Pilot trial of dialectical behavior therapy-enhanced habit reversal for trichotillomania
Open accessAbstract
BACKGROUND: Not all hair pullers improve acutely with cognitive-behavioral treatment (CBT) and few maintain their gains over time. METHODS: We conducted an open clinical trial of a new treatment that addresses affectively triggered pulling and emphasizes relapse prevention in addition to standard CBT approaches. Ten female participants satisfying DSM-IV criteria for trichotillomania (TTM) at two study sites received Dialectical Behavior Therapy (DBT)-enhanced CBT consisting of 11 weekly sessions and 4 maintenance sessions over the following 3 months. Independent assessors rated hair pulling impairment and global improvement at several study time points. Participants completed self-report measures of hair pulling severity and emotion regulation. RESULTS: Significant improvement in hair pulling severity and emotion regulation, as well as hair pulling impairment and anxiety and depressive symptoms, occurred during acute treatment and were maintained during the subsequent 3 months. Significant correlations were reported between changes in emotion regulation and hair pulling severity during both the acute treatment and maintenance phases. CONCLUSIONS: This study offers preliminary evidence for the efficacy of DBT-enhanced CBT for TTM and suggests the importance of addressing emotion regulation during TTM treatment.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Expected correlations between emotion regulation capacity and hair pulling severity were demonstrated during both acute and maintenance treatment.
“Expected correlations between ER capacity and hair pulling severity were demonstrated during both acute and maintenance treatment.”
From Dbt-enhanced cognitive-behavioral treatment for trichotillomania: A randomized controlled trial (2012) · cites this paper as Keuthen et al., 2010
The Relationship Between TTM Severity and Emotion Regulation section (pp. 953–959) reports significant correlations between changes in emotion regulation and hair-pulling severity from pretreatment to posttreatment, and from pretreatment to three-month maintenance. It also says that none of the correlations for changes specifically between posttreatment and three-month maintenance were significant. Thus the acute-treatment finding is supported, but the wording overstates the finding during maintenance treatment. (LLM, conf=0.87)
Experimental — accuracy not yet measuredOpen trial treatment resulted in significant improvement in TTM severity, emotion regulation capacity, experiential avoidance, anxiety and depression, with changes generally maintained over time.
“Open trial treatment resulted in significant improvement in TTM severity, emotion regulation (ER) capacity, experiential avoidance, anxiety and depression with changes generally maintained over time.”
From Dbt-enhanced cognitive-behavioral treatment for trichotillomania: A randomized controlled trial (2012) · cites this paper as Keuthen et al., 2010
The Acute Treatment Outcomes and 3-Month Maintenance Outcomes sections report significant improvements in TTM severity, emotion regulation, anxiety, and depression that were generally maintained. They do not report experiential avoidance as an outcome of this open trial; the Introduction attributes that improvement to a separate wait-list-controlled study by Woods et al. (LLM, conf=0.91)
Experimental — accuracy not yet measuredIn a pilot open treatment trial, DBT-enhanced habit reversal training produced significant improvement in hair pulling severity/impairment, emotion regulation and anxiety and depressive symptoms at both post-treatment and 3-month maintenance.
“In a pilot open treatment trial of DBT-enhanced habit reversal training for TTM, we demonstrated significant improvement in hair pulling severity/impairment, ER and anxiety and depressive symptoms at both post-treatment and 3-month maintenance (Keuthen et al., 2010).”
From Dbt-enhanced cognitive-behavioral treatment for trichotillomania: A randomized controlled trial (2012) · cites this paper as Keuthen et al., 2010
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
An inventory for measuring clinical anxiety: Psychometric properties.
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.56.6.893 · Cited by 14,407 · see citing works
Gratz, K. L., & Roemer, L. (2004) · Journal of Psychopathology and Behavioral Assessment · doi:10.1023/b:joba.0000007455.08539.94 · Cited by 8,942 · see citing works
(1976) · Medical Entomology and Zoology · Cited by 8,899 · see citing works
(1993) · Cited by 7,136 · see citing works
Cognitive-Behavioral Treatment of Borderline Personality Disorder
Cary, G. L. (1994) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.1994.48.1.155 · Cited by 6,300 · see citing works
(1993) · Medical Entomology and Zoology · Cited by 2,491 · see citing works
Habit-reversal: a method of eliminating nervous habits and tics
Azrin, N. H., & Nunn, R. G. (1973) · Behaviour Research and Therapy · doi:10.1016/0005-7967(73)90119-8 · Cited by 967 · see citing works
Catanzaro, S. J., & Mearns, J. (1990) · Journal of Personality Assessment · doi:10.1080/00223891.1990.9674019 · Cited by 609 · cited 10× · see citing works
“Pretreatment to 3-month maintenance scores for the NMR cognitive subscale approached significance (Z 5 1.84, P 5.066, n 5 10).”
