title: Defining treatment response in trichotillomania: a signal detection analysis.
abstract: The Massachusetts General Hospital Hairpulling Scale (MGH-HPS) and the NIMH Trichotillomania Severity Scale (NIMH-TSS) are two widely used measures of trichotillomania severity. Despite their popular use, currently no empirically-supported guidelines exist to determine the degrees of change on these scales that best indicate treatment response. Determination of such criteria could aid in clinical decision-making by defining clinically significant treatment response/recovery and producing accurate power analyses for use in clinical trials research. Adults with trichotillomania (N=69) participated in a randomized controlled trial of psychotherapy and were assessed before and after treatment. Response status was measured via the Clinical Global Impressions-Improvement Scale, and remission status was measured via the Clinical Global Impressions-Severity Scale. For treatment response, a 45% reduction or 7-point raw score change on the MGH-HPS was the best indicator of clinically significant treatment response, and on the NIMH-TSS, a 30-40% reduction or 6-point raw score difference was most effective cutoff. For disorder remission, a 55-60% reduction or 7-point raw score change on the MGH-HPS was the best predictor, and on the NIMH-TSS, a 65% reduction or 6-point raw score change was the best indicator of disorder remission. Implications of these findings are discussed.
authors.affiliation: Texas A&M University, Department of Psychology, 4235 TAMU, College Station, TX 77843, USA. Electronic address: davidhoughton@tamu.edu.
authors.forename: David C
authors.initials: DC
authors.lastname: Houghton
authors.affiliation: University of California San Francisco, Department of Psychiatry, 401 Parnassus Ave., Box 0984, San Francisco, CA 94143, USA. Electronic address: matthew.capriotti@ucsf.edu.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Capriotti
authors.affiliation: University of South Florida, Department of Psychology, 4202 East Fowler Ave., PCD 4118G, Tampa, FL 33620, USA. Electronic address: denadai@mail.usf.edu.
authors.forename: Alessandro S
authors.initials: AS
authors.lastname: De Nadai
authors.affiliation: Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, 2213 Elba St., Durham, NC 27705, USA. Electronic address: scompton@duke.edu.
authors.forename: Scott N
authors.initials: SN
authors.lastname: Compton
authors.affiliation: Utah State University, Department of Psychology, 2810 Old Main Hill, Logan, UT 84322, USA. Electronic address: michael.twohig@usu.edu.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Twohig
authors.affiliation: Kent State University, Department of Psychological Sciences, 600 Hilltop Drive, Kent, OH 44242, USA. Electronic address: aneal@kent.edu.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Neal-Barnett
authors.affiliation: Marquette University, Department of Psychology, 317 Cramer Hall, Milwaukee, WI 53233, USA. Electronic address: stephen.saunders@marquette.edu.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Saunders
authors.affiliation: University of Pennsylvania School of Medicine, Department of Psychiatry, 3535 Market St., Philadelphia, PA 19104, USA. Electronic address: marty@mail.med.upenn.edu.
authors.forename: Martin E
authors.initials: ME
authors.lastname: Franklin
authors.affiliation: Texas A&M University, Department of Psychology, 4235 TAMU, College Station, TX 77843, USA. Electronic address: dowoods@tamu.edu.
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Woods
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001521:Behavior Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011613:Psychotherapy / Q000379:methods*; D012372:ROC Curve; D017603:Signal Detection, Psychological; D016896:Treatment Outcome; D014256:Trichotillomania / Q000175:diagnosis / Q000628:therapy*; D055815:Young Adult
keywords: Hair pulling; Obsessive-compulsive disorder; Psychotherapy; Signal detection; Trichotillomania