ACT-enhanced group behavior therapy for trichotillomania and skin-picking disorder: a feasibility study
Open accessAbstract
OBJECTIVE: To evaluate the feasibility and efficacy of ACT-enhanced Group Behavior Therapy (AEGBT) for mixed diagnosis groups including patients with trichotillomania (TTM) and skin-picking disorder (SPD) in routine psychiatric care. METHOD: Adult patients (N = 40) with TTM and/or SPD received 10 weeks of AEGBT followed by five booster sessions. The primary outcome measure for TTM was the Massachusetts General Hospital Hairpulling Scale (MGH-HPS) and for SPD the Skin Picking Scale-Revised (SPS-R), assessed at posttreatment and at booster sessions. RESULTS: Results showed significant reductions in hair pulling and skin-picking severity from baseline to posttreatment and large effect sizes at posttreatment. Improvements remained significant at the 12-month follow-up for patients with SPD, but not for patients with TTM. Group attendance was high and few patients dropped out from treatment. The group format enabled therapists to see 25% more patients compared with an individual format. CONCLUSION: The results provide initial support for the feasibility and efficacy of an adapted treatment approach for TTM and SPD.
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A BT program for TTM/SPD has previously been shown effective when delivered in a group format at the authors' clinic.
“a BT program for TTM/SPD previously shown effective when delivered in a group format at our clinic (Asplund et al., 2021)”
From Internet-delivered acceptance-based behavior therapy for trichotillomania and skin-picking disorder in a psychiatric setting: A feasibility trial (2022) · cites this paper as Asplund et al., 2021
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“…treatments, HRT, might not target all aspects of TTM and SPD. HRT was initially developed for reducing different types of repetitive behaviors, such as habits and tics (Azrin & Nunn, 1973) and consists of three components (awareness training, competing response training, and stimulus control).”
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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 11× · see citing works
“R, z(27)=10.07, p 0.001, d = 0.73), but not for patients with TTM (MGH‐HPS, z(19)=10.28, p = 0.672, d = 0.19).”
InfluentialGrant, J. E., Odlaug, B. L., & Won Kim, S. (2009) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2009.60 · Cited by 424 · see citing works
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Ninan, P. T., Rothbaum, B. O., Marsteller, F. A., Knight, B. T., & Eccard, M. B. (2000) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v61n0111 · Cited by 303 · cited 5× · see citing works
“Another challenge in the care of TTM and SPD is that many sufferers remain symptomatic after treatment (Ninan et al., 2000; van Minnen et al., 2003) and relapse is common, especially for TTM (Diefenbach et al., 2006; Keijsers et al., 2006, 2016; Maas et al., 2018; Rogers et al., 2014).”
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“Another challenge in the care of TTM and SPD is that many sufferers remain symptomatic after treatment (Ninan et al., 2000; van Minnen et al., 2003) and relapse is common, especially for TTM (Diefenbach et al., 2006; Keijsers et al., 2006, 2016; Maas et al., 2018; Rogers et al., 2014).”
BackgroundResultInfluentialMonzani, B., Rijsdijk, F., Harris, J., & Mataix-Cols, D. (2014) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2013.3524 · Cited by 208 · cited 1× · see citing works
“…or pleasure after pulling or picking (Grant et al., 2012), presence of both automatic and focused pulling/picking, shared etiological mechanisms (Monzani et al., 2014), similar course of illness (onset during puberty, chronic with waxing and waning symptoms) suggest that the disorders can be…”
BackgroundFlessner, C. A., & Woods, D. W. (2006) · Behavior Modification · doi:10.1177/0145445506294083 · Cited by 202 · cited 2× · see citing works
“Patients with TTM and/or SPD can spend several hours every day pulling or picking (Snorrason et al., 2012) and trying to conceal the hair loss or skin lesions (Arnold et al., 1998; Diefenbach et al., 2005; Flessner & Woods, 2006).”