BackgroundInfluentialCatanzaro, S., & Mearns, J. (1990) · Journal of Personality Assessment · doi:10.1207/s15327752jpa5403&4_11 · Cited by 609 · see citing works
Swedo, S. E., Leonard, H. L., Rapoport, J. L., Lenane, M. C., Goldberger, E. L., & Cheslow, D. L. (1989) · New England Journal of Medicine · doi:10.1056/nejm198908243210803 · Cited by 601 · cited 4× · see citing works
“Total scale scores improved significantly from pre- to posttreatment for the NIMH-TIS (Z 5 2.02, P 5.043, n 5 5).”
BackgroundInfluentialCharacteristics of 60 adult chronic hair pullers
(1991) · American Journal of Psychiatry · doi:10.1176/ajp.148.3.365 · Cited by 570 · cited 2× · see citing works
“In the early 1990s, Christenson et al.([11]) proposed two types of hair pulling: automatic or habit-like pulling occurring out of conscious awareness and focused pulling occurring volitionally in response to uncomfortable inner experiences (e.”
BackgroundThe Massachusetts General Hospital (MGH) Hairpulling Scale: 1. Development and Factor Analyses
Keuthen, N. J., O’Sullivan, R. L., Ricciardi, J. N., Shera, D., Savage, C. R., Borgmann, A. S., Jenike, M. A., & Baer, L. (2010) · Psychotherapy and Psychosomatics · doi:10.1159/000289003 · Cited by 444 · cited 1× · see citing works
“The MGH-HPS([33]) is a self-report instrument for the assessment of severity of hair pulling behavior, urges, and distress.”
BackgroundSelf-citationGrant, J. E., Odlaug, B. L., & Won Kim, S. (2009) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2009.60 · Cited by 424 · cited 2× · see citing works
“More recently, Grant et al.([10]) reported successful outcomes using N-acetylcysteine, an amino acid known to modulate glutamate function, in a doubleblind, placebo-controlled study of TTM.”
Woods, D. W., Wetterneck, C. T., & Flessner, C. A. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2005.05.006 · Cited by 381 · cited 6× · see citing works
“To date, Woods et al.([5]) are the only researchers who have addressed both styles of TTM in their treatment protocol by utilizing Acceptance and Commitment Therapy (ACT) in combination with HRT.”
BackgroundMethodResultInfluentialWoods, D. W., Flessner, C. A., Franklin, M. E., Keuthen, N. J., Goodwin, R. D., Stein, D. J., Walther, M. R., & Trichotillomania Learning Center-Scientific Advisory Board (2006) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v67n1207 · Cited by 317 · cited 1× · see citing works
“INTRODUCTION Empirical research has recently documented the phenomenology and psychosocial impairment associated with trichotillomania (TTM).([1,2]) Unfortunately, though, treatment options are limited, with clinical outcomes modest at best, even with first-line interventions such as cognitive–behavioral treatment (CB…”
BackgroundSelf-citationSystematic Review: Pharmacological and Behavioral Treatment for Trichotillomania
Bloch, M. H., Landeros-Weisenberger, A., Dombrowski, P., Kelmendi, B., Wegner, R., Nudel, J., Pittenger, C., Leckman, J. F., & Coric, V. (2007) · Biological Psychiatry · doi:10.1016/j.biopsych.2007.05.019 · Cited by 280 · cited 2× · see citing works
“Several years ago, the meta-analysis of Bloch et al.[6] demonstrated the superiority of habit reversal training (HRT),[7,8] the hallmark CBTapproach for TTM, over pharmacotherapy with either clomipramine or selective serotonergic reuptake inhibitors.”
Azrin, N. H., Nunn, R. G., & Frantz, S. E. (1980) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/0005-7916(80)90045-2 · Cited by 249 · see citing works
Psychiatric interviews suitable for use in research with children and adolescents.
Orvaschel, H. (1985) · PubMed · Cited by 238 · see citing works
Franklin, M. E., Flessner, C. A., Woods, D. W., Keuthen, N. J., Piacentini, J. C., Moore, P. S., Stein, D. J., Cohen, S. B., & Wilson, M. A. (2008) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0b013e31818d4328 · Cited by 167 · see citing works
Trichotillomania: a comprehensive behavioral model.
Mansueto, C., Stemberger, R. M. T., Thomas, A. M., & Golomb, R. (1997) · Clinical Psychology Review · doi:10.1016/s0272-7358(97)00028-7 · Cited by 152 · see citing works
Affective correlates of trichotillomania.
