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. 2024 Mar:333:115767.
doi: 10.1016/j.psychres.2024.115767. Epub 2024 Jan 30.

Long-term follow-up of acceptance-enhanced behavior therapy for trichotillomania

Kathryn E Barber  1 , Douglas W Woods  2 , Laura J Ely  3 , Stephen M Saunders  1 , Scott N Compton  4 , Angela Neal-Barnett  5 , Martin E Franklin  6 , Matthew R Capriotti  7 , Christine A Conelea  8 , Michael P Twohig  9
Affiliations

Long-term follow-up of acceptance-enhanced behavior therapy for trichotillomania

Kathryn E Barber et al. Psychiatry Res. 2024 Mar.

Abstract

Acceptance-enhanced behavior therapy for trichotillomania (AEBT-TTM) is effective in reducing trichotillomania (TTM) symptoms, but the durability of treatment effects remains in question. This study analyzed 6-month follow-up data from a large randomized clinical trial comparing AEBT-TTM to an active psychoeducation and supportive therapy control (PST). Adults with TTM (N=85; 92% women) received 10 sessions of AEBT-TTM or PST across 12 weeks. Independent evaluators assessed participants at baseline, post-treatment, and 6 months follow-up. For both AEBT-TTM and PST, self-reported and evaluator-rated TTM symptom severity decreased from baseline to follow-up. TTM symptoms did not worsen from post-treatment to follow-up. At follow-up, AEBT-TTM and PST did not differ in rates of treatment response, TTM diagnosis, or symptom severity. High baseline TTM symptom severity was a stronger predictor of high follow-up severity for PST than for AEBT-TTM, suggesting AEBT-TTM may be a better option for more severe TTM. Results support the efficacy of AEBT-TTM and show that treatment gains were maintained over time. Although AEBT-TTM yielded lower symptoms at post-treatment, 6-month follow-up outcomes suggest AEBT-TTM and PST may lead to similar symptom levels in the longer term. Future research should examine mechanisms that contribute to long-term gain maintenance.

Keywords: ACT; Behavior therapy; Clinical trial; Habit reversal training; Hair-pulling disorder; Maintenance; Relapse.

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Conflict of interest statement

Declaration of competing interest Ms. Barber, Dr. Ely, Dr. Saunders, Dr. Compton, Dr. Neal-Barnett, Dr. Franklin, Dr. Capriotti, and Dr. Conelea declare that they have no conflicts of interest. Dr. Woods and Dr. Twohig are the authors of the treatment manual tested in this study and receive book royalties from Oxford University Press.

Figures

Figure 1.
Figure 1.
CONSORT Diagram
Figure 2.
Figure 2.
Follow-Up MGH-HS by Baseline MGH-HS and Treatment Group Note. Figure 2 shows model-based MGH-HS means at follow-up for participants in each treatment group (AEBT-TTM and PST) who scored one standard deviation above (High Group) and below (Low Group) the mean on the MGH-HS at baseline. MGH-HS scores at follow-up were significantly lower in the Low MGH-HS PST Group when compared to the High MGH-HS PST Group (p < .014). MGH-HS = Massachusetts General Hospital- Hairpulling Scale; AEBT-TTM = Acceptance-enhanced behavior therapy for trichotillomania; PST = Psychoeducation and supportive therapy
See this image and copyright information in PMC

References

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