Stepped Care in the Treatment of Trichotillomania

Trichotillomania (TTM), repetitive pulling out of one's own hair to the extent that
noticeable hair loss occurs, is a distressing condition interfering substantially with
functioning and quality of life. The longterm objective of this research is to determine
whether psychological treatment of TTM could be disseminated more effectively by using a
stepped care model in which less intensive interventions are tried first, with more
intensive interventions used only if initial treatment proves insufficient. This project is
a pilot study of the first two steps in a stepped care model of treatment. After baseline
assessment, 50 participants with TTM will be randomly assigned to (a) Immediate condition,
in which they are offered 10-week self-help treatment via an interactive website (Step 1) or
(b) Wait List/Delayed Start condition, a 10-week wait list prior to being offered Step 1.
In each condition, at the end of Step 1, participants will be offered 8 weeks of in-person
habit reversal training provided by psychology graduate students (Step 2). TTM symptoms
will be measured from baseline through a follow-up 3 months after the end of Step 2, as will
depression, anxiety, quality of life, functional impairment , treatment utilization, and
treatment satisfaction.

The specific aims of the study are:

1. To gather preliminary data on the efficacy of web-based self-help, compared to wait
list control;

2. To characterize the acceptability of stepped care to patients with TTM by assessing the
proportion of enrolled participants who proceed from step 1 to step 2 treatment;

3. To evaluate the convergent validity of four decision rules for concluding that a
patient with TTM has benefited sufficiently from a treatment step: (a) No longer
meeting TTM diagnostic criteria; (b) Showing a 25% or greater reduction in total scores
on self-report and clinician-rated TTM symptoms; (c) achieving complete abstinence from
hair-pulling; and (d) clinically significant response on both self-report and
clinician-rated TTM symptom measures

4. To evaluate the concurrent and predictive validity of criteria for sufficient benefit
from a treatment step by relating them to treatment satisfaction, treatment
utilization, and scores on a measure of functional impairment from TTM.