Diefenbach, G., Mouton-Odum, S., & Stanley, M. A. (2002) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(02)00006-2 · Cited by 139 · see citing works
The assessment of trichotillomania.
Rothbaum, B., & Ninan, P. (1994) · Behaviour Research and Therapy · doi:10.1016/0005-7967(94)90022-1 · Cited by 138 · see citing works
Flessner, C., Conelea, C. A., Woods, D. W., Franklin, M., Keuthen, N., & Cashin, S. E. (2008) · Behaviour Research and Therapy · doi:10.1016/j.brat.2007.12.009 · Cited by 127 · see citing works
Affective regulation in trichotillomania: Evidence from a large-scale internet survey
Shusterman, A., Feld, L., Baer, L., & Keuthen, N. (2009) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.04.004 · Cited by 127 · cited 3× · see citing works
“More recently, Shusterman et al.([21]) conducted a large-scale Internet survey of self-identified hair pullers to examine the potential contribution of affective regulation in TTM.”
BackgroundResultIdentification of trichotillomania cue profiles.
Christenson, G., Ristvedt, S. L., & Mackenzie, T. (1993) · Behaviour Research and Therapy · doi:10.1016/0005-7967(93)90030-x · Cited by 114 · see citing works
Lerner, J., Franklin, M., Meadows, E., Hembree, E., & Foa, E. (1998) · Behavior Therapy · doi:10.1016/s0005-7894(98)80036-1 · Cited by 102 · see citing works
Grey matter abnormalities in trichotillomania: morphometric magnetic resonance imaging study
Chamberlain, S., Menzies, L., Fineberg, N., Campo, N. D., Suckling, J., Craig, K., Müller, U., Robbins, T., Bullmore, E., & Sahakian, B. (2008) · The British journal of psychiatry : the journal of mental science · doi:10.1192/bjp.bp.107.048314 · Cited by 97 · see citing works
Emotion regulation and trichotillomania: a comparison of clinical and nonclinical hair pulling.
Diefenbach, G., Tolin, D., Meunier, S. A., & Worhunsky, P. (2008) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2006.09.002 · Cited by 94 · see citing works
An A-B-C Model of Habit Disorders: Hair-Pulling, Skin-Picking, and Other Stereotypic Conditions
Stein, D. J., Chamberlain, S., & Fineberg, N. (2006) · CNS Spectrums · doi:10.1017/s1092852900014978 · Cited by 94 · see citing works
(1992) · PubMed · Cited by 78 · see citing works
Behavioural treatment of trichotillomania: two-year follow-up results
Keijsers, G. P. J., van Minnen, A., Hoogduin, C. A. L., Klaassen, B. N. W., Hendriks, M. J., & Tanis-Jacobs, J. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2005.03.004 · Cited by 76 · see citing works
Nonclinical hair-pulling: affective correlates and comparison with clinical samples.
Stanley, M. A., Borden, J. W., Mouton, S., & Breckenridge, J. K. (1995) · Behaviour Research and Therapy · doi:10.1016/0005-7967(94)e0018-e · Cited by 70 · see citing works
Flessner, C., Woods, D. W., Franklin, M., Keuthen, N., & Piacentini, J. (2009) · Child Psychiatry and Human Development · doi:10.1007/s10578-008-0118-5 · Cited by 67 · see citing works
Hairpulling and Skin Picking in Relation to Affective Distress and Obsessive-Compulsive Symptoms
Hajcak, G., Franklin, M., Simons, R., & Keuthen, N. (2006) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-005-9001-x · Cited by 56 · see citing works
Flessner, C. A., Woods, D. W., Franklin, M. E., Keuthen, N. J., & Piacentini, J. C. (2008) · Behaviour Research and Therapy · doi:10.1016/j.brat.2008.06.006 · Cited by 43 · see citing works
Current Treatment Practices for Children and Adults With Trichotillomania: Consensus Among Experts
Flessner, C. A., Penzel, F., & Keuthen, N. J. (2010) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2009.10.006 · Cited by 42 · see citing works
Self-citationAffective and Sensory Correlates of Hair Pulling in Pediatric Trichotillomania
Meunier, S. A., Tolin, D., & Franklin, M. (2009) · Behavior Modification · doi:10.1177/0145445508326260 · Cited by 28 · see citing works
Flagged first, then by citations
Research works printed but not linked: 5
- Flessner CA, Penzel F, Trichotillomania Learning Center Scientific Advisory Board & Keuthen NJ. Current treatment practices for children and adults with trichotillomania. Cogn Behav Pract 2010;17:290-300.
- Grant JE, Odlaug BL, King SW. N-acetylcysteine, a glutamate modulator, in the treatment of trichotillomania. Arch Gen Psychiatry 2009;66:756-763.