BackgroundResultThe Massachusetts General Hospital (MGH) hairpulling scale: 2. Reliability and validity
O’Sullivan, R. L., Keuthen, N. J., Hayday, C. F., Ricciardi, J. N., Buttolph, L., Jenike, M. A., & Baer, L. (2010) · Psychotherapy and Psychosomatics · doi:10.1159/000289004 · Cited by 191 · see citing works
Characteristics of 34 Adults With Psychogenic Excoriation
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“However, based on the chronicity of TTM and SPD (Snorrason et al., 2012) and by comparing the effect size of the supportive therapy in the study of Diefenbach et al. (2006) with the greater effect size from our study (Cohen's d 0.45 vs. 0.77), it is likely that our results might not be due to…”
BackgroundMethodResultInfluential<i>N</i>-Acetylcysteine in the Treatment of Excoriation Disorder: A Randomized Clinical Trial
Grant, J. E., Chamberlain, S. R., Redden, S. A., Leppink, E. W., Odlaug, B. L., & Kim, S. W. (2016) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2016.0060 · Cited by 172 · cited 1× · see citing works
“There is however some evidence suggesting that N‐acetyl cysteine (NAC) is potentially at least as efficacious as behavioral treatments (Grant et al., 2009, 2016).”
BackgroundTrichotillomania: impact on psychosocial functioning and quality of life
Diefenbach, G. J., Tolin, D. F., Hannan, S. E., Crocetto, J., & Worhunsky, P. D. (2004) · Behaviour Research and Therapy · doi:10.1016/j.brat.2004.06.010 · Cited by 161 · cited 2× · see citing works
“Patients with TTM and/or SPD can spend several hours every day pulling or picking (Snorrason et al., 2012) and trying to conceal the hair loss or skin lesions (Arnold et al., 1998; Diefenbach et al., 2005; Flessner & Woods, 2006).”
BackgroundResultHabit Reversal as a Treatment for Chronic Skin Picking
Teng, E. J., Woods, D. W., & Twohig, M. P. (2006) · Behavior Modification · doi:10.1177/0145445504265707 · Cited by 155 · cited 4× · see citing works
“Treatment development for the two disorders is still in its infancy, with behavioral treatments being the most widely researched psychological treatments (Azrin et al., 1980; Keijsers et al., 2006, 2016; Keuthen et al., 2012; Schuck et al., 2011; Shareh, 2018; Teng et al., 2006; Weidt et al., 2015).”
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“This also has the potential to increase the access to treatment as it allows for more patients to be treated by fewer therapists (Morrison, 2001; Tucker & Oei, 2007).”
BackgroundMcGuire, J. F., Ung, D., Selles, R. R., Rahman, O., Lewin, A. B., Murphy, T. K., & Storch, E. A. (2014) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2014.07.015 · Cited by 142 · cited 1× · see citing works
“The results for the participants with SPD are in line with previous meta‐analyses (Schumer et al., 2016; Selles et al., 2016), whereas the effect size of the primary outcome measure for TTM is somewhat lower than in prior studies (McGuire et al., 2014; Slikboer et al., 2017).”
ResultEnander, J., Andersson, E., Mataix-Cols, D., Lichtenstein, L., Alström, K., Andersson, G., Ljótsson, B., & Rück, C. (2016) · BMJ · doi:10.1136/bmj.i241 · Cited by 129 · cited 1× · see citing works
“…therapist‐guided behavior therapy entirely via the Internet, which has been successful for OCD (Andersson et al., 2012) and body dysmorphic disorder (Enander et al., 2016) could substantially increase the accessibility, and as we suggest above, enable even more patients to participate in…”
BackgroundSelf-citationFlessner, 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 · cited 1× · see citing works
“HRT does however not target intentional behaviors which function to avoid unpleasant private experiences, such as urges to pull or pick, anxiety, distressing thoughts, or even boredom (Flessner et al., 2008; Snorrason et al., 2012).”
BackgroundDbt-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
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BackgroundThe Skin Picking Impact Scale (SPIS): scale development and psychometric analyses.
Keuthen, N., Deckersbach, T., Wilhelm, S., Engelhard, I., Forker, A. E., O'Sullivan, R. L., Jenike, M., & Lee, B.-E. (2001) · Psychosomatics · doi:10.1176/appi.psy.42.5.397 · Cited by 111 · cited 4× · see citing works
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BackgroundMethodInfluentialGroup cognitive therapy: treatment of choice or sub-optimal option?
