Dissemination Trial of Provider Training of ACT-Enhanced Behavior Therapy for Trichotillomania: A Waitlist Controlled Study

Abstract

Trichotillomania is a psychiatric disorder characterized by recurrent hair-pulling, leading to distress and impairment. Despite the efficacy of habit reversal training (HRT) and ACT-enhanced behavior therapy (A-EBT), there is a significant knowledge gap among providers about evidence-based treatments. This study aimed to bridge this gap by evaluating the feasibility, acceptability, and effects of internet-delivered therapist training in A-EBT for trichotillomania. A randomized waitlist-controlled implementation trial was conducted with 119 licensed mental health providers assigned to either immediate training or waitlist cohorts. The immediate training group participated in a 1-day online workshop followed by 6 months of consultation. Compared to the waitlist cohort, the immediate training cohort showed significant improvements in knowledge of trichotillomania, its treatments, and self-efficacy in providing the therapy, which were maintained throughout the end of the consultation period. Behavioral outcomes indicated that the immediate training cohort was more likely to self-promote their ability to treat trichotillomania, leading to an increased caseload of clients with trichotillomania and other body-focused repetitive behaviors (BFRBs). Approximately one-third of providers in both groups began treating at least one client with trichotillomania or another BFRB during the training period. In conclusion, training providers in A-EBT for trichotillomania is feasible and effective in improving provider knowledge and self-efficacy, leading to more individuals receiving evidence-based care. Future research should explore long-term impacts on client outcomes and ways to further enhance training dissemination and implementation for trichotillomania and other BFRBs.