- Depression and Anxiety 15206394, 2010, 10, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/da.20732 by Mount Vernon Nazarene University, Wiley Online Library on [04/09/2026]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License · DOI
- First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV Axis I Disorders: Patient Edition, (SCID-I/P, Version 2.0). New York: Biometrics Research Department; 1995.
- Beck AT, Steer RA, Brown GK. Beck Depression Inventory- Second Edition: Manual. San Antonio, TX: The Psychological Corporation; 1996.
Cited by
Sorted by citations
Dialectical Behavior Therapy for Adolescents: Theory, Treatment Adaptations, and Empirical Outcomes
MacPherson, H. A., Cheavens, J., & Fristad, M. (2012) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-012-0126-7 · Cited by 178 · see citing works
“Also, DBT has been adapted for adults with TTM and demonstrated promising results in a case study (Keuthen and Spirch 2012) and open trial (Keuthen et al. 2010, 2011).”
Snorrason, I., Belleau, E. L., & Woods, D. W. (2012) · Clinical Psychology Review · doi:10.1016/j.cpr.2012.05.008 · Cited by 174 · see citing works
“Empirical evidence has consistently shown that habit reversal is effective in eliminating or reducing both hair pulling (Bloch et al., 2007; Keuthen et al., 2010; van Minnen et al., 2003; Woods, Wetterneck, et al., 2006) and skin picking (Schuck et al.”
BackgroundEmotion regulation and other psychological models for body-focused repetitive behaviors.
Roberts, S., O'Connor, K., & Bélanger, C. (2013) · Clinical Psychology Review · doi:10.1016/j.cpr.2013.05.004 · Cited by 169 · see citing works
“Klatte and Deardorff (1981) measured anxiety in 10 individuals with NB and 10 controls, and found that individuals with NB reported greater anxiety.”
Trichotillomania and its treatment: a review and recommendations
Franklin, M., Zagrabbe, K., & Benavides, K. L. (2011) · Expert Review of Neurotherapeutics · doi:10.1586/ern.11.93 · Cited by 130 · see citing works
Dbt-enhanced cognitive-behavioral treatment for trichotillomania: A randomized controlled trial
Keuthen, N. J., Rothbaum, B. O., Fama, J., Altenburger, E., Falkenstein, M. J., Sprich, S. E., Kearns, M., Meunier, S., Jenike, M. A., & Welch, S. S. (2012) · Journal of Behavioral Addictions · doi:10.1556/jba.1.2012.003 · Cited by 124 · see citing works
“In a pilot open treatment trial of DBT-enhanced habit reversal training for TTM, we demonstrated significant improvement in hair pulling severity/impairment, ER and anxiety and depressive symptoms at both post-treatment and 3-month maintenance (Keuthen et al., 2010).”
BackgroundInfluentialDBT-enhanced habit reversal treatment for trichotillomania: 3- and 6-month follow-up results
Keuthen, N. J., Rothbaum, B. O., Falkenstein, M. J., Meunier, S., Timpano, K. R., Jenike, M. A., & Welch, S. S. (2011) · Depression and Anxiety · doi:10.1002/da.20778 · Cited by 89 · see citing works
Measuring the role of psychological inflexibility in trichotillomania
Houghton, D. C., Compton, S. N., Twohig, M. P., Saunders, S. M., Franklin, M. E., Neal-Barnett, A. M., Ely, L., Capriotti, M. R., & Woods, D. W. (2014) · Psychiatry Research · doi:10.1016/j.psychres.2014.08.003 · Cited by 84 · see citing works
“Several preliminary studies of these treatments in TTM have been undertaken (Ninan et al., 2000; Woods et al., 2006; Keuthen et al., 2010, 2011), but all suffer from methodological shortcomings including small sample size and/or lack of a control group.”
BackgroundCognitive Behavior Therapy for Obsessive-Compulsive and Related Disorders
Lewin, A. B., Wu, M. S., Mcguire, J. F., & Storch, E. A. (2014) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2014.05.002 · Cited by 70 · see citing works
“dients to HRT treatment packages for TTM, more recent studies have examined the incorporation of components from acceptance and commitment therapy(83) and dialectical behavior therapy.(84)”
Motor Inhibition, Reflection Impulsivity, and Trait Impulsivity in Pathological Skin Picking
Snorrason, Í., Smári, J., & Ólafsson, R. P. (2011) · Behavior Therapy · doi:10.1016/j.beth.2010.12.002 · Cited by 66 · see citing works
Acceptance and Commitment Therapy and Habit Reversal Training for the Treatment of Trichotillomania
Crosby, J. M., Dehlin, J. P., Mitchell, P. R., & Twohig, M. (2012) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2012.02.002 · Cited by 48 · see citing works
Emotion regulation in individuals with and without trichotillomania
Arabatzoudis, T., Rehm, I. C., Nedeljkovic, M., & Moulding, R. (2017) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2017.01.003 · Cited by 48 · see citing works
Comprehensive Behavioral Treatment of Trichotillomania
Falkenstein, M. J., Mouton‐Odum, S., Mansueto, C. S., Golomb, R. G., & Haaga, D. A. F. (2015) · Behavior Modification · doi:10.1177/0145445515616369 · Cited by 41 · see citing works
“The ComB treatment protocol appears promising and is worth further study in a RCT.”