Morrison, N. (2001) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465801003058 · Cited by 110 · cited 1× · see citing works
“This also has the potential to increase the access to treatment as it allows for more patients to be treated by fewer therapists (Morrison, 2001; Tucker & Oei, 2007).”
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“Treatment development for the two disorders is still in its infancy, with behavioral treatments being the most widely researched psychological treatments (Azrin et al., 1980; Keijsers et al., 2006, 2016; Keuthen et al., 2012; Schuck et al., 2011; Shareh, 2018; Teng et al., 2006; Weidt et al., 2015).”
BackgroundResultInfluentialTrichotillomania, Skin Picking, and Other Body-Focused Repetitive Behaviors
Stein, D. J., Woods, D. W., & Keuthen, N. J. (2011) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615378159 · Cited by 89 · see citing works
Measuring the role of psychological inflexibility in trichotillomania
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Systematic Review of Pharmacological and Behavioral Treatments for Skin Picking Disorder
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“05) when compared with studies with either passive or active control conditions (Schumer et al., 2016).”
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“Behavioral treatments are efficacious and appear superior to most pharmacological treatments (Ninan et al., 2000; Schumer et al., 2016; Selles et al., 2016; Slikboer et al., 2017; van Minnen et al., 2003).”
BackgroundResultBehavioural 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 · cited 5× · see citing works
“Treatment development for the two disorders is still in its infancy, with behavioral treatments being the most widely researched psychological treatments (Azrin et al., 1980; Keijsers et al., 2006, 2016; Keuthen et al., 2012; Schuck et al., 2011; Shareh, 2018; Teng et al., 2006; Weidt et al., 2015).”
BackgroundResultInfluentialGroup treatment for trichotillomania: behavior therapy versus supportive therapy
Diefenbach, G. J., Tolin, D. F., Hannan, S., Maltby, N., & Crocetto, J. (2006) · Behavior Therapy · doi:10.1016/j.beth.2006.01.006 · Cited by 73 · cited 1× · see citing works
“Figure 1 describes the participant flow through the trial, according to the Consolidated Standards of Reporting Trials (CONSORT) (Eldridge et al., 2016).”
MethodTwo-year outcome of internet-based relapse prevention for partially remitted depression
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Stepped care in the treatment of trichotillomania
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“Web‐based self‐help can also be followed with more treatment intense in‐person habit reversal training (HRT) sessions in a stepped‐care format for patients with more severe symptoms (Rogers et al., 2014).”
BackgroundStopPicking.com: Internet-based treatment for self-injurious skin picking
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Intensive Cognitive Behavioural Group Treatment for Social Phobia: a Pilot Study
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Self-citationGroup Treatment for Trichotillomania
Toledo, E. L., Muniz, E. D. T., de Brito, A. M. C., de Abreu, C. N., & Tavares, H. (2014) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.13m08964 · Cited by 36 · cited 2× · see citing works
“Posttreatment outcomes in the study are comparable to other studies of behavior group therapy for TTM (Diefenbach et al., 2006; Toledo et al., 2015) and to outcomes in individual behavior therapy for SPD (Schuck et al., 2011).”
BackgroundResultStopPulling.com: An Interactive, Self-Help Program for Trichotillomania
Mouton‐Odum, S., Keuthen, N. J., Wagener, P. D., & Stanley, M. A. (2006) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2005.05.004 · Cited by 34 · see citing works
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“In other studies, the drop‐out rate ranged from 11% to 37% (Diefenbach et al., 2006; Ninan et al., 2000; Schuck et al., 2011; Weidt et al., 2015; Woods et al., 2006).”
BackgroundThe Skin Picking Impact Scale: Factor structure, validity and development of a short version
Snorrason, Í., Ólafsson, R. P., Flessner, C. A., Keuthen, N. J., Franklin, M. E., & Woods, D. W. (2013) · Scandinavian Journal of Psychology · doi:10.1111/sjop.12057 · Cited by 32 · cited 1× · see citing works
“R) (Snorrason et al., 2013).”
Investigating healthcare providers' knowledge of trichotillomania and its treatment
Marcks, B. A., Wetterneck, C. T., & Woods, D. W. (2006) · Cognitive Behaviour Therapy · doi:10.1080/16506070510010657a · Cited by 32 · cited 1× · see citing works
“However, most people who suffer from these disorders do not have access to behavioral treatments, primarily due to the lack of knowledge about these disorders and their proper treatment among health‐care professionals (Marcks et al., 2006).”
