Document Type

Article

Journal/Book Title/Conference

Cognitive and Behavioral Practice

Publisher

Elsevier Ltd

Publication Date

8-13-2025

Journal Article Version

Accepted Manuscript

First Page

1

Last Page

42

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Abstract

While treatment for trichotillomania has improved in the last twenty years, trichotillomania is considered difficult to treat and often gains made during treatment are not maintained. The literature calls for individualized treatments as a potential way to improve overall symptom improvement. One potential method that is scalable and clinically useful may be stepped care combining digital mental health interventions (DMHI) with individual therapy to improve individualization of interventions while decreasing cost for the individual and therapist burden. This study aimed to test a quasi-stepped care model utilizing both an eight module DMHI followed by six sessions of individual therapy utilizing acceptance and commitment therapy-enhanced behavior therapy (A-EBT). Our results provide preliminary support that combining interventions improved treatment outcomes for adults with trichotillomania. Participants reported significant decreases in hair pulling symptom severity (SMD=2.98) from pretreatment through follow-up and increases in psychological flexibility (SMD=-1.26) from pretreatment through follow-up. This pilot study provides preliminary evidence that a quasi-stepped-care A-EBT model combining a web-based program with brief individual therapy is a feasible and acceptable intervention for adults. Clinical implications are discussed.

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Available for download on Friday, August 13, 2027

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