BackgroundInfluentialEmotion regulation deficits in persons with body-focused repetitive behavior disorders
Alexander, J. R., Houghton, D. C., Bauer, C. C., Lench, H. C., & Woods, D. W. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.11.035 · Cited by 43 · see citing works
Benfer, N., Bardeen, J. R., & Clauss, K. E. (2018) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2018.09.006 · Cited by 37 · see citing works
“This is consistent with previous research that demonstrated DBT is particularly helpful for individuals struggling with low emotion regulation self-efficacy (Keuthen et al., 2010).”
ResultSnorrason, Í., Berlin, G. S., & Lee, H. (2015) · Psychology Research and Behavior Management · doi:10.2147/prbm.s53977 · Cited by 36 · see citing works
Harrison, J. P., & Franklin, M. E. (2012) · Current Psychiatry Reports · doi:10.1007/s11920-012-0269-8 · Cited by 25 · see citing works
“In general, expert opinion recommends CBT, including habit reversal training (HRT), as the first line of treatment for TTM. Behavioral interventions for TTM [33] generally surround three core elements: awareness training, stimulus control, and competing response training.”
BackgroundInfluentialKeuthen, N., Tung, E. S., Woods, D. W., Franklin, M., Altenburger, E. M., Pauls, D., & Flessner, C. (2015) · Behavior Modification · doi:10.1177/0145445515580533 · Cited by 30 · see citing works
“…advances utilizing Acceptance and Commitment Therapy (ACT) (Woods, Wetterneck, & Flessner, 2006) and Dialectical Behavior Therapy (DBT) augmentation strategies (Keuthen et al., 2012; Keuthen et al., 2010) specifically to address affect and uncomfortable internal sensations involved in hair pulling.”
BackgroundRecent advances in the treatment of trichotillomania (hair‐pulling disorder)
Everett, G. J., Jafferany, M., & Skurya, J. (2020) · Dermatologic Therapy · doi:10.1111/dth.13818 · Cited by 14 · see citing works
“Dialectical behavioral therapy has been shown to significantly reduce hair-pulling behavior and improve emotional regulation as well as comorbid anxiety and depression in those with TTM.(29) This therapy seeks to increase a patient awareness and regulation of emotions.”
BackgroundClarifying the relationship between Trichotillomania and anxiety
Alexander, J. R., Houghton, D. C., Twohig, M. P., Franklin, M. E., Saunders, S. M., Neal-Barnett, A. M., Compton, S. N., & Woods, D. W. (2017) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2017.02.004 · Cited by 31 · see citing works
“…cognitions and feelings via techniques like cognitive restructuring (Lerner, Franklin, Meadows, Hembree, & Foa, 1999); and third-wave behavioral treatment models target meta-cognitions about experiencing anxiety via techniques like mindfulness (Keuthen et al., 2010; Woods & Twohig, 2008).”
MethodFactor analysis of the Milwaukee Inventory for Subtypes of Trichotillomania-Adult Version
Alexander, J. R., Houghton, D., Twohig, M., Franklin, M., Saunders, S., Neal-Barnett, A., Compton, S., & Woods, D. W. (2016) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2016.08.001 · Cited by 27 · see citing works
DBT-Enhanced Cognitive Behavioral Therapy for Adolescent Trichotillomania: An Adolescent Case Study
Welch, S. S., & Kim, J. (2012) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2011.11.002 · Cited by 27 · see citing works
Predictors of Relapse Following Treatment of Trichotillomania
Falkenstein, M. J., Rogers, K., Malloy, E., & Haaga, D. (2014) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2014.09.001 · Cited by 27 · see citing works
“In a study of acceptance and commitment therapy (ACT)-enhanced HRT, 66% of participants were defined as responders at post-treatment (Woods, Wetterneck, & Flessner, 2006b), and 80% were considered responders at post-treatment in a study of dialectical behavior therapy (DBT)-enhanced HRT (Keuthen et al., 2010).”
