Top

Cognitive Therapy and Research

Gepubliceerd in:

14-08-2023 | Original Article

Moderators and Preliminary Processes of Change in a Randomized Controlled Trial of a Fully Automated, Website Delivering AEBT for Adults with Trichotillomania

Auteurs: Leila K. Capel, Julie M. Petersen, Michael E. Levin, Michael P. Twohig

Gepubliceerd in: Cognitive Therapy and Research | Uitgave 1/2024

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.

vorige artikel Self-Help to Reduce Body-Focused Repetitive Behaviors via Video or Website? A Randomized Controlled Trial

volgende artikel Clinical Characteristics, Sleep, and Temperament in Infants and Young Children with Problematic Hair Pulling and Skin Picking

Alexander, J. R., Houghton, D. C., Twohig, M. P., Franklin, M. E., Saunders, S. M., Neal-Barnett, A. M., Compton, S. N., & Woods, D. W. (2017). Clarifying the relationship between Trichotillomania and anxiety. Journal of obsessive-compulsive and related disorders, 13, 30–34.CrossRefPubMedPubMedCentral

Arch, J. J., Wolitzky-Taylor, K. B., Eifert, G. H., & Craske, M. G. (2012). Longitudinal treatment mediation of traditional cognitive behavioral therapy and acceptance and commitment therapy for anxiety disorders. Behaviour Research and Therapy, 50(7–8), 469–478.CrossRefPubMed

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5™ (5th ed.). American Psychiatric Publishing.CrossRef

Bates, D., Maechler, M., Bolker, B., & Walker, S. (2015). Fitting Linear Mixed-Effects Models Using lme4. Journal of Statistical Software, 67(1), 1–48. https://doi.org/10.18637/jss.v067.i01CrossRef

Capel, L. K., Petersen, J. M., Becker, M. R., Levin, M. L., & Twohig, M. P. (2023). Examining the efficacy and feasibility of a web-based acceptance enhanced behavior therapy for trichotillomania: A randomized waitlist-controlled trial. Journal of Obsessive-Compulsive and Related Disorders., 37, 100800.CrossRef

Elliott, A. J., & Fuqua, R. W. (2002). Acceptability of treatments for trichotillomania: Effects of age and severity. Behavior Modification, 26(3), 378–399.CrossRefPubMed

Flessner, C. A., Woods, D. W., Franklin, M. E., Cashin, S. E., & Keuthen, N. J. (2008). The milwaukee inventory for subtypes of trichotillomania- adult version (MIST-A): Development of an instrument for the assessment of “focused” and “automatic” hair pulling. Journal of Psychopathology Behavior and Assessment, 30, 20–30. https://doi.org/10.1007/s10862-007-9073-xCrossRef

Franklin, M. E., Edson, A. L., & Freeman, J. B. (2010). Behavior therapy for pediatric trichotillomania: Exploring the effects of age on treatment outcome. Child and Adolescent Psychiatry and Mental Health, 4, 1–6.CrossRef

Franklin, M. E., Zagrabbe, K., & Benavides, K. L. (2011). Trichotillomania and its treatment: A review and recommendations. Expert Review of Neurotherapeutics, 11(8), 1165–1174.CrossRefPubMedPubMedCentral

Grant, J. E., Redden, S. A., Leppink, E. W., & Chamberlain, S. R. (2017a). Trichotillomania and co-occurring anxiety. Comprehensive Psychiatry, 72, 1–5.CrossRefPubMed

Grant, J. E., Redden, S. A., Medeiros, G. C., Odlaug, B. L., Curley, E. E., Tavares, H., & Keuthen, N. J. (2017). Trichotillomania and its clinical relationship to depression and anxiety. International Journal of Psychiatry in Clinical Practice. https://doi.org/10.1080/13651501.2017.1314509CrossRefPubMed

