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Symposia

Technology/Digital Health

The Latest Technology Research across the Obsessive Compulsive and Related Disorders: Research from Academia and Industry, across Youth and Adults

2 - (SYM 79) Building Just-in-time Interventions in Trichotillomania Using Intensive Longitudinal Data

Sunday, November 23, 2025
12:22 PM - 12:39 PM CST
Location: Bolden 6, Level 2
Keywords: Trichotillomania, Body Dysmorphic Disorder, Telehealth/m-health
Recommended Readings: Feusner JD, Farrell NR, Nunez M, Lume N, MacDonald CW, McGrath PB, Trusky L, Smith S, Rhode A
Effectiveness of Video Teletherapy in Treating Obsessive-Compulsive Disorder in Children and Adolescents With Exposure and Response Prevention: Retrospective Longitudinal Observational Study
J Med Internet Res 2025;27:e66715,   Stiede JT, Woods DW, Idnani AK, Pritchard J, Klobe K, Kumar S. Pilot trial of a technology assisted treatment for trichotillomania. J Obsessive Compuls Relat Disord. 2022 Apr;33:100726. doi: 10.1016/j.jocrd.2022.100726. Epub 2022 Apr 29. PMID: 37305101; PMCID: PMC10256116.,   Capel, L.K., Petersen, J.M., Becker, M.R., Levin, M.E., Twohig, M.P. (2023). The efficacy and feasibility of a fully automated, web-based acceptance-enhanced behavioral treatment for trichotillomania in adults: A randomized waitlist-controlled trial. Journal of Obsessive-Compulsive and Related Disorders. https://doi.org/10.1016/j.jocrd.2023.100800,   Dietel, F. A., & Buhlmann, U. (2023). Special issue on digital interventions in obsessive-compulsive and related disorders: Editorial and research agenda. Journal of Obsessive-Compulsive and Related Disorders, 39, 100847. https://doi.org/10.1016/j.jocrd.2023.100847,  
Abstract Body

The factors that trigger, maintain, and reinforce hairpulling in TTM are complex, and the field’s understanding of these variables is limited. To enhance habit reversal training (HRT) support tools, we collected 6 weeks of ecological momentary assessment (EMA) data on the severity, emotions, locations, and activities present during 1,912 pulling episodes in 36 adults with TTM, via an NIH SBIR-funded industry-academic partnership.

We are using EMA and smartphone-based GPS data to build predictive algorithms that detect high-risk moments for pulling, to deliver just-in-time adaptive interventions (JITAIs). For example, suppose a participant often pulls at home while getting ready for work in the morning. In that case, the system will detect when these contextual factors are present and, just before the predicted high-risk time, deliver a reminder to use context-relevant evidence-based strategies (e.g., stimulus control, such as putting away a magnifying mirror) via a companion smartphone app. 

We will present descriptive results from EMA data on contextual factors present during logged pulling episodes that informed the just-in-time algorithm, including when and where pulling episodes occurred. Mean (SD) duration of pulling episodes by participant ranged from 1.04 (0.20) minutes to 73.08 (37.72) minutes. Most pulling episodes occurred at home (1550/1912 [81.07%]), in the afternoon and evening.  
Alongside descriptive findings, we will present preliminary work to harness EMA and GPS data to build JITAIs. We developed a novel algorithm to deliver contextually relevant interventions via mobile phone notifications. EMA data were processed by grouping episode timestamps and identifying candidate notification time windows. Contextual data, including activities, moods, and locations, were analyzed within these windows to generate personalized probability density functions (PDFs), which estimate the likelihood of specific contexts. Building on PDFs, a mobile app uses live GPS data and time of day to predict current moods and activities, informing the selection of relevant, tailored notification content. We will present results from participant interviews, indicating whether JITAIs were effective and relevant. To our knowledge, this is the first study to use EMA methods to understand TTM and the first study to build and test JITAIs to enhance frontline HRT for TTM.