Effective Therapies for Trichotillomania


An effective treatment for trichotillomania has been disclosed by research published in Psychotherapy and Psychosomatics.

A previous pilot study demonstrated “decoupling,” a self-help intervention, may be effective at reducing hair-pulling and may be more effective than progressive muscle relaxation. Decoupling mimics the actions of compulsive hair-pulling but substitutes a similar but harmless behavior, such as touching the ear or massaging the neck rather than pulling out hair. The action is performed in a rapid motion to block the old behavior from emerging. Progressive muscle relaxation releases tense muscles through a 2-step process of tensing and then relaxing muscle groups in the body.

For this study, investigators sought to expand the findings of the pilot study in a more robust randomized clinical trial. They recruited 105 participants with trichotillomania and randomly assigned them to either decoupling or to progressive muscle relaxation. The intervention lasted 4 weeks, and severity of trichotillomania was assessed at baseline, immediately after the intervention, and at 6-month follow-up.

The researchers found highly significant and comparable reductions in trichotillomania symptoms for both types of intervention that persisted through 6-month follow-up. Participants favored decoupling in certain respects, but the researchers found that both therapies were comparably effective.

The researchers concluded that longitudinal studies that include nontreated control groups are warranted.

Effective Therapies for Trichotillomania
Researchers found significant improvements in hair-pulling symptoms with both “decoupling” and progressive muscle relaxation.

A randomized controlled trial published in the current issue of Psychotherapy and Psychosomatics by Swiss investigators discloses a new treatment approach to hair pulling compulsion called Trichotillomania.

Trichotillomania (TTM) is characterized by recurrent hair-pulling that results in substantial hair loss. A previous pilot study demonstrated that the online self-help intervention ‘decoupling’ (DC) might be effective at reducing hair-pulling symptoms, with a stronger effect than progressive muscle relaxation (PMR). We aimed to extend these findings using a more robust randomized clinical trial design, including diagnostic interviews by phone, a 6-month follow-up and e-mail support. One hundred five adults with TTM were recruited online and randomly allocated to either DC (n = 55) or PMR (n = 50).

The intervention lasted 4 weeks, with severity of TTM assessed at 3 time points (before intervention, immediately after intervention and at the 6-month follow-up) using the Massachusetts General Hospital Hair-Pulling Scale (MGH-HPS

Both intention-to-treat and completer analyses were conducted. Intention-to-treat analysis demonstrated highly significant and comparable symptom reductions (MGH-HPS) in both the DC and PMR groups (p < 0.001, partial η2 = 0.31) that persisted through 6 months of follow-up. Participants’ subjective appraisals favoured DC in some areas (e.g. greater satisfaction with DC than PMR).

Completer analyses demonstrated the same pattern as the intention-to-treat analyses. The Authors concluded that despite subjective appraisals in favour of DC, symptom reduction was comparable in the two groups. While the results suggest that even short Internet-based interventions like DC and PMR potentially help individuals with TTM, a partial effect of unspecific factors, like regression towards the mean, cannot be ruled out. Therefore, longitudinal studies with non-treated controls are warranted.


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