InfluentialShareh, H. (2018) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465817000546 · Cited by 25 · see citing works
Ricketts, E. J., Peris, T. S., Grant, J. E., Valle, S., Cavic, E., Lerner, J. E., Lochner, C., Stein, D. J., Dougherty, D. D., O’Neill, J., et al. (2024) · Child Psychiatry & Human Development · doi:10.1007/s10578-022-01458-w · Cited by 23 · see citing works
“…impulsivity suggest the utility of applying behavioral interventions that incorporate third-wave cognitive-behavioral therapies focused on tolerance of unpleasant emotions, such as acceptance and commitment therapy, dialectical behavior therapy, and mindfulness-based intervention [12, 56, 87–89].”
The role of emotion regulation in body-focused repetitive behaviours
Roberts, S., O'Connor, K., Aardema, F., Bélanger, C., & Courchesne, C. (2016) · Cognitive Behaviour Therapy · doi:10.1017/s1754470x16000039 · Cited by 23 · see citing works
Crowe, E., Staiger, P. K., Bowe, S. J., Rehm, I. C., Moulding, R., Herrick, C. A., & Hallford, D. J. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.11.010 · Cited by 28 · see citing works
Utilizing DBT Skills to Augment Traditional CBT for Trichotillomania: An Adult Case Study
Keuthen, N. J., & Sprich, S. E. (2012) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2011.02.004 · Cited by 19 · see citing works
Newer Generations of CBT for Anxiety Disorders
Twohig, M. P., Woidneck, M. R., & Crosby, J. M. (2013) · CBT for Anxiety Disorders · doi:10.1002/9781118330043.ch9 · Cited by 19 · see citing works
Psychological treatments for trichotillomania: Update and future directions
Rehm, I., Moulding, R., & Nedeljkovic, M. (2015) · Australasian Psychiatry · doi:10.1177/1039856215590029 · Cited by 16 · see citing works
Badenoch, J., Searle, T., Watson, I., & Cavanna, A. E. (2020) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2020.10.008 · Cited by 17 · see citing works
Where on the obsessive impulsive–compulsive spectrum does hair-pulling sisorder belong?
Odlaug, B., Chamberlain, S., Schreiber, L. R. N., & Grant, J. (2013) · International journal of psychiatry in clinical practice · doi:10.3109/13651501.2013.828079 · Cited by 12 · see citing works
“…as acceptance and commitment therapy/habit reversal (targeting experiential avoidance and triggers to engage in the behavior) (Woods et al. 2006) as well as dialectical behavior therapy (targeting aff ectively triggered pulling with relapse prevention) (Keuthen et al. 2010) in the treatment of HPD.”
BackgroundNeal-Barnett, A. M., Woods, D. W., Espil, F. M., Davis, M., Alexander, J. R., Compton, S. N., Walther, M. R., Twohig, M. P., Saunders, S. M., Cahill, S. P., et al. (2019) · Bulletin of the Menninger Clinic · doi:10.1521/bumc_2019_83_04 · Cited by 15 · see citing works
Rosencrans, P. L., Bui, E., Rogers, A. H., Simon, N. M., & Baker, A. W. (2017) · International Journal of Cognitive Therapy · doi:10.1521/ijct.2017.10.4.283 · Cited by 12 · see citing works
Lungu, A., & Linehan, M. M. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-803457-6.00018-0 · Cited by 12 · see citing works
Slikboer, R., Castle, D., Nedeljkovic, M., & Rossell, S. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2017.12.056 · Cited by 9 · see citing works
Flannery, M. K., Coyne, A. F., Carlson, E. J., & Haaga, D. A. F. (2021) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2021.100706 · Cited by 7 · see citing works
Affective regulation in trichotillomania before and after self-help interventions.
