Stepped care in the treatment of trichotillomania
Open accessAbstract
OBJECTIVE: There are effective treatments of trichotillomania (TTM), but access to expert providers is limited. This study tested a stepped care model aimed at improving access. METHOD: Participants were 60 (95% women, 75% Caucasian, 2% Hispanic) adults (M = 33.18 years) with TTM. They were randomly assigned to immediate versus waitlist (WL) conditions for Step 1 (10 weeks of web-based self-help via StopPulling.com). After Step 1, participants chose whether to engage in Step 2 (8 sessions of in-person habit reversal training [HRT]). RESULTS: In Step 1, the immediate condition had a small (d = .21) but significant advantage, relative to WL, in reducing TTM symptom ratings by interviewers (masked to experimental condition but not to assessment point); there were no differences in self-reported TTM symptoms, alopecia, functional impairment, or quality of life. Step 1 was more effective for those who used the site more often. Stepped care was highly acceptable: Motivation did not decrease during Step 1; treatment satisfaction was high, and 76% enrolled in Step 2. More symptomatic patients self-selected into HRT, and on average they improved significantly. Over one third (36%) made clinically significant improvement in self-reported TTM symptoms. Considering the entire stepped care program, participants significantly reduced symptoms, alopecia, and impairment, and increased quality of life. For quality of life and symptom severity, there was some relapse by 3-month follow-up. CONCLUSIONS: Stepped care is acceptable, and HRT was associated with improvement. Further work is needed to determine which patients with TTM can benefit from self-help and how to reduce relapse.
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BT for TTM and SPD can be efficacious when delivered online instead of face-to-face.
“There is some research indicating that BT for TTM and SPD can be efficacious also when delivered online instead of face-to-face”
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 Rogers et al., 2014
The Discussion (page not provided) reports a small improvement in interviewer-rated TTM symptoms with web-based self-help compared with a waitlist, supporting the possibility that online behavioral treatment can help with TTM. The study did not address SPD, and its online treatment was not directly compared with face-to-face treatment. (LLM, conf=0.88)
Experimental — accuracy not yet measuredPrevious studies of online BT for TTM/SPD have mainly used self-recruited samples in a university context.
“previous studies have mainly used self-recruited samples in a university context”
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 Rogers et al., 2014
The Method (Participants; Procedure, page unavailable) describes this online TTM treatment study as recruiting adults through advertisements and clinician referrals, with in-person assessments at American University. That supports a university-based example with some participant-initiated recruitment, but it does not establish that previous online BT studies mainly used self-recruited samples or extend that pattern to SPD. (LLM, conf=0.80)
Experimental — accuracy not yet measuredIn the only controlled trial of online BT for TTM (Rogers et al., 2014), self-guided online BT produced a significant but small symptom reduction favoring the intervention (d = 0.21), but effects did not extend to self-rated symptoms.
“Results showed a significant, but small, symptom reduction favoring the intervention (d = 0.21); however, effects did not extend to self-rated symptoms.”
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 Rogers et al., 2014
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- Authors
- Rogers, K., Banis, M., Falkenstein, M. J., Malloy, E. J., McDonough, L., Nelson, S. O., Rusch, N., & Haaga, D. A. F.
- Affiliations
- American University (US)
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2014-04
- Volume
- 82
- Issue
- 2
- Pages
- 361-367
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- PMC
- PMC3966933
- OpenAlex
- W2007070992
- Cited by
- 59
- References
- 1
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 5 · 2023: 4 · 2022: 3 · 2021: 5 · 2020: 7 · 2019: 1 · 2018: 6 · 2017: 5 · 2016: 7 · 2015: 6 · 2014: 1
- FWCI
- 7.48
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (1R15MH086852-01)
- 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 › Applied Psychology › Digital Mental Health Interventions
- Keywords
- trichotillomania, stepped care, habit reversal training, treatment access, hair loss, quality of life, functional disability, relapse, treatment acceptability, treatment satisfaction
- MeSH terms
- Adult, Female, Humans, Male, Quality of Life, Trichotillomania, Cognitive Behavioral Therapy, Treatment Outcome, Patient Satisfaction, Young Adult
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