Response Inhibition Training for Individuals With Trichotillomania

Despite ongoing research into causes and treatments for trichotillomania, it remains poorly
understood, underdiagnosed and inadequately treated. Further, treatment of TTM in children
has received little attention, and only recently have the investigators begun to see
research in pediatric trich. One possible way of progressing treatment development for
pediatric trich is to clarify the nature of inhibitory control processes implicated in TTM
and to develop a treatment that specifically targets these implicated cognitive processes.
Examples of this strategy are found in the increasing availability of translational research
that has demonstrated the therapeutic benefits of computerized cognitive training programs
(CTPs) in modifying problematic cognitive processes in numerous psychiatric conditions. The
objective of this study is to examine the feasibility of CTP for enhancing response
inhibition capabilities among individuals with trich, thereby reducing TTM symptoms.

To this end, young individuals aged between 12 and 18 with TTM will be randomly assigned to
the CTP condition vs. a wait-list condition. Participants in the CTP condition will receive
eight 30-min training sessions over a 4-week period and will be assessed at three time
points. Participants in the wait-list will be evaluated at baseline and post-training
assessments, and will be allowed to receive the CTP after completing the post-training
assessment. Wait-list controls who choose to cross over to the CTP condition will also
provide a small replication sample to test the effect of our response inhibition training.

There are three primary implications from this work. First, demonstrating successful
enhancement in response inhibition by our proposed CTP is expected to create ample
opportunities for clinical research not only on TTM, but also for numerous other psychiatric
problems in which poor response inhibition is implicated (e.g., Chronic Skin Picking,
Tourette Syndrome, OCD, and ADHD).

This research has the potential to produce a highly cost-efficient self-administered
intervention for TTM. Upon establishing efficacy, CTPs may be easily integrated into various
contexts, examples include CTPs as an adjunctive intervention to existing behavioral and/or
pharmacological treatments, an instrument to identify and help at-risk individuals for
preventative training, a stand-alone short-term intervention, and a remote web-based
self-help intervention for individuals who have no easy access to treatment resources or are
reluctant to seek treatment.

Inclusion Criteria:

- Aged between 9 and 17

- A primary diagnosis of Trichotillomania based on DSM-IV criteria (using
Trichotillomania Diagnostic Interview)

Exclusion Criteria:

- those who are actively psychotic

- those who have visual impairments that prevent them from performing computer tasks

- those who present developmental disabilities and/or low overall IQ estimated to be
below low average (< 79)

- those whose medication status has not been stable

- those who present with past/current substance abuse/dependence problems