Abstract
Introduction
Access to treatment for trichotillomania has barriers and many people never receive evidence-based treatment. Understanding what treatments and modalities work, and how people get better through those treatments and modalities, is needed.
Methods
We include analyses of moderators of treatment outcomes and preliminary processes of change from a randomized controlled trial assessing the efficacy of a fully automated website delivering acceptance-enhanced behavior therapy (AEBT) for adults (N = 81) with trichotillomania. All participants received an eight-module website of AEBT, and assessments were completed at baseline, mid-, post-treatment, and a one-month follow-up. Using multilevel modeling, the moderation effects of baseline trichotillomania specific psychological flexibility, age, baseline and time -varying anxiety, and baseline and time varying depression were explored. Preliminary process of change using psychological flexibility was explored.
Results
Baseline trichotillomania-specific psychological flexibility is correlated with changes in symptom severity over time but not by condition. Lower trichotillomania specific psychological flexibility at baseline was associated with better outcomes. Age also moderated treatment outcomes, specifically, participants between 18 and 30 had better treatment outcomes than participants over 30 years old. Baseline anxiety correlated with symptom severity but did not moderate intervention effects. Changes in anxiety were correlated with symptom severity over time. Baseline depression was not a significant moderator. Preliminary process of change analyses suggests that changes in psychological flexibility is correlated with changes in trichotillomania symptom severity across time. This relationship did not change in strength over time and was not moderated by condition.
Conclusion
This study highlights how baseline trichotillomania specific psychological flexibility and anxiety impact changes in symptom severity and the function in a website delivered AEBT for adults with trichotillomania. Additionally, it provides preliminary support of the role of trichotillomania-specific psychological flexibility as a process of change in treatment of trichotillomania. Implications are discussed.
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Funding
This project was supported with funding from the Huntsman Foundation.
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Leila K. Capel, Julie M. Petersen, and Michael E. Levin declare no conflicts of interest. Michael P. Twohig notes his role as author of several books in this area and his role as the Huntsman Foundation award recipient.
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Capel, L.K., Petersen, J.M., Levin, M.E. et al. Moderators and Preliminary Processes of Change in a Randomized Controlled Trial of a Fully Automated, Website Delivering AEBT for Adults with Trichotillomania. Cogn Ther Res 48, 107–118 (2024). https://doi.org/10.1007/s10608-023-10418-0
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DOI: https://doi.org/10.1007/s10608-023-10418-0