Testing a New Therapy for Trichotillomania

Acceptance Enhanced Behavior Therapy for Trichotillomania

This study will test the effectiveness of a new behavioral therapy for adults with trichotillomania (compulsive hair pulling).

Study Overview

• Status: Completed
• Conditions: Trichotillomania
• Intervention / Treatment: Behavioral: Acceptance enhanced behavior therapy (AEBT); Behavioral: Psychoeducation and supportive therapy (PST)

Detailed Description

Trichotillomania (TTM) is a disorder in which people compulsively pull out their own hair. Treatments for TTM sometimes do not have long-term effectiveness. Acceptance and commitment therapy (ACT) is a therapeutic approach thought to have longer lasting effects than standard cognitive behavioral therapy (CBT) approaches, because ACT focuses on accepting thoughts and behaviors as opposed to changing them. Previous research indicates that a combination of ACT and habit reversal behavioral therapy is more effective than no treatment. This study will test whether a combination of ACT and behavioral therapy, called acceptance enhanced behavioral therapy (AEBT), is more effective than the current standard treatment for TTM.

Participation in this study will last 12 weeks, and follow-up assessments will last for 6 months. At study entry, participants will complete a brief intelligence test and an in-person interview about their medical history, psychiatric history, and hair pulling. At their second visit, participants will have digital pictures taken of their hair-pulling sites and complete two computer tasks measuring their response inhibition and cognitive flexibility. After the second visit, participants will be randomly assigned to receive either AEBT or psychoeducation and supportive therapy (PST)-a standard treatment for TTM. Both treatments will involve ten 1-hour sessions completed over 12 weeks. Assessments of participants will occur after 6 weeks of treatment, at treatment completion, and after 6 months. These assessments will measure treatment effectiveness, based on several clinical scales and measures of TTM symptoms. Participants who receive PST during this study will be offered AEBT afterward.

• Study Type: Interventional
• Enrollment (Actual): 85
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Wisconsin
    • Milwaukee, Wisconsin, United States, 53211
      • Marquette University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Current DSM-IV diagnosis of trichotillomania
• Massachusetts General Hospital Hair Scale score greater than 12
• Wechsler Test of Adult Reading score greater than 85
• Fluent in English
• Outpatient status
• Agreement to not alter the dosage of any psychotropic medication throughout the course of the study, or, if such a dosage change is required, understanding that the participant will continue to receive treatment, and data will continue to be collected on him or her
• Individuals who eat their hair after pulling will be eligible for participation only after they have received a physical exam from their primary care physician to determine whether there is any gastrointestinal blockage due to hair pulling, which would require more immediate clinical care.

Exclusion Criteria:

• Diagnosis of bipolar disorder, psychotic disorder, mental retardation, pervasive developmental disorder, or current substance dependence (with the exception of nicotine dependence)
• Current mood or anxiety disorder with an active suicide risk
• Currently receiving psychotherapy for trichotillomania or another psychiatric condition
• Initiation or change in the dosage of any psychotropic medication for up to 8 weeks preceding participation in the study

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: SINGLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
EXPERIMENTAL: 1; Participants will receive acceptance enhanced behavior therapy (AEBT) for trichotillomania (TTM).	Behavioral: Acceptance enhanced behavior therapy (AEBT); Ten 1-hour sessions over 12 weeks, enhancing awareness of hair-pulling behavior and teaching strategies to deal with hair pulling; Other Names: Behavior Therapy; ACT; Acceptance and Commitment Therapy; Habit Reversal
ACTIVE_COMPARATOR: 2; Participants will receive psychoeducation and supportive therapy (PST) for TTM.	Behavioral: Psychoeducation and supportive therapy (PST); Ten 1-hour sessions over 12 weeks, teaching the participant about hair pulling and discussing how hair pulling affects those who do it; Other Names: Supportive Therapy; Psychoeducation

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Clinical Global Impressions-Improvement Scale	Measured after 6 weeks, 12 weeks, and 6 months

Secondary Outcome Measures

Outcome Measure	Time Frame
Massachusetts General Hospital Hairpulling Scale	Measured at screening, baseline, and after 6 weeks, 12 weeks, and 6 months
National Institute of Mental Health (NIMH) Trichotillomania Severity and Impairment Scales	Measured at screening, baseline, and after 6 weeks, 12 weeks, and 6 months
Clinical Global Impressions-Severity Scale	Measured at screening, baseline, and after 6 weeks, 12 weeks, and 6 months

Collaborators and Investigators

• Sponsor: University of Wisconsin, Milwaukee
• Collaborators: National Institute of Mental Health (NIMH)
• Investigators: Principal Investigator: Douglas W. Woods, PhD, Marquette University

Publications and helpful links

General Publications

• Houghton DC, McFarland CS, Franklin ME, Twohig MP, Compton SN, Neal-Barnett AM, Saunders SM, Woods DW. DSM-5 Trichotillomania: Perception of Adults With Trichotillomania After Psychosocial Treatment. Psychiatry. 2016 Summer;79(2):164-169. doi: 10.1080/00332747.2016.1144438.

Study record dates

Study Major Dates

• Study Start: March 1, 2009
• Primary Completion (ACTUAL): October 1, 2013
• Study Completion (ACTUAL): November 30, 2015

Study Registration Dates

• First Submitted: March 30, 2009
• First Submitted That Met QC Criteria: March 30, 2009
• First Posted (ESTIMATE): March 31, 2009

Study Record Updates

• Last Update Posted (ACTUAL): October 5, 2021
• Last Update Submitted That Met QC Criteria: September 27, 2021
• Last Verified: September 1, 2021

More Information

Terms related to this study

• Keywords: Behavior Therapy; Acceptance; Impulse Control Disorders; Habit Reversal
• Additional Relevant MeSH Terms: Mental Disorders; Disruptive, Impulse Control, and Conduct Disorders; Trichotillomania
• Other Study ID Numbers: R01MH080966 (NIH); DATR A2-AIR; 1R01MH080966 (NIH); NIMH-3065236