Acceptance and Commitment Therapy for Trichotillomania: A Randomized Controlled Trial of Adults and Adolescents

Abstract

The purpose of this study was to examine acceptance and commitment therapy (ACT) as a standalone treatment for trichotillomania in a randomized controlled trial of adults and adolescents. Participants consisted of a community sample of treatment seeking adults and adolescents with trichotillomania. Of the eligible 39 participants randomized into treatment and waitlist groups, 25 completed treatment and were included in the final analysis. Treatment consisted of a 10-session ACT protocol. Multiple mixed models repeated measures analyses were utilized to evaluate changes in trichotillomania symptom severity, daily number of hairs pulled and urges experienced, and experiential avoidance from pretreatment to posttreatment. Findings indicated significant changes in symptom severity and daily hairs pulled, but not daily urges experienced or psychological flexibility. However, psychological flexibility saw a 24.5% decrease in the treatment group and reduced from clinical to subclinical levels on average. This study suggests that ACT alone is an effective treatment for adults and adolescents with trichotillomania. Outcomes appear to be similar to trials that combined ACT and habit reversal training (HRT).

Psychological flexibility: What we know, what we do not know, and what we think we know

“…ACT outcome studies and clinical trials also point to the benefits of psychological flexibility. These studies suggest that ACT is an effective treatment for numerous presenting problems, including depression, chronic pain, anxiety, post‐traumatic stress disorder, obsessive‐compulsive disorder, trichotillomania, psychosis, and substance use (e.g., Arch et al, 2012; Gaudiano & Herbert, 2006; Hann & McCracken, 2014; Lee, An, Levin, & Twohig, 2015; Lee et al, 2020; Twohig et al, 2010; Zettle, Rains, & Hayes, 2011). Several meta‐analyses suggest that, across dozens of studies and hundreds of patients, ACT is more effective than waitlist and placebo conditions and at least as effective as gold‐standard cognitive behavioral interventions (e.g., A‐tjak et al, 2015; Jiménez, 2012; Levin, Hildebrandt, Lillis, & Hayes, 2012; Powers, Vörding, & Emmelkamp, 2009).…”

Trichotillomania is more related to Tourette disorder than to obsessive-compulsive disorder

“…Urge intensity was not correlated with tic severity, but was correlated with compulsion in TS patients (only in those under age 10, however). Lee 47 Acceptance and commitment therapy did not improve urges in TTM patients.…”

“…9 As in Tourette and OCD, urges are found in TTM. 47 The urge to pull was greater in patients who experienced perfectionistic thoughts, 48 which could be associated with symmetry or ''just-right'' phenomena.…”

Hair pulling antecedents in trichotillomania: Their relationship with experiential avoidance

“…Therapeutic techniques that target EA in this manner, such as the acceptance technique highlighted in Ac-ceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999), already have demonstrated some success when included in a treatment package for TTM. This includes two single-subject design studies (Crosby et al, 2012;Twohig & Woods, 2004), as well as a limited number of small-scale randomized controlled trials (RCT; e.g., Lee, Haeger, Levin, Ong, & Twohig, 2018;Lee, Homan, et al, 2018;Woods et al, 2006). Several of these studies included enhancing the already existing gold-standard treatment of Habit Reversal Training (HRT) to incorporate ACT.…”