ACT-enhanced group behavior therapy for trichotillomania and skin-picking disorder: A feasibility study.

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.

Internet-delivered acceptance-based behavior therapy for trichotillomania and skin-picking disorder in a psychiatric setting: A feasibility trial.

Trichotillomania (TTM) and skin-picking disorder (SPD) are two clinically related conditions that can be successfully treated with behavior therapy (BT). There is some research indicating that BT for TTM and SPD can be efficacious also when delivered online instead of face-to-face, however, previous studies have mainly used self-recruited samples in a university context and it is unclear if the effects of online BT also extend to regular psychiatric patients. The current study set out to investigate if internet-delivered BT (I-BT) is a feasible, acceptable and preliminarily efficacious treatment for patients in a routine psychiatric setting. Twenty-five adult clinician-referred patients with TTM (n = 7) and/or SPD (n = 18) received 10 weeks of therapist-guided I-BT. The I-BT program incorporated both traditional interventions (e.g. habit reversal) as well as more recent acceptance-based techniques (e.g. embracing the urges and mindfulness). Clinician- and self-rated outcomes were assessed at pretreatment, posttreatment and at the delivery of 4 additional booster modules. Results showed that the majority of the participants were satisfied with the treatment and found it credible. The average number of completed internet modules was 7.2/10; five participants ended treatment prematurely. Significant decreases in hair pulling and skin picking severity were demonstrated from pretreatment to posttreatment with within-group effect sizes ranging from d = 0.89 to 1.75. The results remained significant up to the 12-month follow-up on most outcome measures. Altogether, the results provide initial evidence suggesting that I-BT could be a feasible, acceptable and potentially effective treatment for TTM and SPD for patients in a regular psychiatric setting.