Comprehensive Behavioral (ComB) Treatment of Trichotillomania: A Randomized Clinical Trial.

OBJECTIVE: This study is the first controlled trial of comprehensive behavioral (ComB) treatment of trichotillomania (TTM). ComB provides individualized treatment based on factors triggering and maintaining hair pulling. METHOD: Participants (N = 36) were adults (M = 34.08 years old, SD = 12.26) meeting DSM5 criteria for TTM. A majority were female (80%) and Caucasian (75%), whereas 17% were African American and 19% Hispanic/Latinx. In a parallel-group design, participants were randomly assigned to (a) Immediate ComB (12 sessions) or (b) Minimal Attention Control (MAC), followed by delayed ComB after week 12. Follow-up continued through week 38. Primary outcomes were self-report (Massachusetts General Hospital Hair pulling Scale; MGH-HPS) and interviewer-rated (NIMH-Trichotillomania Impact Scale and Trichotillomania Severity Scale; TIS/TSS) TTM symptom severity, as well as diagnosis (Trichotillomania Diagnostic Interview). RESULTS: Immediate efficacy of ComB (vs. MAC) was statistically significant (p = .03) for self-reported symptoms, with an effect size d = -.78, but not significant for interviewer-rated symptoms or diagnostic status. Immediate ComB was significantly more likely than MAC (27% vs. 0%) to lead to complete abstinence from hair pulling at week 12. Follow-ups showed good maintenance of effects. CONCLUSIONS: Efficacy of ComB was established for self-reported symptoms. Future research is needed to establish whether the lack of more widespread effects stems from limitations of the model or to a need for more extensive therapist training, as secondary analyses suggested stronger results among therapists with more TTM experience.

Comprehensive Behavioral Treatment of Trichotillomania: A Treatment Development Study.

This study aimed to concretize and pilot test comprehensive behavioral (ComB) treatment of trichotillomania (TTM), to facilitate rigorous testing of its efficacy. ComB provides a conceptualization to develop individualized treatment and choose interventions for managing distinct factors that maintain the individual's hair pulling. It has been used by clinicians for almost three decades, yet was not previously manualized or studied empirically. A manual was drafted and revised based on patient (N= 16) and therapist feedback, an intervention choice study demonstrated therapists reliably selected model-consistent interventions, and a therapist adherence measure was developed and tested. Uncontrolled preliminary data showed ComB to be highly acceptable, and it led to reduced TTM symptom severity and impairment, with large effects. Quality of life and disability also improved, with effects maintained at follow-up. This study resulted in the development of a manual and measures to be used in a randomized controlled trial (RCT) of ComB for TTM.