double-blind) to either a training condition (n = 27), learning to avoid hair-pulling-related stimuli, or to a control condition (n = 27). Symptom severity was assessed with the Massachussetts General Hospital Hairpulling Scale, Severity Urge Resistance Frequency Scale, Self-Control Cognition Questionnaire, and Alopecia Scale. Results: In line with existing research, CBT showed to be an effective treatment for HPD in the short-term. There was no significant symptom increase after one and three months, but effect sizes were reduced approximately by half at the twelve-month measurement. The AAT training prior to CBT did not result in enhanced symptom reduction or reduced relapse after CBT. Conclusions: AAT training could not resolve the substantial relapse after successful CBT. Future research should take into account the complexity of stimuli that elicit hair pulling (e.g., tactile stimuli) and consider investigating other types of biases.

中文翻译：

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在标准的简短认知行为疗法之前进行认知偏向调整是否会降低拔毛障碍的复发率？双盲随机对照试验

背景：与先前对酒精成瘾的研究相一致，我们测试了在标准的六节式拔毛障碍（HPD）认知行为疗法（CBT）之前进行的方法避免训练（AAT）是否可以减少该人群中常见的问题复发。方法：在进行CBT之前，将54名具有HPD初步诊断的门诊患者随机分配（双盲）训练条件（n = 27），学习避免与拔毛有关的刺激或控制状况（n = 27）。症状严重程度通过马萨诸塞州综合医院的拉毛量表，严重性抗冲频率量表，自我控制认知问卷和脱发量表进行评估。结果：与现有研究一致，CBT在短期内显示对HPD有效。1个月和3个月后，症状没有明显增加，但是在12个月的测量中，效果大小降低了约一半。CBT之前的AAT训练并没有导致症状减轻或CBT后复发减少。结论：AAT培训不能解决成功CBT后的实质性复发。未来的研究应考虑引起头发拉扯的刺激的复杂性（例如，触觉刺激），并考虑研究其他类型的偏见。