Internet-Based Self-Help for Trichotillomania: A Randomized Controlled Study Comparing Decoupling and Progressive Muscle Relaxation

Weidt, Steffi; Klaghofer, Richard; Kuenburg, Alexa; Bruehl, Annette Beatrix; Delsignore, Aba; Moritz, Steffen; Rufer, Michael

doi:10.1159/000431290

Cited by 26 publications

(26 citation statements)

References 43 publications

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“…Our TTM sample was recruited from an Internet-based interventional, double-blind randomized controlled trial (NCT02044237), which was published previously 15. The study was approved by the local ethics committee of the Canton of Zurich in Switzerland and was conducted according to the Declaration of Helsinki.…”

Section: Methodsmentioning

confidence: 99%

“…After the pretreatment assessment, individuals were contacted for a telephone interview in order to assess for the diagnostic criteria of TTM, depressive symptoms, and psychiatric comorbidity. Participants were then randomly allocated to one of two intervention groups (decoupling or PMR) 15. After the 4-week intervention period and the 6-month follow-up, subjects completed questionnaires and were interviewed by phone.…”

Section: Methodsmentioning

confidence: 99%

“…Detailed information is given in the study of Weidt et al15 In short, both methods (decoupling and PMR) were mailed to the participants in PDF files, which included written and illustrated instructions. Decoupling instructed the participants to redirect their movement from the hair to a different target close to the pulling side or into the room (= decouple) 14.…”

Section: Methodsmentioning

confidence: 99%

“…Cognitive-behavioral therapy (CBT), including habit reversal training (HRT),11 progressive muscle relaxation (PMR),12 acceptance and commitment therapy (ACT),13 and decoupling (DC),14,15 are effective treatments for TTM. However, individuals with TTM often report feelings of embarrassment and shame that have been shown to be significant barriers for them to access and seek treatment 3,7,8,16.…”

Section: Introductionmentioning

confidence: 99%

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Trichotillomania: the impact of treatment history on the outcome of an Internet-based intervention

Weidt¹,

Bruehl²,

Delsignore³

et al. 2017

NDT

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BackgroundMany patients suffering from trichotillomania (TTM) have never undergone treatment. Without treatment, TTM often presents with a chronic course. Characteristics of TTM individuals who have never been treated (untreated) remain largely unknown. Whether treatment history impacts Internet-based interventions has not yet been investigated. We aimed to answer whether Internet-based interventions can reach untreated individuals and whether treatment history is associated with certain characteristics and impacts on the outcome of an Internet-based intervention.MethodsWe provided Internet-based interventions. Subjects were characterized at three time points using the Massachusetts General Hospital Hairpulling Scale, Hamilton Depression Rating Scale, and the World Health Organization Quality of Life questionnaire.ResultsOf 105 individuals, 34 were untreated. Health-related quality of life (HRQoL) was markedly impaired in untreated and treated individuals. Symptom severity did not differ between untreated and treated individuals. Nontreatment was associated with fewer depressive symptoms (P=0.002). Treatment history demonstrated no impact on the outcome of Internet-based interventions.ConclusionResults demonstrate that Internet-based interventions can reach untreated TTM individuals. They show that untreated individuals benefit as much as treated individuals from such interventions. Future Internet-based interventions should focus on how to best reach/support untreated individuals with TTM. Additionally, future studies may examine whether Internet-based interventions can reach and help untreated individuals suffering from other psychiatric disorders.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Trichotillomania: the impact of treatment history on the outcome of an Internet-based intervention

Weidt¹,

Bruehl²,

Delsignore³

et al. 2017

NDT

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“…These therapies include a modification of Cognitive behavioral therapy (CBT) known as the cognitive psychophysiological model, 33 acceptance and commitment therapy 34 and psychodynamic psychotherapy 35 . Other strategies to augment therapy include mindfulness based therapy 36 and progressive muscle relaxation (PMR) 38 37 …”

Section: Treatment Approachmentioning

confidence: 99%

Habit reversal therapy in the management of body focused repetitive behavior disorders

