Project information

Alopecia UK funds invested:  £9840

When:  April 2017-March 2020 (completed)

Project type:  Psychology single case series

Project Lead:  Dr Andrew Thompson

Length of project: 16 months

Research Institute:  Sheffield University

Condition of interest:  Alopecia Areata (including totalis and universalis)

Funds being used for:  Research Associate (staff costs), Accredited Mindfulness Based Cognitive Therapy sessions, travel expenses, dissemination costs, and trial registration with ISRCTN.

Research question:

The main aim of the proposed study is to provide an initial test of the effectiveness of Mindfulness based cognitive group therapy (MBCT) in reducing clinically significant levels of social anxiety in people living with alopecia areata (AA).  The proposed research will also examine whether the intervention impacts on depression, generalised anxiety and quality of life.

Justification for research project:

Whilst AA has few physical health consequences, it can lead to psychological consequences. A recent study found that 42.4% of respondents reported clinically significant social anxiety symptoms. The prognosis for AA is highly variable leading to frustration and uncertainty for the patient, and health care professionals may feel ‘stuck’ with how to support patients. Currently, there is a lack of psychological support for people with AA, despite the clear need. Mindfulness based cognitive group therapy (MBCT) has been found to be helpful in reducing distress in other conditions but has not been tested with people with AA. 

The Hair Loss Priority Setting Partnership identified the need for psychological interventions as a top ten priority for patients and clinicians.  The proposed research will provide initial evidence on the effectiveness of MBCT for people with AA who experience social anxiety. The data provided from single case research will give (i) a detailed insight into the process of change which can inform intervention development and (ii) detailed information on the types of difficulties people with AA experience.

Who is leading the project:

Dr Andrew Thompson will lead the project.  Dr Thompson has specialist expertise within psychodermatology and has conducted research in this area for the last 15 years. Dr Thompson has developed skin specific self-help using randomised control trials and qualitative methods.  He will be working alongside a team of people including psychologists, PhD students, therapists, and dermatologists. 

Project Outcomes: 

This was a small-scale study to see whether there is promise in using MBCT to help reduce social anxiety in individuals with alopecia. Five participants took part in an 8-week MBCT group. All participants found some improvement in social anxiety (as defined by themselves), suggesting MBCT is a useful intervention for some individuals with alopecia. Larger scale studies should be carried out to test the impact of MBCT more thoroughly in individuals with alopecia and social anxiety.

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What were the results? (update shared August 2023)

The results of this study were published in the Journal of Behavioural and Cognitive Psychotherapy: 'The effectiveness of mindfulness-based cognitive therapy for social anxiety symptoms in people living with alopecia areata: a single-group case-series design'. 

The paper is summarised here: 

In this study, five women with alopecia areata completed a series of mindfulness-based cognitive therapy (MBCT) sessions. These were in-person group sessions held at the University of Sheffield. The researchers measured their mindfulness, social anxiety, general anxiety, depression and quality of life using questionnaires for each. This was done over a period of 2-3 weeks at baseline, to get a stable read on people's initial levels of mental health, and again after 8 weeks of therapy sessions. In these sessions, which lasted 2.5 hours each, participants were taught how to apply mindfulness to their daily lives. They were also encouraged to carry out home practice each week based on the contents of the session. The sessions also included meditation practice and group discussions.

During the study period, participants also answered two questions each day: these were chosen by participants themselves and were based on an aspect of social anxiety they wanted to focus on. One was focused on something they wanted to decrease, for example, ‘How affected have you been today by people looking at your head/hair?’ and another was focused on something they wanted to increase, for example: ‘How brave have you felt today (e.g. when in social situations and around others)?

Using these self-reported measures of daily social anxiety, 4/4 participants showed an improvement in the 'increase-focused' aspect, and 2/4 showed an improvement in the 'decrease-focused' aspect of social anxiety. Participants who reported practising mindfulness most between sessions also saw the largest reductions in social anxiety.

After the 8-week intervention, mindfulness, social anxiety, general anxiety, depression and quality of life were again measured using standard questionnaires. The participants were encouraged to continue practicising the mindfulness techniques they had learned and these 5 measures of mental health were again assessed 4-weeks after the study had ended. Two participants showed an improvement in social anxiety, three participants showed an improvement in at least one aspect of mindfulness, three participants showed an improvement in depression or anxiety, and two participants showed an improvement in quality of life.

In conclusion, the mindfulness-based cognitive therapy model can succesfully reduce the social anxiety of people with alopecia areata. In some people, it may also improve other aspects of mental health and quality of life. These effects lasted even after the study finished, as people learned how to apply these techniques to their daily lives. This was a very small study, and the researchers suggest larger studies that compare mindfulness-based cognitive therapy to standard cognitive behavioural therapy may identify the specific benefits of mindfulness. They also acknowledge that more research is needed in a more diverse sample of people with AA, such as men or individuals from minority ethnic backgrounds.