Weidt, S., Zai, G., Drabe, N., Delsignore, A., Bruehl, A., Klaghofer, R., & Rufer, M. (2016) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2015.12.020 · Cited by 7 · see citing works
Curley, E. E., Tung, E. S., & Keuthen, N. J. (2016) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2016.04.005 · Cited by 8 · see citing works
Body focused repetitive behavior disorders and perceived stress: Clinical and cognitive associations
Grant, J., Leppink, E. W., & Chamberlain, S. (2015) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2015.02.001 · Cited by 10 · see citing works
Psychosocial Treatment of Trichotillomania: A Review
Capel, L., Woolley, M. G., & Twohig, M. (2024) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2024.05.003 · Cited by 9 · see citing works
Clinical Aspects of Hair Pulling, Skin Picking, and Nail Biting
Falkenstein, M. J. (2016) · Current Treatment Options in Psychiatry · doi:10.1007/s40501-016-0096-3 · Cited by 5 · see citing works
Mindfulness-Based Cognitive Therapy for Trichotillomania: A Bayesian Case-Control Study
Heeren, A., Busana, C., Coussement, C., & Philippot, P. (2015) · Psychologica Belgica · doi:10.5334/pb.bj · Cited by 5 · see citing works
Borderline personality disorder in Trichotillomania and skin picking disorder: a survey study
Grant, J. E., Collins, M., & Chamberlain, S. R. (2024) · BMC Psychology · doi:10.1186/s40359-024-02258-8 · Cited by 6 · see citing works
Long-term follow-up of acceptance-enhanced behavior therapy for trichotillomania
Barber, K. E., Woods, D. W., Ely, L. J., Saunders, S. M., Compton, S. N., Neal-Barnett, A. M., Franklin, M. E., Capriotti, M. R., Conelea, C. A., & Twohig, M. P. (2024) · Psychiatry Research · doi:10.1016/j.psychres.2024.115767 · Cited by 6 · see citing works
Psychological Treatment of Excoriation Disorder
Snorrason, Í., Goetz, A. R., & Lee, H. (2017) · doi:10.1002/9781118890233.ch56 · Cited by 6 · see citing works
Shamsudeen, S., & Kannekanti, P. (2023) · Clinical Case Studies · doi:10.1177/15346501231189552 · Cited by 5 · see citing works
“The availability of well-established interventions for trichotillomania in adults is limited, as only HRT-based therapy has appeared to be ef fi cacious in trials (Flessner et al., 2010), and not all patients maintain treatment bene fi ts from HRT over time (Keuthen et al., 2010).”
MethodResultOverview of Current Treatments that Enhance Emotion Regulation Skills
Berking, M., & Whitley, B. (2014) · Springer eBooks · doi:10.1007/978-1-4939-1022-9_5 · Cited by 5 · see citing works
Lootens, C. M., & Nelson‐Gray, R. O. (2016) · Clinical Case Studies · doi:10.1177/1534650116649438 · Cited by 5 · see citing works
Computerized Trans-Diagnostic Dialectical Behavior Therapy Skills Training for Emotion Dysregulation
Lungu, A. (2015) · ResearchWorks at the University of Washington (University of Washington) · Cited by 5 · see citing works
Trichotillomania and its treatment: an updated review and recommendations
DuBois, M. C., Feler, B., Flessner, C., & Franklin, M. E. (2025) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2025.2557395 · Cited by 5 · see citing works
“The first pilot trial of DBT-enhanced HRT was conducted in 2010 [73].”
A Review of Behavioral and Pharmacological Treatments for Adult Trichotillomania
Bennett, L., & Ryznar, R. (2024) · Psychology International · doi:10.3390/psycholint6020031 · Cited by 4 · see citing works
“One study of 10 subjects undergoing DBT for eleven weeks showed significant improvement in the hair-pulling severity on the MGH-HPS, Trichotillomania Impairment Scale (TIS), and impairment measures of the CGI after intervention [51].”
BackgroundCasas, J. B., Szoke, D. R., & Benuto, L. T. (2020) · Clinical Case Studies · doi:10.1177/1534650120964581 · Cited by 4 · see citing works
Swisher, V. S., Ricketts, E. J., Peris, T. S., Jones, G. M., Dunning, E. E., Valle, S., Cavic, E., Löchner, C., Stein, D. J., Dougherty, D. D., et al. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.10.037 · Cited by 3 · see citing works
Slikboer, R., Nedeljkovic, M., Castle, D., & Rossell, S. (2018) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2018.06.007 · Cited by 3 · see citing works
Targeting the function of inner experiences in obsessive compulsive and related disorders
Twohig, M. P., & Smith, B. M. (2015) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2014.12.033 · Cited by 3 · see citing works
Cloître, M., Bryant, R. A., & Schnyder, U. (2015) · Springer eBooks · doi:10.1007/978-3-319-07109-1_27 · Cited by 3 · see citing works
Body‐Focused Repetitive Behavior
Conelea, C. A., Frank, H., & Walther, M. R. (2017) · doi:10.1002/9781118877142.ch21 · Cited by 3 · see citing works
Nadai, A. S. D., Bicak, Z., Finch, A., Patyk, K. C., Zamora, R. J., & Mouton-Odum, S. (2023) · Cognitive Therapy and Research · doi:10.1007/s10608-023-10431-3 · Cited by 2 · see citing works
Rehm, I. C., Moulding, R., & Nedeljkovic, M. (2024) · Australian Psychologist · doi:10.1080/00050067.2024.2376881 · Cited by 2 · see citing works
“…et al., 2009) influenced the development of habit reversal therapy (HRT) protocols, since “enhanced” through the incorporation of acceptance and commitment therapy (ACT; e.g., Twohig & Woods, 2004; Woods et al., 2006) or dialectical behaviour therapy (DBT; e.g., Keuthen et al., 2010, 2012).”
