title: Internet-based self-help for trichotillomania: a randomized controlled study comparing decoupling and progressive muscle relaxation.
abstract: BACKGROUND
  Trichotillomania (TTM) is characterized by recurrent hair-pulling that results in substantial hair loss. A previous pilot study demonstrated that the online self-help intervention 'decoupling' (DC) might be effective at reducing hair-pulling symptoms, with a stronger effect than progressive muscle relaxation (PMR). We aimed to extend these findings using a more robust randomized clinical trial design, including diagnostic interviews by phone, a 6-month follow-up and e-mail support.
  
  
  METHODS
  One hundred five adults with TTM were recruited online and randomly allocated to either DC (n = 55) or PMR (n = 50). The intervention lasted 4 weeks, with severity of TTM assessed at 3 time points (before intervention, immediately after intervention and at the 6-month follow-up) using the Massachusetts General Hospital Hair-Pulling Scale (MGH-HPS). Both intention-to-treat and completer analyses were conducted.
  
  
  RESULTS
  Intention-to-treat analysis demonstrated highly significant and comparable symptom reductions (MGH-HPS) in both the DC and PMR groups (p < 0.001, partial x03B7;2 = 0.31) that persisted through 6 months of follow-up. Participants' subjective appraisals favoured DC in some areas (e.g. greater satisfaction with DC than PMR). Completer analyses demonstrated the same pattern as the intention-to-treat analyses.
  
  
  CONCLUSIONS
  Despite subjective appraisals in favour of DC, symptom reduction was comparable in the two groups. While the results suggest that even short Internet-based interventions like DC and PMR potentially help individuals with TTM, a partial effect of unspecific factors, like regression towards the mean, cannot be ruled out. Therefore, longitudinal studies with non-treated controls are warranted.
authors.affiliation: Department of Psychiatry and Psychotherapy, University Hospital Zurich, Switzerland.
authors.forename: Steffi
authors.initials: S
authors.lastname: Weidt
authors.forename: Richard
authors.initials: R
authors.lastname: Klaghofer
authors.forename: Alexa
authors.initials: A
authors.lastname: Kuenburg
authors.forename: Annette Beatrix
authors.initials: AB
authors.lastname: Bruehl
authors.forename: Aba
authors.initials: A
authors.lastname: Delsignore
authors.forename: Steffen
authors.initials: S
authors.lastname: Moritz
authors.forename: Michael
authors.initials: M
authors.lastname: Rufer
mesh_terms: D000328:Adult; D001326:Autogenic Training / Q000379:methods*; D015928:Cognitive Behavioral Therapy; D004311:Double-Blind Method; D005260:Female; D015438:Health Behavior; D006801:Humans; D020407:Internet; D008297:Male; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D012648:Self Care; D016896:Treatment Outcome; D014256:Trichotillomania / Q000628:therapy*