Defining treatment response in trichotillomania: a signal detection analysis

David C Houghton; Matthew R Capriotti; Alessandro S De Nadai; Scott N Compton; Michael P Twohig; Angela M Neal-Barnett; Stephen M Saunders; Martin E Franklin; Douglas W Woods

doi:10.1016/j.janxdis.2015.09.008

Defining treatment response in trichotillomania: a signal detection analysis

J Anxiety Disord. 2015 Dec:36:44-51. doi: 10.1016/j.janxdis.2015.09.008. Epub 2015 Sep 24.

Authors

David C Houghton¹, Matthew R Capriotti², Alessandro S De Nadai³, Scott N Compton⁴, Michael P Twohig⁵, Angela M Neal-Barnett⁶, Stephen M Saunders⁷, Martin E Franklin⁸, Douglas W Woods⁹

Affiliations

¹ Texas A&M University, Department of Psychology, 4235 TAMU, College Station, TX 77843, USA. Electronic address: davidhoughton@tamu.edu.
² University of California San Francisco, Department of Psychiatry, 401 Parnassus Ave., Box 0984, San Francisco, CA 94143, USA. Electronic address: matthew.capriotti@ucsf.edu.
³ University of South Florida, Department of Psychology, 4202 East Fowler Ave., PCD 4118G, Tampa, FL 33620, USA. Electronic address: denadai@mail.usf.edu.
⁴ Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, 2213 Elba St., Durham, NC 27705, USA. Electronic address: scompton@duke.edu.
⁵ Utah State University, Department of Psychology, 2810 Old Main Hill, Logan, UT 84322, USA. Electronic address: michael.twohig@usu.edu.
⁶ Kent State University, Department of Psychological Sciences, 600 Hilltop Drive, Kent, OH 44242, USA. Electronic address: aneal@kent.edu.
⁷ Marquette University, Department of Psychology, 317 Cramer Hall, Milwaukee, WI 53233, USA. Electronic address: stephen.saunders@marquette.edu.
⁸ University of Pennsylvania School of Medicine, Department of Psychiatry, 3535 Market St., Philadelphia, PA 19104, USA. Electronic address: marty@mail.med.upenn.edu.
⁹ Texas A&M University, Department of Psychology, 4235 TAMU, College Station, TX 77843, USA. Electronic address: dowoods@tamu.edu.

Abstract

The Massachusetts General Hospital Hairpulling Scale (MGH-HPS) and the NIMH Trichotillomania Severity Scale (NIMH-TSS) are two widely used measures of trichotillomania severity. Despite their popular use, currently no empirically-supported guidelines exist to determine the degrees of change on these scales that best indicate treatment response. Determination of such criteria could aid in clinical decision-making by defining clinically significant treatment response/recovery and producing accurate power analyses for use in clinical trials research. Adults with trichotillomania (N=69) participated in a randomized controlled trial of psychotherapy and were assessed before and after treatment. Response status was measured via the Clinical Global Impressions-Improvement Scale, and remission status was measured via the Clinical Global Impressions-Severity Scale. For treatment response, a 45% reduction or 7-point raw score change on the MGH-HPS was the best indicator of clinically significant treatment response, and on the NIMH-TSS, a 30-40% reduction or 6-point raw score difference was most effective cutoff. For disorder remission, a 55-60% reduction or 7-point raw score change on the MGH-HPS was the best predictor, and on the NIMH-TSS, a 65% reduction or 6-point raw score change was the best indicator of disorder remission. Implications of these findings are discussed.

Keywords: Hair pulling; Obsessive-compulsive disorder; Psychotherapy; Signal detection; Trichotillomania.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Adult
Aged
Behavior Therapy / methods
Female
Humans
Male
Middle Aged
Patient Education as Topic
Psychotherapy / methods*
ROC Curve
Signal Detection, Psychological*
Treatment Outcome
Trichotillomania / diagnosis
Trichotillomania / therapy*
Young Adult

Abstract

Publication types

MeSH terms

Grants and funding