Awareness Enhancement and Monitoring Device for Treatment of Trichotillomania

DESCRIPTION (provided by applicant): The goal of the proposed research is to further refine
and evaluate an inconspicuous, awareness- enhancement and monitoring device (AEMD) which
will assist the treatment of trichotillomania (TTM). TTM is associated with significant
impairments in social functioning and often has a profound negative impact on self- esteem
and well being. Conservative estimates suggest that 0.6% percent of the US population, or
about 1.8 million people, meet full diagnostic criteria for TTM and approximately 7.5
million US residents have significant hair pulling problems. Of those treated, 60% to 70%
are wholly or partially refractory to standard behavioral and pharmacological treatments and
could therefore potentially benefit from this device. Best practice treatment for TTM
involves a form of behavioral therapy known as habit reversal therapy (HRT). HRT requires
persons with TTM to be aware of their hair pulling behaviors, yet the majority of persons
with TTM pull most of their hair outside of their awareness. HRT also requires TTM sufferers
to record the frequency and duration of their hair pulling behaviors yet it is impossible
for a person to monitor behaviors that they are unaware of. Our Phase I efforts have
produced a prototype device (AEMD) that solves these two problems. The prototype AEMD
signals the TTM sufferer if their hand approaches their hair, thereby bringing
pulling-related behavior into awareness. The prototype AEMD also logs the time, date,
duration, and user classification of hair pulling related events. Our published pilot study
and subsequent investigations establish that the prototype AEMD successfully alerts TTM
sufferers to pulling-related behaviors and monitors TTM-related behavior in a laboratory
setting. With respect to technological innovation, this project has the potential to develop
the first available miniaturized, wearable, patient interactive, real-time data collecting
and proximity-sensing device that both alerts sufferers to the presence of mental illness
symptoms as they occur and keeps track of the frequency and intensity of the problem. The
patented technologies developed for the AEMD have the potential to be of great value for a
range of other health/mental health conditions or industrial applications. Our overall Phase
II aim is to further refine the AEMD and to evaluate its acceptance and utility when used in
an open trial course of professionally-led habit reversal therapy. It is hypothesized that
the AEMD will be enthusiastically accepted by TTM sufferers and their clinicians and that it
will perform as designed during the clinical trial. The Phase II AEMD will include a
bracelet(s)/watch to be worn on each wrist, another element to be placed at the rear base of
the neck, and a pager-like alert device to be worn at the belt-line or in a pocket. The
AEMD, if found to be useful and effective, has the potential to significantly reduce the
symptoms of TTM and its associated functional impairments. The AEMD also has great potential
to improve assessment and monitoring of TTM behaviors which could be invaluable to
clinicians planning treatment and to researchers evaluating the efficacy of various
treatment strategies.

Inclusion Criteria:

- Must have active hair pulling over the month prior to enrollment

- Must have noticeable hair loss

- Must experience significant distress related to Trichotillomania

- Must primarily pull from the head area

- Subjects taking medications will be included

- Must be able to read/write English

Exclusion Criteria:

- Current substance use diagnosis

- Chronic neurological disorder (other than chronic tics)

- Mental retardation

- Schizophrenia and other psychotic disorders

- Bipolar I disorder

- Prominent suicidal/homicidal ideation with imminent risk