Grant, J. E., Dougherty, D. D., & Chamberlin, S. R. (2020). Prevalence, gender correlates, and co-morbidity of trichotillomania. Psychiatry Research. https://doi.org/10.1016/j.psychres.2020.112948CrossRefPubMedPubMedCentral

Haaland, A. T., Ekeland, S. O., Moen, E. M., Vogel, P. A., Haseth, S., Mellingen, K., Himle, J. A., Woods, D. W., & Hummelen, B. (2017). ACT-enhanced behavior therapy in group format for trichotillomania: An effectiveness study. Journal of Obsessive-Compulsive and Related Disorders, 12, 109–116.CrossRef

Hofmann, S. G., & Hayes, S. C. (2019). The future of intervention science: Process-based therapy. Clinical Psychological Science, 7(1), 37–50.CrossRefPubMed

Houghton, D. C., Compton, S. N., Twohig, M. P., Saunders, S. M., Franklin, M. E., Neal-Barnett, A. M., Ely, L., Capriotti, M. R., & Woods, D. W. (2014). Measuring the role of psychological inflexibility in Trichotillomania. Psychiatry Research, 220(1–2), 356–361. https://doi.org/10.1016/j.psychres.2014.08.003CrossRefPubMedPubMedCentral

Houghton, D. C., Capriotti, M. R., De Nadai, A. S., Compton, S. N., Twohig, M. P., Neal-Barnett, A. M., Saunders, S. M., Franklin, M. E., Woods, D. W. (2015). Definining treatment response in trichotillomania: A signal detection anaylsis. Journal of Anxiety Disorders, 36, 44-51, https://doi.org/10.1016/j.janxdis.2015.09.008

Houghton, D. C., Maas, J., Twohig, M. P., Saunders, S. M., Compton, S. N., Neal-Barnett, A. M., Franklin, M. E., & Woods, D. W. (2016). Comorbidity and quality of life in adults with hair pulling disorder. Psychiatry Research, 239, 12–9. https://doi.org/10.1016/j.psychres.2016.02.063CrossRefPubMedPubMedCentral

Hox, J. J., Moerbeek, M., & Van de Schoot, R. (2017). Multilevel analysis: Techniques and applications (3rd ed.). Taylor & Francis Group.CrossRef

Keuthen, N. J., O’Sullivan, R. L., Ricciardi, J. N., Shera, D., Savage, C. R., Borgmann, A. S., Jenike, M. A., & Baer, L. (1995). The massachusetts general hospital (MGH) hairpulling scale: Development and factor analyses. Psychotherapy and Psychosomatics, 64(3), 141–145. https://doi.org/10.1159/000289003CrossRefPubMed

Lee, E. B., Haeger, J. A., Levin, M. E., Ong, C. W., & Twohig, M. P. (2018). Telepsychotherapy for trichotillomania: A randomized controlled trial of ACT-enhanced behavior therapy. Journal of Obsessive-Compulsive and Related Disorders, 18, 106–115. https://doi.org/10.1016/j.jocrd.2018.04.003CrossRef

Lee, E. B., Homan, K. J., Morrison, K. L., Ong, C. W., Levin, M. E., & Twohig, M. P. (2018b). Acceptance and commitment therapy for trichotillomania: A randomized controlled trial of adults and adolescents. Behavior Modification., 44(1), 70–91. https://doi.org/10.1177/0145445518794366CrossRefPubMed

Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales. Sydney psychology foundation.

Morris, S. H., Zickgraf, H. F., Dingfelder, H. E., & Franklin, M. E. (2013). Habit reversal training in trichotillomania: Guide for the clinician. Expert Review of Neurotherapeutics, 13(9), 1069–1077.CrossRefPubMed

Ong, C. W., & Eustis, E. H. (2021). Psychological flexibility. In M. P. Twohig, M. E. Levin, & J. M. Petersen (Eds.), The Oxford Handbook of Acceptance and Commitment Therapy. Oxford University Press.

