Pilot trial of dialectical behavior therapy-enhanced habit reversal for trichotillomania

Nancy J. Keuthen, Barbara O. Rothbaum, Stacy Shaw Welch, Caitlin Taylor, Martha Falkenstein, Mary Heekin, Cathrine Arndt Jordan, Kiara Timpano, Suzanne Meunier, Jeanne Fama, Michael A. Jenike

Research output: Contribution to journalArticlepeer-review

51 Scopus citations


Background: Not all hair pullers improve acutely with cognitive-behavioral treatment (CBT) and few maintain their gains over time. Methods: We conducted an open clinical trial of a new treatment that addresses affectively triggered pulling and emphasizes relapse prevention in addition to standard CBT approaches. Ten female participants satisfying DSM-IV criteria for trichotillomania (TTM) at two study sites received Dialectical Behavior Therapy (DBT)-enhanced CBTconsisting of 11 weekly sessions and 4 maintenance sessions over the following 3 months. Independent assessors rated hair pulling impairment and global improvement at several study time points. Participants completed self-report measures of hair pulling severity and emotion regulation. Results: Significant improvement in hair pulling severity and emotion regulation, as well as hair pulling impairment and anxiety and depressive symptoms, occurred during acute treatment and were maintained during the subsequent 3 months. Significant correlations were reported between changes in emotion regulation and hair pulling severity during both the acute treatment and maintenance phases. Conclusions: This study offers preliminary evidence for the efficacy of DBT-enhanced CBT for TTM and suggests the importance of addressing emotion regulation during TTM treatment.

Original languageEnglish (US)
Pages (from-to)953-959
Number of pages7
JournalDepression and anxiety
Issue number10
StatePublished - Oct 1 2010
Externally publishedYes


  • Dialectical behavior therapy
  • Habit reversal
  • Hair pulling
  • Trichotillomania

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology


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