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Evaluation ViewAttendees 1

Category: Tic and Impulse Control Disorders

Symposium 140 - Enhancing Behavior Therapy for Trichotillomania

Sunday, November 19, 2023
10:30 AM – 12:00 PM PST
Location: Chiwawa (501), Level 5
CE: 1.5

Keywords: Trichotillomania, Psychotherapy Outcome, ACT (Acceptance & Commitment Therapy)
Level of Familiarity: Basic to Moderate
Recommended Readings: Woods, D. W., Ely, L. J., Bauer, C. C., Twohig, M. P., Saunders, S. M., Compton, S. N., . . . Franklin, M. E. (2022). Acceptance-enhanced behavior therapy for trichotillomania in adults: A randomized clinical trial. Behaviour Research and Therapy, 158, 104187. https://doi.org/10.1016/j.brat.2022.104187,  

Lee, E. B., Haeger, J. A., Levin, M. E., Ong, C. W., & Twohig, M. P. (2018). Telepsychotherapy for trichotillomania: A randomized controlled trial of ACT enhanced behavior therapy. Journal of Obsessive-Compulsive and Related Disorders, 18, 106–115. https://doi.org/10.1016/j.jocrd.2018.04.003

,   Marcks, B.A., Wetterneck, C.T., Woods, D.W. (2006). Investigating healthcare providers knowledge of trichotillomania and it's treatment. Cognitive Behavior Therapy, 35(1), 19-27. https://doi.org/10.1080/16506070510010657a,   Rogers, K., Banis, M., Falkenstein, M. J., Malloy, E. J., McDonough, L., Nelson, S. O., Rusch, N., & Haaga, D. A. F. (2014). Stepped care in the treatment of trichotillomania. Journal of Consulting and Clinical Psychology, 82, 361-367,   Himle, J. A., Bybee, D., O’Donnell, L. A., Weaver, A., Vlnka, S., DeSena, D. T., & Rimer, J. M. (2018). Awareness Enhancing and Monitoring Device plus Habit Reversal in the Treatment of Trichotillomania: An Open Feasibility Trial. Journal of Obsessive-Compulsive and Related Disorders, 16, 14-20. https://doi.org/10.1016/j.jocrd.2017.10.007

Trichotillomania (TTM) is a common psychiatric disorder characterized by repetitive hair pulling that results in significant distress and impairment. Despite its prevalence and negative consequences, TTM remains under-researched and is often inadequately treated. The limited evidence base on TTM treatment supports the use of behavior therapy with habit reversal training (HRT) (Slikboer et al., 2017). Although behavior therapy trials for TTM demonstrate compelling short-term effects, some individuals show only partial response to these interventions. Moreover, few TTM treatment studies have evaluated long-term outcomes, and those that have often find that improvements from behavior therapy lack durability. Another barrier to effective TTM treatment is access to clinicians who are knowledgeable about TTM, indicating the need for effective online or self-guided behavior therapy options. Thus, it is necessary to study additional modalities and strategies that can improve behavior therapy for TTM. This symposium will include five studies focused on enhancing or supplementing behavior therapy for TTM.

A growing body of evidence supports the combination of behavior therapy and acceptance and commitment therapy (ACT), or acceptance-enhanced behavior therapy (AEBT) to treat TTM (Farhat et al., 2020; Lee et al., 2018b; Woods et al., 2022). Two of the current studies will present data on the efficacy of AEBT for TTM and durability of treatment gains. As long-term outcomes for AEBT have not been widely studied, our first presentation examines six-month outcome data from a randomized controlled trial (RCT) comparing AEBT for TTM to a credible therapeutic control. This presentation will highlight predictors of durable symptom improvement and clinical response. Recent studies suggest that AEBT for TTM can be effectively delivered online (Asplund et al., 2022; Lee et al., 2018a), but web-based AEBT studies are limited. Our second presentation examines outcomes, moderators, and processes of change from an RCT testing a web-based version of AEBT for TTM.

Our next presentation features a study on mental health providers’ knowledge of TTM, which revealed providers’ perceived lack of training and preparedness to treat TTM. These findings underscore the importance of improving online and self-guided behavior therapy for TTM. Existing research shows promising results for self-paced online TTM treatment (Mouton-Odum et al., 2006; Rogers et al., 2014). However, low treatment adherence can be an obstacle to the efficacy of self-help modalities. Our next presentation examines a self-control training strategy to enhance adherence to a self-help web-based behavioral TTM treatment. Change in TTM symptoms and participant feedback will also presented. Continuing with the themes of technology-enhanced and self-guided treatment, our final study will present data on the efficacy and acceptability of a wrist-worn electronic awareness enhancement device for TTM. This device is designed to improve awareness of pulling behaviors, a key aspect of HRT in behavior therapy.

Finally, our discussant, an expert in TTM, will synthesize the presentations and discuss future directions to improve treatment outcomes for TTM.

Learning Objectives:

At the end of the session, the learner will be able to:
  • Recognize potential treatment modalities and strategies for enhancing behavior therapy for TTM.
  • Evaluate the strengths and limitations of these approaches by summarizing data from recent clinical trials.
  • Describe the evidence base on the long-term efficacy of acceptance-enhanced behavioral treatment for TTM.
  • Identify innovative technology approaches for optimizing TTM treatment accessibility and adherence.
  • Use evidence from clinical trials when considering using ACT or technology-based approaches to augment behavior therapy in research or practice.
  • Identify future research directions for improving the efficacy and accessibility of TTM treatment.