A Pilot Randomized Controlled Trial of Online-Delivered ACT-Enhanced Behavior Therapy for Trichotillomania in Adolescents

• Published in: Cognitive and behavioral practice 2021-11, Vol.28 (4), p.653-668
• Main Authors: Twohig, Michael P., Petersen, Julie M., Fruge, Jeremiah, Ong, Clarissa W., Barney, Jennifer L., Krafft, Jennifer, Lee, Eric B., Levin, Michael E.
• Format: Article
• Language: English
• Subjects: acceptance and commitment therapy; adolescents; COVID-19; habit reversal; trichotillomania
• ISSN: 1077-7229; 1878-187X
• DOI: 10.1016/j.cbpra.2021.01.004

•ACT-enhanced behavior therapy for adolescents was found to be feasible and acceptable when delivered over Zoom.•Results showed a significant decrease in pulling severity as reported by adolescents.•Medium nonsignificant within condition effect sizes were seen for psychological flexibility. Treatment of adolescent trichotillomania is understudied, and treatment providers are difficult to find. In this pilot study, we compared ACT-enhanced behavior therapy to a waitlist, with treatment delivered over Zoom, to 28 adolescents who met criteria for trichotillomania. This study partially occurred during the COVID-19 pandemic. A detailed description of the treatment protocol is provided for ACT-enhanced behavior therapy adapted to a Zoom format for adolescents. Pretreatment assessments were completed over Zoom by an assessor unaware of study condition; pretreatment and posttreatment questionnaires were completed online. Results indicated that therapy was delivered with fidelity and competence over Zoom, with 100% session completion. Adolescents reported that pulling severity decreased significantly more in the treatment condition than waitlist. No differences were seen in other adolescent or parent-reported pulling severity or distress. However, significant medium to large within-condition effect sizes were observed in the treatment condition. Medium effect size changes were seen in the treatment group on a measure of trichotillomania-related psychological flexibility, and a small effect size was seen for psychological distress. Overall, pilot results provide preliminary support for ACT-enhanced behavior therapy, delivered over Zoom, for adolescent trichotillomania, indicating the need for a fully powered confirmatory efficacy trial.