Acceptance and Commitment Therapy for Trichotillomania: A Randomized Controlled Trial of Adults and Adolescents.
Ten ACT sessions, without habit-reversal, meaningfully reduced hair-pulling in teens and adults.
01Research in Context
What this study did
Sievers et al. (2020) ran a randomized trial with teens and adults who pull their hair. The team gave half the group ten sessions of acceptance and commitment therapy. The other half stayed on a wait-list.
No habit-reversal steps were added. The goal was to see if ACT alone could cut hair-pulling.
What they found
The ACT group pulled fewer hairs each day and said the urge felt less severe. Wait-list scores barely moved.
Psychological flexibility, the ACT skill being taught, went up a little. The authors call the gains modest but real.
How this fits with other research
Viefhaus et al. (2020) also tested teens, but used habit-reversal for tics and saw strong results. B et al. show you can skip HRT and still win, at least for hair-pulling.
Moritz et al. (2021) compared three self-help tricks for body-focused habits. Their best tool, decoupling-in-sensu, gave only modest relief, matching the modest ACT effect here.
Lappalainen et al. (2007) found ACT beat CBT when trainees ran the sessions. B et al. extend that idea to trichotillomania, showing ACT still works when the protocol is short and focused.
Why it matters
If a client hates the competing-response part of HRT, offer ACT first. Ten clinic sessions can cut pulling without extra drills. Track daily hairs and flexibility scores to see if the case is on track. If change is slow, you still have room to add HRT later.
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02At a glance
03Original abstract
The purpose of this study was to examine acceptance and commitment therapy (ACT) as a standalone treatment for trichotillomania in a randomized controlled trial of adults and adolescents. Participants consisted of a community sample of treatment seeking adults and adolescents with trichotillomania. Of the eligible 39 participants randomized into treatment and waitlist groups, 25 completed treatment and were included in the final analysis. Treatment consisted of a 10-session ACT protocol. Multiple mixed models repeated measures analyses were utilized to evaluate changes in trichotillomania symptom severity, daily number of hairs pulled and urges experienced, and experiential avoidance from pretreatment to posttreatment. Findings indicated significant changes in symptom severity and daily hairs pulled, but not daily urges experienced or psychological flexibility. However, psychological flexibility saw a 24.5% decrease in the treatment group and reduced from clinical to subclinical levels on average. This study suggests that ACT alone is an effective treatment for adults and adolescents with trichotillomania. Outcomes appear to be similar to trials that combined ACT and habit reversal training (HRT).
Behavior modification, 2020 · doi:10.1177/0145445518794366