4 - (SYM 140) Improving Web-based Self-help Adherence for Trichotillomania and Body Focused Repetitive Behaviors Using Self-control Training

Behavioral treatments of trichotillomania and other body-focused repetitive behaviors are effective, but access to expert therapists is limited. Providers are generally less knowledgeable about these disorders or not trained in the corresponding evidence-based treatments, leading to misdiagnoses and unmet needs (Marcks et al., 2006). One way to improve access is to disseminate behavior therapy via web-based self-help programs such as stoppulling.com, which appears promising in uncontrolled studies (Mouton-Odum et al., 2006). The first randomized controlled trial of stoppulling.com, however, yielded modest results (Rogers et al., 2014). Nonadherence seemed to limit efficacy. Those who used it more got more benefit, but the sample as a whole logged on and entered data on a median of just 12.5 days out of the intended 70.

Adherence to web-based self-help requires self-control in that its costs are borne immediately (e.g., somewhat tedious assessments such as self-monitoring logs), whereas the benefits are probabilistic and delayed (i.e., eventual reduction of symptoms). The present study tests the impact on adherence of a method for improving self-control derived from the “strength” model of self-control, which posits that self-control is analogous to a muscle and can be enhanced or “strengthened” through repeated use and frequent exertion (Baumeister et al., 2018). 

Adult participants (40 hair pullers, 40 skin pickers—20 of each in each experimental condition) were randomly assigned to one of two conditions: (a) 2-week self-control task vs. (b) 2-week wait list, followed in each condition by paid access to web-based self-help for 10 weeks and then post-test. The self-control intervention (i.e., avoiding eating sweet foods) is based on one used successfully with smokers (Muraven, 2010). The main dependent variable is adherence, the number of days on which the participant logged in and entered data on their behavior. Secondary outcomes include change in BFRB symptoms and qualitative feedback on the self-control task. Data collection was completed in November 2022, and the dataset will be cleaned and analyzed in time for reporting at ABCT in Seattle.