4 - (SYM 79) Assessing Factors of Adherence and Efficacy of a Fully Automated Self-help ACT Enhanced Behavior Therapy Website for Adults with Trichotillomania: A Randomized Controlled Trial

Introduction: Treatment for trichotillomania is limited by a variety of factors including lack of provider knowledge, lack of resources, and financial concerns. This study assessed factors impacting adherence and efficacy of a digital mental health intervention delivering ACT-enhanced behavior therapy (A-EBT) for adults with trichotillomania. We aimed to assess whether treatment with weekly check-ins significantly improved adherence and efficacy compared to treatment without check-ins.


Method: Adults with trichotillomania (N=101) were recruited from November 2023 to January 2024. Participants completed a structured diagnostic interview for trichotillomania and co-occuring conditions. Participants were then randomized into either receiving the online intervention with check-ins or without check-ins. All participants completed self-report assessments of trichotillomania severity, trichotillomania specific psychological inflexibility, well-being, and distress at pre-treatment, post-treatment, one-month and six-month follow-up.  Analyses were conducted in R Studio using multilevel modeling with the full intent-to-treat sample.


Results: Results suggest that while adherence to the program predicted better outcomes, the check-in conditions did not improve significantly more than individuals in the condition without check-ins. Additionally, check-ins did not result in greater module completion nor did participants in the check-in condition have significantly better outcomes with respect to decreasing symptom severity. At post-treatment, 32% in the check-in and 21 % in the no-check-in conditions met trichotillomania treatment response status with no significant difference between the groups. Hair pulling severity, trichotillomania specific psychological inflexibility, and well-being significantly improved across conditions (SMD > - 0.80, p< .01). Distress did not significantly improve.  The treatment was acceptable on both rating of system usability and overall acceptability of the treatment.


Conclusion: The findings support efficacy of A-EBT and feasibility of A-EBT in a fully automated website with or without phone check-ins. Check-ins did not significantly increase adherence which has notable implications for public dissemination of the website and increasing access to care without the delay of infrastructure development to provide large scale check-ins. Intervention delivery in this fashion is promising with respect to increasing access and reach.