(PS7-C56) Therapist Competence Measure Development for Comprehensive Behavioral (ComB) treatment of Trichotillomania

Trichotillomania (TTM) is a difficult to treat mental health disorder characterized by the recurrent pulling of one’s own hair, with an estimated prevalence of 1.7% among U.S. adults (Grant et al., 2020). To date, behavioral interventions have demonstrated greater treatment efficacy than pharmacological interventions alone (Farhat et al., 2020). One promising and novel behavioral treatment for TTM is Comprehensive Behavioral Treatment of Trichotillomania (ComB), which provides individualized treatment by grouping hairpulling triggers into modalities (i.e., sensory, cognitive, affective, motoric, and place) and collaborating with the patient to implement interventions that target triggers within the same modality (Mansueto et al., 1999). Exploratory analysis from the first randomized controlled trial (RCT) of ComB suggested that its efficacy varied across therapists, such that patients assigned to therapists with prior TTM experience made greater gains (Carlson et al., 2021). To facilitate future ComB research, this current project aims to develop a measure of therapist competence in delivering ComB and will perform initial tests of its psychometric properties. The ComB competence measure is composed of 14 items that encompass core ComB skills outlined in the treatment manual. Two independent evaluators with prior knowledge of ComB and TTM were trained by a ComB expert to rate therapist competency in ComB session recordings from the first ComB RCT (Carlson et al., 2021). Sixty session recordings have been randomly selected for rating. When ratings are completed (projected for June 2023), we will evaluate inter-rater reliability and concurrent validity (difference of mean competence scores between therapists with and without prior TTM treatment experience). This research addresses method limitations of earlier studies of therapist competence (Fairburn & Cooper, 2011) in that (a) this measure primarily draws upon skills unique to ComB; (b) we included recordings across all sessions with the exception of introductory and final sessions; c) trial therapists varied in experience and skill; and (d) independent competence evaluators have no relationship with therapists involved in the RCT.

A reliable and valid ComB competence measure appears critical for effective delivery and evaluation of ComB. The measure can be used to define and enforce an acceptable threshold that clinicians must meet prior to being included into trials. In a future practice context, the measure may be used with ComB trainees in order to assess their current facility with the method and coach them towards gaining further expertise.