5 - (SYM 140) Pilot Trial of a Technology Assisted Treatment for Trichotillomania

Habit Reversal Training (HRT), which includes awareness training, competing response training and social support, is the most widely tested treatment for trichotillomania (TTM). Studies have shown that successful awareness training is a key component of HRT; therefore, several studies have employed electronic awareness enhancement devices (AEDs) to improve awareness of repetitive behaviors. Unfortunately, these AEDs had some limitations including poor detection accuracy and issues regarding device wearability. To address these limitations, the current study used a newly designed wrist-worn device and accompanying app, developed by HabitAware®, as a system for increasing the participant’s awareness of hair pulling behaviors, while training them to deliver self-administered HRT.  

The study examined the usability, acceptability, and feasibility of the prototype wrist-worn motion detection device and accompanying app. It also evaluated the preliminary efficacy of the device and app as a method for decreasing pulling severity, and as an exploratory aim, the efficacy of the device and app combination was compared to a reminder bracelet. The pilot trial included 15 adults with TTM who interacted with the device and app system (n=10) or reminder bracelet (n=5) for 4 weeks. At baseline, midpoint (2 weeks) and post (4 weeks), an independent evaluator administered the National Institute of Mental Health - Trichotillomania Severity Scale (NIMH-TSS) to examine the participants’ hair pulling severity. Further, at each visit, participants completed an acceptability survey and the Massachusetts General Hospital – Hairpulling Scale (MGH-HS), which is a self-report hair pulling severity measure.  

Participants in the device and app condition reported high usability, acceptability, and efficacy of the device and app system. The use of a small, discreet wrist-worn device, rather than the wrist and neck units used in past studies, mitigated concerns related to device wearability. Additionally, results suggested that the device and app combination was an effective tool for reducing hair pulling severity, as significant reductions in hair pulling were demonstrated from pre to post treatment on the NIMH-TSS and MGH-HS. Individuals in the reminder bracelet condition also showed improvement in hair pulling. The current pilot trial suggests that a future efficacy study with a larger sample size, longer timeframe, and improved gesture detection algorithm is warranted.