Stepped Care in the Treatment of Trichotillomania

描述（由申请人提供）：拔毛癖（TTM），反复拔自己的头发，达到明显脱发的程度，是一种严重干扰功能和生活质量的令人痛苦的疾病。本研究的长期目标是确定TTM的心理治疗是否可以通过使用阶梯式护理模式更有效地传播，在该模式中，首先尝试不太密集的干预措施，只有在初步治疗证明不充分时才使用更密集的干预措施。本申请用于治疗的阶梯式护理模型中的前两个步骤的试点研究。基线评估后，50例TTM受试者将被随机分配至（a）即刻条件，即通过交互式网站StopPulling.com（步骤1）向其提供10周自助治疗，或（B）等待列表/延迟开始条件，即在提供步骤1之前的10周等待列表。在每种情况下，在第一步结束时，参与者将接受由心理学研究生提供的8周面对面的习惯逆转训练（第二步）。将从基线到第2步结束后3个月的随访期间测量TTM症状，以及抑郁、焦虑、生活质量、功能障碍、治疗利用和治疗满意度。本研究的具体目的是：（1）收集关于StopPulling.com作为TTM第1步自助治疗与等待列表对照相比的疗效的初步数据;（2）通过评估从第1步治疗进入第2步治疗的入组受试者比例，表征TTM患者阶梯式治疗的可接受性;（3）评价四个决策规则的收敛有效性，以得出TTM患者已从治疗步骤中充分获益的结论：（a）不再符合TTM诊断标准;（B）自我报告和临床医生评定的TTM症状的总分降低25%或更多;（c）实现完全戒断拔毛发;和（d）自我报告和临床医生评定的TTM症状测量的临床显著应答（4）通过将标准与治疗满意度、治疗利用率和TTM功能损害指标评分相关联，评价治疗步骤充分获益标准的并发和预测有效性。这项初步研究将提供新的，需要的信息，可接受的阶梯式护理和有效性的可能的决策规则，认为一个治疗步骤足够有帮助。这些信息将为将来研究TTM分级治疗方法的疗效和成本效益奠定基础。 拔毛癖（TTM）是一种心理疾病，人们反复拔自己的头发。TTM有有效的治疗方法，但获得专家治疗师的机会有限。这项研究测试了一种改善获得的方法，即从基于网络的自助开始，只有在自助不充分的情况下才转向更昂贵和更密集的治疗。

DESCRIPTION (provided by applicant): Trichotillomania (TTM), repetitive pulling out of one's own hair to the extent that noticeable hair loss occurs, is a distressing condition interfering substantially with functioning and quality of life. The longterm objective of this research is to determine whether psychological treatment of TTM could be disseminated more effectively by using a stepped care model in which less intensive interventions are tried first, with more intensive interventions used only if initial treatment proves insufficient. The present application is for a pilot study of the first two steps in a stepped care model of treatment. After baseline assessment, 50 participants with TTM will be randomly assigned to (a) Immediate condition, in which they are offered 10-week self-help treatment via an interactive website, StopPulling.com (Step 1) or (b) Wait List/Delayed Start condition, a 10-week wait list prior to being offered Step 1. In each condition, at the end of Step 1, participants will be offered 8 weeks of in-person habit reversal training provided by psychology graduate students (Step 2). TTM symptoms will be measured from baseline through a follow-up 3 months after the end of Step 2, as will depression, anxiety, quality of life, functional impairment, treatment utilization, and treatment satisfaction. The specific aims of the study are: (1) To gather preliminary data on the efficacy of StopPulling.com as a step 1 self-help treatment for TTM, compared to wait list control; (2) To characterize the acceptability of stepped care to patients with TTM by assessing the proportion of enrolled participants who proceed from step 1 to step 2 treatment; (3) To evaluate the convergent validity of four decision rules for concluding that a patient with TTM has benefited sufficiently from a treatment step: (a) No longer meeting TTM diagnostic criteria; (b) Showing a 25% or greater reduction in total scores on self-report and clinician-rated TTM symptoms; (c) achieving complete abstinence from hair-pulling; and (d) clinically significant response on both self-report and clinician-rated TTM symptom measures (4) To evaluate the concurrent and predictive validity of criteria for sufficient benefit from a treatment step by relating them to treatment satisfaction, treatment utilization, and scores on a measure of functional impairment from TTM. This pilot study will provide novel, needed information about the acceptability of stepped care and the validity of possible decision rules for considering a treatment step sufficiently helpful. This information will lay the groundwork for future studies of the efficacy and cost-effectiveness of stepped care methods for allocating treatment for TTM. PUBLIC HEALTH RELEVANCE: Trichotillomania (TTM) is a psychological disorder in which people repetitively pull out their own hair. There are effective therapies for TTM, but access to expert therapists is limited. This study tests one way to improve access, by starting with web-based self-help and moving on to more costly and intensive treatments only if self-help is insufficient.