BackgroundSlikboer, R., Nedeljkovic, M., Bowe, S., & Moulding, R. (2017) · Clinical Psychologist · doi:10.1111/cp.12074 · Cited by 26 · cited 3× · see citing works
“Behavioral treatments are efficacious and appear superior to most pharmacological treatments (Ninan et al., 2000; Schumer et al., 2016; Selles et al., 2016; Slikboer et al., 2017; van Minnen et al., 2003).”
BackgroundResultInfluentialShareh, H. (2018) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465817000546 · Cited by 25 · cited 1× · see citing works
“Treatment development for the two disorders is still in its infancy, with behavioral treatments being the most widely researched psychological treatments (Azrin et al., 1980; Keijsers et al., 2006, 2016; Keuthen et al., 2012; Schuck et al., 2011; Shareh, 2018; Teng et al., 2006; Weidt et al., 2015).”
BackgroundKeijsers, G. P. J., Maas, J., van Opdorp, A., & van Minnen, A. (2016) · Cognitive Therapy and Research · doi:10.1007/s10608-016-9754-4 · Cited by 24 · cited 2× · see citing works
“Treatment development for the two disorders is still in its infancy, with behavioral treatments being the most widely researched psychological treatments (Azrin et al., 1980; Keijsers et al., 2006, 2016; Keuthen et al., 2012; Schuck et al., 2011; Shareh, 2018; Teng et al., 2006; Weidt et al., 2015).”
BackgroundComputerized response inhibition training for children with trichotillomania
Lee, H., Espil, F. M., Bauer, C. C., Siwiec, S. G., & Woods, D. W. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2017.12.070 · Cited by 21 · cited 1× · see citing works
“Indeed, some promising results of computer or internet‐delivered self‐help treatments for TTM (Lee et al., 2018; Mouton‐Odum et al., 2006; Rogers et al., 2014) and SPD (Flessner et al., 2007; Gallinat et al., 2019) have already been presented.”
BackgroundValidating indicators of treatment response: application to trichotillomania
Nelson, S. O., Rogers, K., Rusch, N., McDonough, L., Malloy, E. J., Falkenstein, M. J., Banis, M., & Haaga, D. A. F. (2014) · Psychological Assessment · doi:10.1037/a0036333 · Cited by 17 · cited 3× · see citing works
“When we calculated clinical significance according to the definition by Nelson et al. (2014), the proportion of participants achieving clinically significant change at posttreatment increased even more (53%).”
MethodTrichotillomania: Therapist Guide
Woods, D. W., & Twohig, M. P. (2008) · Oxford University Press eBooks · doi:10.1093/med:psych/9780195336030.001.0001 · Cited by 12 · cited 5× · see citing works
“AEBT aims to disrupt both the automatic pulling/picking, which often occurs out of the person's awareness and to target the focused pulling/picking associated with experiential avoidance (Woods et al., 2006).”
MethodInfluentialMaas, J., Keijsers, G. P. J., Rinck, M., & Becker, E. S. (2018) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.2018.37.6.453 · Cited by 12 · cited 1× · see citing works
“Another challenge in the care of TTM and SPD is that many sufferers remain symptomatic after treatment (Ninan et al., 2000; van Minnen et al., 2003) and relapse is common, especially for TTM (Diefenbach et al., 2006; Keijsers et al., 2006, 2016; Maas et al., 2018; Rogers et al., 2014).”
