Integrated cognitive-behavioral therapy for Trichotillomania: a multiple-baseline single-case experimental design.

Introduction: Despite much has been learned about Trichotillomania (TTM) over the last decade, a gold-standard, evidence-based psychological intervention for this disorder still has not been identified. The current study evaluated an 8-session integrated cognitive-behavioral therapy (CBT) intervention for TTM, developed from the Comprehensive Behavioral Model for Trichotillomania (Mansueto et al., 1997) and delivered to 3 women with TTM on an individual basis. Method: A multiple-baseline, single case experimental design was used. The effect of the intervention was assessed by self-reported daily measures of symptom severity (number of hair- pulling episodes, number of hair pulled, attempts to inhibit the behavior, level of distress). The study was conducted over 3 phases: baseline (with different lengths: 7, 14, and 21 days), intervention (8 weeks), and follow-up (3 months). Visual analysis of the graphs and the Test C were used to examine change in the trends of the measures across phases. The Depression Anxiety Stress Scales-21 (DASS-21) total score was used to test clinically significant change from baseline to completion of the intervention. Results: Two out of 3 patients displayed significant increases in their ability to inhibit the behavior, Patient 1 during the intervention (p=.007) and Patient 2 during the follow-up (p=.02). Patient 3 reported a significant reduction in level of distress during the intervention (p=.006). With respect to clinically significant change, only Patient 1 achieved a significant reduction (75%) in the DASS- 21 total score. Conclusions: Current results suggest that such an integrated CBT intervention might show promise in effectively addressing TTM, and particularly in improving the ability to resist hair-pulling. Importantly, present findings are in line with extant literature, which suggests that integrating behavioral and cognitive techniques may represent the most valuable and effective approach to target TTM.