Document Type
Article
Journal/Book Title/Conference
Behavior Therapy
Publisher
Elsevier Inc.
Publication Date
1-16-2025
Journal Article Version
Accepted Manuscript
First Page
1
Last Page
38
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
Abstract
Between-session therapy homework is a key component of cognitive-behavioral therapies, yet its role in trichotillomania treatment remains understudied. The present study examined the associations between homework compliance and treatment outcomes in acceptance and commitment therapy (ACT) enhanced behavior therapy (AEBT) for trichotillomania. Participants included 35 adults with trichotillomania who participated in a 12-week randomized controlled trial of AEBT. Therapists documented patient homework assignment completion and rated homework adherence after each session. Trichotillomania symptom severity was assessed posttreatment and at 6-month follow-up. Higher overall homework completion rate and therapist-rated homework adherence predicted lower trichotillomania symptom severity at posttreatment and follow-up. These findings were consistent for homework compliance during early and late treatment phases and for both ACT and behavior therapy–based homework assignments. A stronger therapeutic relationship strengthened the positive effects of homework compliance on symptom reduction. Higher automatic pulling moderated the association between overall homework completion and better outcomes. Predictors of higher homework compliance included higher therapeutic relationship quality, younger age, and lower anxiety. These findings underscore the importance of between-session homework in trichotillomania treatment and support the inclusion of both ACT and behavior therapy assignments. Interventions to promote homework compliance could enhance the efficacy of AEBT and lead to greater symptom improvements.
Recommended Citation
Kathryn E. Barber, Douglas W. Woods, Michael P. Twohig, Stephen M. Saunders, Scott N. Compton, Martin E. Franklin, Examining the Role of Homework Compliance in Acceptance-Enhanced Behavior Therapy for Trichotillomania, Behavior Therapy, 2025, https://doi.org/10.1016/j.beth.2025.01.003.