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Self-citationEmotion regulation deficits in skin picking (excoriation) disorder: A systematic review
Barber, K. E., & Fitzgerald, J. M. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.119500 · Cited by 11 · see citing works
Sapuppo, W., Sbrizzi, C., Boltri, M., Marra, M. L., Giacconi, D., Saccenti, D., & Mineo, C. M. (2024) · Current Psychology · doi:10.1007/s12144-024-06300-1 · Cited by 7 · see citing works
“…Grant & Chamberlain, 2017, 2022; Har - ries et al., 2017; Schienle, 2018; Valle et al., 2022 ; Xavier et al., 2019, 2022), and longitudinal studies (Asplund et al., 2021, 2022; Aydin et al., 2020 ; Grant et al., 2022; Grant, Leppink, et al., 2016 ; Gulassa et al., 2019 ; Jaffer-any & Osuagwu,…”
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
Recent advances in trichotillomania: a narrative review
Christensen, R. E., Tan, I., & Jafferany, M. (2023) · Acta Dermatovenerologica Alpina, Pannonica et Adriatica · doi:10.15570/actaapa.2023.28 · Cited by 6 · see citing works
Asplund, M., Lenhard, F., Rück, C., Andersson, E., Grimlund, T., Nilsson, M., Sarachu-Nilsson, M., Sundh, L., & Ivanov, V. (2024) · The Behavior Therapist · doi:10.1016/j.beth.2024.04.006 · Cited by 6 · see citing works
Self-citationEskeland, S. O., Moen, E. M., Meland, K. J., Andersen, A., & Hummelen, B. (2021) · Tidsskrift for Den norske legeforening · doi:10.4045/tidsskr.21.0128 · Cited by 5 · see citing works
Bowers, E. M., Capel, L. K., Woolley, M. G., Barnes, A., Twohig, M. P., & Levin, M. E. (2024) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2024.100909 · Cited by 5 · see citing works
Capel, L. K., Bowers, E. M., Becker, M. R., Davis, M. P., Levin, M. E., & Twohig, M. P. (2024) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2024.100908 · Cited by 4 · 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
“AEBT has also been adapted and shown promise in group [69,70], telehealth (i.e. remote delivery) [71], and web-based (i.e. self-guided) [72] formats.”
Twohig, M. P., & Capel, L. K. (2025) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2025.02.011 · Cited by 4 · see citing works
“42 Psychological flexibility was improved from pre-to post-treatment with moderate to large effect sizes on the AAQ-II (d=0.”
InfluentialTrichotillomania: Therapist Guide
Twohig, M. P., & Woods, D. W. (2023) · doi:10.1093/med-psych/9780197670309.001.0001 · Cited by 4 · see citing works
Cerda-De la O, B., Cerda-Molina, A. L., Biagini-Alarcón, M., Mayagoitia-Novales, L., Cruz-López, M. D. L., & Whaley-Sánchez, J. A. (2023) · Salud Mental · doi:10.17711/sm.0185-3325.2023.018 · Cited by 3 · see citing works
A systematic review of nonpharmacological treatment options for skin picking disorder
Loftus, H., Cassidy, C., Mun, L., & Jafferany, M. (2024) · Clinical and Experimental Dermatology · doi:10.1093/ced/llae366 · Cited by 3 · see citing works
Aydın, E. P., Beğenen, A. G., Kenar, J. G., Altunay, İ. K., & Özer, Ö. A. (2024) · European Journal of Trauma & Dissociation · doi:10.1016/j.ejtd.2024.100438 · Cited by 2 · see citing works
Hoyer, L. N., Schmotz, S., Jelinek, L., & Moritz, S. (2024) · Verhaltenstherapie · doi:10.1159/000540265 · Cited by 2 · see citing works
“…bei psychischen Problemen und zu deren Behandlung anhand von psychotherapeutischen Interventionen eignen sich die Kognitive Verhaltenstherapie (KVT), die Akzep- tanz-und Commitment-Therapie (ACT) sowie die Dia-lektisch-Behaviorale Therapie [siehe z. B. Asplund et al., 2021; Keuthen et al., 2012].”
Woolley, M. G., Schwartz, S., Morrison, K. L., & Twohig, M. P. (2025) · Behavior Therapy · doi:10.1016/j.beth.2025.01.005 · Cited by 2 · see citing works
Sabra, M. A. A., Al‐Kalaldeh, M., Alnaeem, M. M., & Zyoud, A. H. (2023) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-023-09604-8 · Cited by 2 · see citing works
“…disorder had significant effects (P < 0.001) in reducing the intensity of skin picking, hair pulling, and eating their own hair, with patients reporting abstinence of these symptoms for more than one-week post-intervention (Asplund et al., 2021; Guldahl, 2016; Lee et al., 2020; Woods et al., 2022).”