Ong, C. W., Woods, D. W., Franklin, M. E., Saunders, S. M., Neal-Barnett, A. M., Compton, S. N., & Twohig, M. P. (2023). The role of psychological flexibility in acceptance-enhanced behavior therapy for trichotillomania: Moderation and mediation findings. Behaviour Research and Therapy, 164, 104302.CrossRefPubMed

Osman, A., Wong, J. L., Bagge, C. L., Freedenthal, S., Gutierrez, P. M., & Lozano, G. (2012). The depression anxiety stress Scales—21 (DASS-21): Further examination of dimensions, scale reliability, and correlates. Journal of Clinical Psychology, 68(12), 1322–1338.CrossRefPubMed

Petersen, J. M., Capel, L. K., Levin, M. E., & Twohig, M. P. (2022). Moderators and processes of change in a pilot randomized controlled trial of acceptance-enhanced behavior therapy for trichotillomania in adolescents. Journal of Obsessive-Compulsive and Related Disorders., 35, 100757.CrossRef

R Core Team. (2022). R: A language and environment for statistical computing. R Foundation for Statistical Computing.

Tung, E. S., Flessner, C. A., Grant, J. E., & Keuthen, N. J. (2015). Predictors of life disability in trichotillomania. Comprehensive Psychiatry, 56, 239–244.CrossRefPubMed

Twohig, M. P., Petersen, J. M., Fruge, J., Ong, C. W., Barney, J. L., Krafft, J., Lee, E. B., & Levin, M. E. (2021). A Pilot randomized controlled trial of online delivered ACT-enhanced behavior therapy for trichotillomania in adolescents. Cognitive and Behavioral Practice., 28(4), 653–668. https://doi.org/10.1016/j.cbpra.2021.01.004CrossRef

Woods, D. W., & Twohig, M. P. (2023). Trichotillomania: An ACT-enhanced Behavior Therapy Approach Therapist Guide (2nd ed.). Oxford University Press.

Woods, D. W., Ely, L. J., Bauer, C. C., Twohig, M. P., Saunders, S. M., Compton, S. N., Espil, F. M., Neal-Barnett, A., Alexander, J. R., Walther, M. R., & Cahill, S. P. (2022). Acceptance-enhanced behavior therapy for trichotillomania in adults: A randomized clinical trial. Behaviour Research and Therapy, 158, 104187.CrossRefPubMedPubMedCentral

Titel: Moderators and Preliminary Processes of Change in a Randomized Controlled Trial of a Fully Automated, Website Delivering AEBT for Adults with Trichotillomania
Auteurs: Leila K. Capel
Julie M. Petersen
Michael E. Levin
Michael P. Twohig
Publicatiedatum: 14-08-2023
Uitgeverij: Springer US
Gepubliceerd in: Cognitive Therapy and Research / Uitgave 1/2024
Print ISSN: 0147-5916
Elektronisch ISSN: 1573-2819
DOI: https://doi.org/10.1007/s10608-023-10418-0

Bohn Stafleu van Loghum

Deel dit onderdeel of sectie (kopieer de link)

Abstract

Introduction

Methods

Results

Conclusion

Log in om toegang te krijgen

Andere artikelen Uitgave 1/2024

When and for Whom to Pick In-Person or Telehealth Delivery of Habit Reversal Training for Body Focused Repetitive Behaviors: An Assessment of Provider Perceptions

Psychometric Properties of Trichotillomania Severity Measures

Pulling Sites in Trichotillomania: Exploring Differences in Characteristics, Phenomenology, and Contextual Variables

Mental Health Providers’ Knowledge of Trichotillomania and Skin Picking Disorder, and Their Treatment

Two-year Follow-up of Habit Reversal Training and Decoupling in a Sample with Body-Focused Repetitive Behaviors

Clinical Characteristics, Sleep, and Temperament in Infants and Young Children with Problematic Hair Pulling and Skin Picking