Courtney Taylor-Browne Luka wins grant from the TLC Foundation for using the Situated Assessment Method to understand and change compulsive hair pulling

December 2020

In collaboration with her supervisors (Lawrence Barsalou and Jude Stevenson), Courtney Taylor-Browne Luka won a competition for TLC Foundation funds to significantly develop and extend her PhD research.

Title:  Understanding, predicting, and changing hairpulling across specific situations

Synopsis:  Our research aims to understand, predict, and ultimately change hairpulling. Hairpulling behaviours are highly varied, differing in pulling sites, frequency, and duration, not only between individuals but also within. Research has further suggested that hairpulling is highly situation specific, tending to occur more often in some situations than others. To the extent that pulling reflects situational constraints, this suggests measuring and working with it in a situated manner.

Problematically, however, measures that assess hairpulling in individuals are unsituated, meaning that they evaluate hairpulling experiences using items that abstract over specific situations. Take, for example, an item from the Massachusetts General Hospital-Hair Pulling Scale, “On an average day, how often did you actually pull your hair?” To evaluate this item, individuals must abstract over many specific situations they experienced previously to provide an overall judgement across them. By not assessing specific situations, unsituated measures may instead measure intuitive theories about oneself more than experiences of actual pulling situations. Further, unsituated theories are unable to provide much detail about pulling behaviour, such as initiating conditions (e.g., environmental triggers), surrounding actions (e.g., rituals), and outcomes (e.g., changes in emotion). Not capturing situational features of pulling experiences limits our ability to understand an individual’s hairpulling, in turn limiting our ability to accurately predict and ultimately change it. Our project aims to better understand, predict, and change hairpulling behaviour in specific situations.

In previous research, we have developed a new situated approach to measuring hairpulling, whereby individuals no longer abstract over specific situations to produce overall judgements of their hairpulling experience. Instead, individuals rate their experiences of pulling in specific situations (e.g., while watching television, while cleaning the house). Because this approach is grounded in two dimensions of situatedness—situational experience and the situated action cycle—we call it the Situated Assessment Method (SAM²). On the first dimension of situatedness, SAM² assesses a behaviour, such as pulling in specific life situations.  On the second dimension of situatedness SAM² assess the basic phases of the target behaviour in the situation, including environmental cues that trigger it, appraisals and goals that arise from these triggers, emotion and motivation in the body, cognitive and motoric actions to achieve goals, and the outcomes of these actions on the environment and oneself.  Thus, to measure a behaviour like hairpulling, SAM² assesses it in the situations where it occurs across all these phases of the behaviour. Additionally, we measure these phases in ways that reflect three major theoretical perspectives traditionally used to explain trichotillomania: the Comprehensive Behavioural Model (ComB), the Cognitions and Beliefs Model, and the Emotion Regulation Model.

Using the SAM2 method, we construct detailed models of the situational features that best predict pulling for a single individual. Consistent with the ComB model, triggers positively predict pulling/urge across most individuals. Consistent with the Cognitions and Beliefs model, reduced control increases hairpulling for many individuals, with negative feelings about oneself predicting pulling urge/frequency in some individuals. Consistent with the Emotion Regulation Model, pulling/urge to pull is positively related to reduction in negative emotion. Beyond the general trends just described, our results highlight how hairpulling experiences vary tremendously across individuals, while demonstrating that SAM² captures them effectively.

We further propose that SAM² can be used as an effective intervention for trichotillomania, decreasing frequency and urge of pulling. Encouraging individuals to process potential pulling situations in terms of the frequency and urge to pull, together with situational predictors of pulling, such as triggers, control, consequences etc., may help them understand what is happening in their specific pulling situations.  As a result of becoming more consciously aware of situational factors associated with pulling, individuals may become better able to cope effectively with them. Essentially, SAM² offers a behaviour change intervention that can translate into helping individuals anticipate their pulling episodes, together with becoming more aware of the situational features relevant to pulling.  By becoming more aware of how their specific form of pulling operates in specific situations, pullers may become better able to regulate their behaviour.  A study to be performed in the coming year will assess whether SAM2 offers an effective behaviour change intervention.

Besides producing an increased understanding of individual hair pulling that promotes effective behaviour change, SAM2 can also be used to provide feedback that directs individuals to effective interventions for moderating the situational factors most relevant for them. If our research demonstrates that SAM² can be an effective behavioural change intervention, we anticipate that an app utilising SAM² could be used by those who wish to understand their hairpulling and potentially reduce its frequency and associated urges.