Psychological Treatment of Trichotillomania
Francazio, S., Murphy, Y. E., & Flessner, C. (2017) · doi:10.1002/9781118890233.ch57 · Cited by 1 · see citing works
Kłosowska, J., & Prochwicz, K. (2026) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2026.152715 · Cited by 1 · see citing works
New Wave Therapies for Pediatric OCD
Bergman, R. L., & Rozenman, M. S. (2019) · Cambridge University Press eBooks · doi:10.1017/9781108235655.025 · Cited by 1 · see citing works
Afshari, B. (2022) · IntechOpen eBooks · doi:10.5772/intechopen.107482 · Cited by 1 · see citing works
Mechanisms of Treatments for Trichotillomania (Hair Pulling Disorder)
Brennan, E., Francazio, S., Murphy, Y. E., & Flessner, C. (2017) · doi:10.1002/9781118877142.ch20 · Cited by 1 · see citing works
Emotion Regulation in the Obsessive‐Compulsive Spectrum Disorders
Napolitano, L. A. (2017) · Wiley eBooks · doi:10.1002/9781118890233.ch64 · Cited by 1 · see citing works
Twohig, M. P., Bluett, E. J., Morrison, K. L., & Woidneck, M. R. (2013) · doi:10.1002/9781118528563.wbcbt10 · Cited by 1 · see citing works
Treatment of an Adult with Trichotillomania
Franklin, M., & Silber, M. (2016) · Springer eBooks · doi:10.1007/978-3-319-17139-5_16
Acceptance and Commitment Therapy for OC‐Spectrum Disorders
Morrison, K. L., Smith, B. M., Lee, E. B., & Twohig, M. P. (2017) · Wiley eBooks · doi:10.1002/9781118890233.ch65
Yager, E. K. (2018) · Journal of Psychology Research · doi:10.17265/2159-5542/2018.06.001
Telepsychotherapy for the Treatment of Trichotillomania: A Randomized Controlled Trial
Lee, E. B. (2018) · Digital Commons - USU (Utah State University) · doi:10.13140/rg.2.2.35306.21448
Mansueto, C. S. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108355605.019
Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder and Associated Disorders
Todd, G., & Branch, R. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108355605.013
Pederson, L. D. (2015) · Wiley eBooks · doi:10.1002/9781118957882.refs
Franklin, M. E., & Morris, S. H. (2017) · Springer eBooks · doi:10.1007/978-3-319-57196-6_12
Miltenberger, R. G., & Spieler, C. A. (2018) · Springer eBooks · doi:10.1007/978-3-319-97529-0_9
Motta, R. W. (2022) · IntechOpen eBooks · doi:10.5772/intechopen.102252
Obsessive‐Compulsive and Related Disorders
Neer, S. M., Gramlich, M. A., & Ragsdale, K. A. (2018) · Wiley eBooks · doi:10.1002/9781394258970.ch10
Greining og meðferð hárplokkunar- og húðkroppunaráráttu
Snorrason, Í., & Bjorgvinsson, T. (2012) · Læknablaðið · doi:10.17992/lbl.2012.03.421
The Effectiveness of Behavioral Therapy versus Medicines When Treating Trichotillomania
Diaz, M. (2015) · UC Merced Undergraduate Research Journal · doi:10.5070/m472027444
- Authors
- Keuthen, N. J., Rothbaum, B. O., Welch, S. S., Taylor, C., Falkenstein, M., Heekin, M., Jordan, C. A., Timpano, K., Meunier, S., Fama, J., & Jenike, M. A.
- Affiliations
- Harvard University (US)
- Emory University (US)
- University of Washington (US)
- Corresponding author
- Keuthen, Nancy J.
- Venue
- Depression and Anxiety
- Publisher
- Hindawi Limited
- Published
- 2010-08-18
- Volume
- 27
- Issue
- 10
- Pages
- 953-959
- ISSN
- 1091-4269 (ISSN-L)
- OpenAlex
- W2160669132
- Cited by
- 81
- References
- 36
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 5 · 2023: 3 · 2022: 3 · 2021: 4 · 2020: 3 · 2019: 2 · 2018: 6 · 2017: 14 · 2016: 5 · 2015: 13 · 2014: 5 · 2013: 4 · 2012: 7
- FWCI
- 5.26
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Depression and Anxiety (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- trichotillomania, dialectical behavior therapy, habit reversal, cognitive behavioral therapy, emotion regulation, hair pulling, relapse prevention, maintenance therapy, anxiety, depressive symptoms
- MeSH terms
- Adult, Emotions, Female, Habits, Humans, Pilot Projects, Psychiatric Status Rating Scales, Psychotropic Drugs, Severity of Illness Index, Trichotillomania, Cognitive Behavioral Therapy, Treatment Outcome
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
