TrichTok: Developing a scalable, video-based mobile intervention with peer support for adolescents and emerging adults with trichotillomania

About This Grant

Trichotillomania (TTM) is a chronic and impairing obsessive-compulsive and related disorder that involves repetitively pulling one’s hair, causing visible hair loss. TTM in youth and emerging adults is associated with shame, low self-esteem, academic and social impairment, and comorbid anxiety and depression. Despite the substantial morbidity associated with this condition, existing treatments have clear limitations. There are no known effective medications. Frontline psychotherapy is habit reversal training (HRT), a simple behavior therapy with modest efficacy and durability, perhaps due to its lack of focus on core emotional and cognitive experiences (e.g., shame, perfectionism) that maintain and exacerbate hairpulling. HRT is also extremely difficult to access, due to a scarcity of trained clinicians, high costs of specialty care, and logistics of receiving care (e.g., needing appointment times after school hours) - barriers which disproportionately affect young people. Indeed, less than one-fifth of youth with TTM receive frontline care. To address critical care gaps in this undertreated specialty population, and in line with NIMH Strategic Goal 4 to improve the efficiency, effectiveness, and reach of mental health services, we seek to develop TrichTok, a novel digital self-help TTM treatment for adolescents and emerging adults that (1) is specifically designed with and for adolescents and emerging adults, (2) is delivered in brief TikTok-style videos, to be scalable, accessible, and engaging for teens, (3) incorporates coach-moderated peer support, to further address shame and isolation that affect youth with TTM, and (4) builds on HRT to also incorporate novel cognitive skills that target mindset shifts around shame and perfectionism, for greater efficacy. Initial pilot data from clinician and teen end-user stakeholders provides very strong support for the idea as important, innovative, and feasible, and underscores the value of adapting the program’s design and content specifically for young people with TTM. To accomplish objectives, we will build a functional beta version of the program via iterative user-centered design and development in collaboration with 10 licensed clinicians with expertise in adolescent TTM and 10 adolescents and emerging adults with TTM (Aim 1). Next, we will test the program’s feasibility, usability, and acceptability in 30 adolescents and emerging adults with TTM nationally, via an open pilot trial. Results will be evaluated against pre-registered success criteria. Our team consists of developers, designers, and people with lived experience who created the HabitAware online community and device (a smartwatch that passively detects hairpulling and supports HRT, developed under R43MH114773) and NIH-funded psychologists with expertise in research and treatment of TTM across the lifespan. If we achieve success criteria, we will seek Phase II funding to validate TrichTok’s efficacy and potential for commercialization via a randomized controlled trial as a next step. If successful, this proposal will uniquely result in a relatable, engaging, and novel intervention for adolescent TTM that can dramatically enhance access to care and effectiveness of care.