Skurya

Jafferany

Everett

2020

Dermatologic Therapy

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Body-focused repetitive behavior disorders are a group of disorders characterized by repetitive actions that include skin picking, hair pulling, nail biting, and other compulsions. These disorders can range from a common habit to a pathological disorder, that negatively impacts the psychiatric health and social well-being of an individual. Diagnosis can be made clinically, and monitored using different scales and assessments. Various treatments have been tried with differing successes. There are currently no first line curative medications for these disorders, but cognitive behavioral therapy has seen the most success in treatment. Specifically habit reversal therapy has shown the most promise in reducing the repetitive behaviors and symptoms seen in these disorders. Habit reversal therapy has also seen success through augmentation with additional therapies such as mindfulness, or treatment with a selective serotonin reuptake inhibitor in a patient with comorbid obsessive compulsive disorder. This paper aims to explore the efficacy of different treatment modalities specifically the effectiveness and approach of habit reversal therapy.

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Self-Help Habit Replacement in Individuals With Body-Focused Repetitive Behaviors

Moritz,

Penney,

Missmann

et al. 2023

JAMA Dermatol

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ImportanceBody-focused repetitive behaviors (BFRBs; eg, skin picking) encompass a set of conditions at the interface of dermatology and psychiatry/psychology. The disorder is prevalent but currently underdiagnosed and undertreated.ObjectiveTo compare a new self-help intervention, habit replacement, against a wait-list control condition for the treatment of BFRBs.Design, Setting, and ParticipantsThis randomized clinical trial was conducted online in 2022. Participants were a population-based nonclinical sample with BFRBs and were recruited via social media. Initially, 481 individuals entered the assessment; 213 were excluded blind to results. A final sample of 268 participants were randomized. The intervention period was 6 weeks.InterventionsParticipants were randomized to a self-help intervention, habit replacement, or a wait-list control condition (each n = 134).Main Outcomes and MeasuresThe Generic BFRB Scale-45 (GBS-45, self-report) represented the primary outcome.ResultsIndividuals in the 2 conditions (n = 268; 241 [89.9%] women; mean [SD] age, 36.8 [11.1] years; skin picking, 68.3%; trichotillomania, 28.4%; nail biting, 36.6%; lip-cheek biting, 26.1%; other, 20.1%) did not differ on any baseline characteristics. The experimental group significantly improved on the primary outcome (GBS-45) for both the per-protocol (technique was used at least once weekly, ηp2 = 0.068, P = .001) and the intention-to-treat analyses relative to the wait-list control group (expectation–maximization algorithm; ηp2 = 0.019, P = .02). The interaction of group and time yielded statistical trends in favor of the experimental condition only on the Patient Health Questionnaire-9 and quality of life. For the Clinical Global Impressions scale, more individuals in the habit replacement group reported improvement (52.8% vs 19.6%; P &lt; .001). User satisfaction in the habit replacement group was high. Moderation analyses that included all baseline variables showed that those who exhibited nail biting particularly benefited from the new technique.Conclusions and RelevanceThe present proof-of-concept randomized clinical trial tentatively demonstrates that habit replacement is a feasible and effective self-help strategy against BFRBs, especially for nail biting. Study limitations include the lack of external assessment and verified diagnoses. In addition, the study is missing follow-up data. Self-help habit replacement shows promise in reducing BFRBs but not concomitant symptoms.Trial RegistrationGerman Clinical Trials Register Identifier: DRKS00030511

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Internet-Based Self-Help for Trichotillomania: A Randomized Controlled Study Comparing Decoupling and Progressive Muscle Relaxation

Cited by 26 publications

References 43 publications

Trichotillomania: the impact of treatment history on the outcome of an Internet-based intervention

Trichotillomania: the impact of treatment history on the outcome of an Internet-based intervention

Habit reversal therapy in the management of body focused repetitive behavior disorders

Self-Help Habit Replacement in Individuals With Body-Focused Repetitive Behaviors

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