Acceptance-enhanced behavior therapy for trichotillomania in adults: A randomized clinical trial

Douglas W Woods; Laura J Ely; Christopher C Bauer; Michael P Twohig; Stephen M Saunders; Scott N Compton; Flint M Espil; Angela Neal-Barnett; Jennifer R Alexander; Michael R Walther; Shawn P Cahill; Thilo Deckersbach; Martin E Franklin

doi:10.1016/j.brat.2022.104187

Acceptance-enhanced behavior therapy for trichotillomania in adults: A randomized clinical trial

Behav Res Ther. 2022 Nov:158:104187. doi: 10.1016/j.brat.2022.104187. Epub 2022 Sep 6.

Authors

Affiliations

¹ Marquette University, Department of Psychology, Cramer Hall, Room 317, 604 N. 16th St., Milwaukee, WI, 53233, USA; University of Wisconsin-Milwaukee, Department of Psychology, Garland Hall, Room 224, 2441 E. Hartford Ave., Milwaukee, WI, 53211, USA. Electronic address: douglas.woods@marquette.edu.
² University of Wisconsin-Milwaukee, Department of Psychology, Garland Hall, Room 224, 2441 E. Hartford Ave., Milwaukee, WI, 53211, USA. Electronic address: ely.laura.j@gmail.com.
³ Marquette University, Department of Psychology, Cramer Hall, Room 317, 604 N. 16th St., Milwaukee, WI, 53233, USA; University of Wisconsin-Milwaukee, Department of Psychology, Garland Hall, Room 224, 2441 E. Hartford Ave., Milwaukee, WI, 53211, USA. Electronic address: chbauer@mcw.edu.
⁴ State University, Department of Psychology, 2810 Old Main Hill, Logan, UT, 84322, USA. Electronic address: michael.twohig@usu.edu.
⁵ Marquette University, Department of Psychology, Cramer Hall, Room 317, 604 N. 16th St., Milwaukee, WI, 53233, USA. Electronic address: stephen.saunders@marquette.edu.
⁶ Duke University School of Medicine, Department of Psychiatry & Behavioral Sciences, 2608 Erwin Rd, Suite 300, Durham, NC, 27705, USA. Electronic address: compt004@duke.edu.
⁷ University of Wisconsin-Milwaukee, Department of Psychology, Garland Hall, Room 224, 2441 E. Hartford Ave., Milwaukee, WI, 53211, USA. Electronic address: espil@stanford.edu.
⁸ Kent State University, Department of Psychology, 144 Kent Hall, Kent State University, Kent, OH, 44242-0001, USA. Electronic address: aneal@kent.edu.
⁹ Marquette University, Department of Psychology, Cramer Hall, Room 317, 604 N. 16th St., Milwaukee, WI, 53233, USA. Electronic address: jalexander@houstonocd.org.
¹⁰ University of Wisconsin-Milwaukee, Department of Psychology, Garland Hall, Room 224, 2441 E. Hartford Ave., Milwaukee, WI, 53211, USA. Electronic address: michael_walther@brown.edu.
¹¹ University of Wisconsin-Milwaukee, Department of Psychology, Garland Hall, Room 224, 2441 E. Hartford Ave., Milwaukee, WI, 53211, USA. Electronic address: cahill@uwm.edu.
¹² University of Applied Sciences, Diploma Hochschule, Germany. Electronic address: thilo.deckersbach@diploma.de.
¹³ Rogers Behavioral Health, 1 Winding Drive, Suite 106, Philadelphia, PA, 19131, USA. Electronic address: Martin.Franklin@rogersbh.org.

Abstract

Given the limited treatment options for trichotillomania (TTM), or Hair Pulling Disorder, this large randomized clinical trial evaluated the efficacy of acceptance-enhanced behavior therapy for TTM (AEBT-TTM) in reducing TTM severity relative to psychoeducation and supportive therapy (PST). Eighty-five adults (78 women) with TTM received 10 sessions (over 12 weeks) of either AEBT-TTM or PST. Independent evaluators masked to treatment assignment assessed participants at baseline (week 0), midpoint (week 6), and endpoint (week 12). Consistent with a priori hypotheses, 64% of the adults treated with AEBT-TTM were classified as clinical responders at post-treatment relative to 38% treated with PST. Clinical responders were identified by a score of 1 or 2 on the Clinical Global Impressions-Improvement (CGI-I) scale. Relative to the PST group, the AEBT-TTM group demonstrated significantly greater pre-to post-treatment reductions on the self-report Massachusetts General Hospital-Hairpulling Scale (MGH-HS) and the evaluator-rated National Institute of Mental Health Trichotillomania Severity Scale (NIMH-TSS). There were no significant post-treatment group differences on the Clinical Global Impressions-Severity (CGI-S) scale, or rate of TTM diagnoses. Results suggest AEBT-TTM provides greater treatment benefit than PST. Future research should continue to investigate AEBT-TTM along with mediators and moderators of its efficacy.

Keywords: Behavior therapy; Habits; Mindfulness; Obsessive compulsive disorder; Treatment effectiveness; Trichotillomania.

Publication types

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

MeSH terms

Adult
Behavior Therapy / methods
Female
Humans
Treatment Outcome
Trichotillomania* / psychology
Trichotillomania* / therapy
United States

Grants and funding

R01 MH080966/MH/NIMH NIH HHS/United States