research
MEMORANDUM
TO: Prof. Nancy Scotto Rosato, PhD
FROM: E. Z.
RE: Single-System Evaluation:
DATE: 10/20
Introduction
The participant is a 24 year old female who has come for outpatient treatment with complaints of constant worry and feelings of anxiety. The participant has identified scalp picking as a maladaptive behavior that she employs when she is feeling tense or anxious, particularly at work. The participant has reported that she would like to stop picking at her scalp at work since her supervisor and coworkers have noticed her doing it throughout the day. The participant has also reported that she has little awareness of her scalp picking, but realizes she has been doing it after a period of time. The participant has agreed to participate in this three week study as a means of decreasing her incidence of scalp picking through the use of habit replacement therapy. See Appendix 1 for a copy of the Informed Consent Form.
Intervention and rationale
Although limited research has been conducted specifically on scalp picking, a study conducted by Croyle and Waltz (2007) identified an association between subclinical or mildly injurious self-harm and a history of other maladaptive characteristics including impulsive behavior and obsessive-compulsive traits. Additional research conducted by Quinn et al. (2010) on effective ways to manage unpleasant habits found vigilant monitoring of habits the most effective method of limiting bad habits, particularly when triggers of behaviors were unknown to the participant. Other methods of behavior modification, including avoidance of situations prompting bad habits and limiting participation in bad habits, were found to be ineffective tools (2010).
Research conducted on trichotillomania, a condition that is associated with anxiety and tension in both adults and children, has found that treatments such as habit reversal therapy are an effective behavior modification technique (Bloch, 2009). Habit reversal therapy includes client self-reporting as a means of increasing client awareness of behaviors, trigger identification, and the introduction of replacement behaviors when the client is feeling the impulse to engage in undesired behavior (2009).
Based on this research, an experimental study has been developed to measure the effectiveness of habit reversal therapy for the cessation of scalp picking in an individual client. The design complied with an A-B-A method of single-system design where baseline A refers to a period of time where data is being collected, but no intervention is being applied, and B refers to collected date during the use of an intervention (Royse, et al., 2010). The use of A-B-A method is of greater significance than simple A-B methods, as collecting data after the scheduled intervention will allow for observation of extraneous factors being inappropriately correlated to the effectiveness of the intervention (2010).
During Week 1, the participant documented each instance of scalp picking in a self-report log. Each log entry included date, time, duration, and emotional state as experienced by the participant. During Week 2, the participant moved a marble in her picking hand every time she became aware of picking behavior. Once the urge to pick had subsided, the participant logged in her self-report book date, time, duration and emotional state before and after implementation of the replacement behavior, i.e. movement of marble in picking hand. During Week 3, the participant discontinued the implementation of replacement behavior, but resumed logging incidents of scalp picking behavior in self-report log as done in Week 1.
Results
As shown in Appendix 2, the frequency of scalp picking was diminished after the introduction of a replacement behavior. Appendix 2 further shows that there was also a slight increase in scalp picking after the intervention was withdrawn. This may indicate that the replacement behavior had some efficacy linked to the reduction of scalp picking behavior.
This results of this study support that there may be some significance in the interventions recommended by habit intervention therapies for scalp-picking behaviors. As a result of this, larger studies using habit intervention therapy with this population may prove to be useful. Future efforts to use habit replacement therapy will be expanded to unwanted behaviors including smoking cessation and overeating, with single-system studies conducted to measure its effectiveness with those behaviors. Additional populations that may benefit from habitual replacement therapy in the future include males and adolescents experiencing unwanted behaviors, as there may be variations in efficacy of this intervention based on age and gender. It is also possible that incorporating habit replacement therapy into other types of therapeutic interventions, including cognitive behavioral therapy, may prove useful by providing by concurrently addressing both the behavior and its underlying cognitive distortions.
This study was limited in its ability to truly gauge the effectiveness of the chosen interventions as participant’s observations were the only method of reporting incidents of scalp picking during both baseline and intervention stages of research. Reporting self awareness is in itself a mode of intervention in habit reversal therapy, and therefore has changed the behaviors of the client at baseline. Additionally, the data may reflect the client’s interest in reporting a decrease of scalp picking as well as any inconsistencies in self reporting.
References
Bloch, M. (2009). Trichotillomania Across the life span. Journal of the American Academy of Child and Adolescent Psychiatry, 48(9), 879-83.
Croyle, K., & Waltz, J. (2007). Subclinical self-harm: range of behaviors, extent, and associated characteristics. American Journal of Orthopsychiatry, 77(2), 332-42.
Quinn, J., Pascoe, A., Wood, W., & Neal, D. (2010). Can’t control yourself? monitor those bad habits. Personality and Social Psychology Bulletin, 36(4), 499-511.
Royse, D., Thyer, B.A., & Padgett, D.K. (2010). Program evaluation: an introduction (5th ed.). Belmont, CA: Wadsworth.
Appendix 1
Chart 1: Effectiveness of Replacement Behavior on Scalp Picking
Effectiveness of Replacement Behavior
on Scalp Picking
0
2
4
6
8
10
12
14
Day 1Day 3Day 5Day 7Day 9
Day 11Day 13Day 15Day 17Day 19Day 21
Day
Scalp Picking Incidents
Baseline
Intervention
Withdrawl
Appendix 2
Scalp Picking Cessation Study
Investigator:
H.B., BA, MSWc, Principle Investigator, (609) xxx-xxxx
I, Information on file, have been asked to participate in a study to evaluate the effectiveness of habit reversal therapy as a type of treatment for scalp picking.
Purpose:
I understand that the purpose of this study is to examine the effectiveness of habit reversal therapy as a type of treatment for scalp picking.
Duration and Location:
I understand that this study will be conducted for a three week period, and that I will be engaging in self-reporting and habit replacement techniques wherever I may be during that time.
Procedures:
I understand that participation in this study will mean that during week 1 I will write down in my self-report log every time I engage in scalp picking. My self-report log will ask for the date, time, and approximate duration of the scalp picking as well as how I was feeling at the time and what I was doing. During week 2, I will write down in my self-report log every time I engage in scalp picking, what replacement behavior I employed, and how I felt while using my replacement behavior. During week 3, I will stop using replacement behaviors, but only write down in my self-report log all incidence of scalp picking.
Risks/Discomforts:
It has been explained to me that some of the information I write down in my self-report log may be of a personal nature and that I may experience some discomfort in writing them down.
Benefits:
I understand that participate in this study will assist the above named researcher in the development of more effective treatment for scalp picking.
Confidentiality:
I understand that a research code will be applied to all information I provided to the above named researcher, and that any indentifying information including my name, address, phone number or personal characteristics will be kept separate from information associated with this study. I understand that this information will be kept in my regular clinical chart, and that only the above named researcher will know my true identity.
Payments:
I understand that I will not be compensated for my participation in this study.
Rights to Withdraw:
I understand that my participation in this study is completely voluntary, and that at any time I can inform the above named researcher of my interest in withdrawing. I understand that withdrawing from the study will not result in the termination of any services that I am entitled to.
Signatures:
I have read this consent form and understand my rights as a potential research participant. I consent voluntarily to participate in this study. I understand that a copy of this consent upon request and that I can contact Ms. B. or the Institutional Review Board of Rutgers University (732 392-0150) to discuss my rights as a research subject.
Signature on file
Signature of Research Subject Date
Signature on file
Signature of Investigator Date