InfluentialGulassa, D. C. R., Amaral, R., Angelo, D. L., de Oliveira, E. C., de Abreu, C. N., & Tavares, H. (2025) · International Journal of Group Psychotherapy · doi:10.1080/00207284.2025.2551504 · Cited by 1 · see citing works
“…– an essential consideration given the limited availability of treatments for ED, a condition affecting 1% to 3% of the general population (Keuthen et al., 2010; Machado et al., 2018) and one that remains largely under-recognized by healthcare professionals (Asplund et al., 2021).”
Barber, K. E., Rogers, K., Woolley, M. G., Hadlock, S., Woods, D. W., & Mouton‐Odum, S. (2025) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2025.2608312 · Cited by 1 · see citing works
“Although StopPulling and StopPicking share a common CBT framework, they target distinct BFRBs, and outcomes observed in trichotillomania cannot be assumed to generalize to SPD, which may show different treatment response patterns (Asplund et al., 2021; Dar et al., 2024).”
Batchelor, R., Penn, C., & Anderson, C. (2024) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x24000163 · Cited by 1 · see citing works
“…interventions, including acceptance and commitment therapy (ACT) and acceptance-enhanced behaviour therapy (AEBT), which combines acceptance commitment therapy and HRT, have also shown promise (Asplund et al ., 2021; Capriotti et al ., 2015; Flessner et al ., 2008; Twohig et al ., 2006).”
BackgroundSession 8: Practicing Acceptance and Commitment Therapy (ACT)
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0008
Client Forms, Graphs, and Worksheets
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.005.0002
Modifications for Working with Adolescents
Petersen, J. M. (2023) · doi:10.1093/med-psych/9780197670309.003.0011
Session 4: Can Pulling-Related Inner Experiences Be Controlled?
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0005
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0002
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.005.0004
Session 2: Habit Reversal Training (HRT) and Trigger Reduction Strategies
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0003
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.005.0001
Session 5: Acceptance of Pulling-Related Inner Experiences
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0006
Sessions 6 and 7: Defusion from Your Inner Experiences: You Are Not Your Urges to Pull
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0007
Session 9: Practicing Acceptance and Commitment Therapy (ACT) and Review of Treatment
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0009
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.005.0003
Session 10: Review and Relapse Prevention
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0010
Session 3: Increasing Motivation for Treatment Through Values
Woods, D. W., & Twohig, M. P. (2023) · doi:10.1093/med-psych/9780197670309.003.0004
Hummelen, B., Brovold, F., Moen, E. M., Meland, K. J., Andersen, A., Johnsen, D. S., Dammen, T., Woods, D. W., & Grøtte, T. (2025) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2025.100972
Moen, A. B., Hummelen, B., Moen, E. M., Dammen, T., Melle, I. S., Strand, D., Woods, D. W., & Grøtte, T. (2026) · BMC Psychology · doi:10.1186/s40359-026-05193-y
“The severity of TTM and SPD symptoms observed in our sample were in line with those reported in previous clinical studies [70, 71], which supports the representativeness of our sample and increases the generalizability of our findings.”
The Role of Online Support Groups in the Management of Trichotillomania Symptoms
Jenkins, D., & Roomaney, R. (2026) · Journal of Clinical Psychology · doi:10.1002/jclp.70214
- Authors
- Asplund, M., Rück, C., Lenhard, F., Gunnarsson, T., Bellander, M., Delby, H., & Ivanov, V. Z.
- Affiliations
- Region Stockholm (SE)
- Corresponding author
- Asplund, Mia
- Venue
- Journal of Clinical Psychology
- Publisher
- Wiley
- Published
- 2021-05-03
- Volume
- 77
- Issue
- 7
- Pages
- 1537-1555
- ISSN
- 0021-9762 (ISSN-L)
- 1097-4679
- OpenAlex
- W3158367024
- Cited by
- 42
- References
- 65
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 9 · 2023: 22 · 2022: 1 · 2021: 1
- FWCI
- 5.64
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Clinical Psychology (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Fredrik och Ingrid Thurings Stiftelse (2017‐00351)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- trichotillomania, skin picking disorder, acceptance and commitment therapy, hair pulling, skin picking, booster sessions, treatment feasibility, treatment efficacy
- MeSH terms
- Adult, Behavior Therapy, Feasibility Studies, Group Processes, Humans, Psychotherapy, Group, Trichotillomania
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