The Experts below are selected from a list of 432 Experts worldwide ranked by ideXlab platform
Douglas W. Woods - One of the best experts on this subject based on the ideXlab platform.
-
reducing risky behavior with Habit Reversal a review of behavioral strategies to reduce Habitual hand to head behavior
Journal of Applied Behavior Analysis, 2020Co-Authors: Megan R Heinicke, Raymond G. Miltenberger, Jordan T Stiede, Douglas W. WoodsAbstract:Habit Reversal Training (HRT) has been a mainstay of behavior analysts' repertoire for nearly the last 50 years. HRT has been effective in treating a host of repetitive behavior problems. In the face of the current coronavirus pandemic, HRT has practical public health importance as a possible intervention for reducing hand-to-head behaviors that increase the risk of viral infection. The current paper provides a brief review of HRT for hand-to-head Habits that is designed for a broad audience and concludes with practical suggestions, based on HRT, for reducing face-touching behaviors.
-
Behavioral therapy for Tourette syndrome and chronic tic disorders
Neurology. Clinical practice, 2017Co-Authors: Odette Fründt, Douglas W. Woods, Christos GanosAbstract:Abstract Purpose of review: To summarize behavioral interventions for the treatment of primary tic disorders. Recent findings: Although tics were attributed to a disordered weak volition, the shift towards neurobiological models of tic disorders also transformed nonpharmacologic treatment practices. Current international guidelines recommend Habit Reversal Training, comprehensive behavioral intervention, and exposure and response prevention as first-line therapies for tics. Appropriate patient selection, including age and presence of comorbidities, are salient clinical features that merit consideration. Evidence for further behavioral interventions is also presented. Summary: Currently recommended behavioral interventions view tics as Habitual responses that may be further strengthened through negative reinforcement. Although availability and costs related to these interventions may limit their effect, Internet-based and telehealth approaches may facilitate wide accessibility. Novel nonpharmacologic treatments that take different approaches, such as autonomic modulation or attention-based interventions, may also hold therapeutic promise.
-
act enhanced behavior therapy in group format for trichotillomania an effectiveness study
Journal of Obsessive-Compulsive and Related Disorders, 2017Co-Authors: Ashild Tellefsen Haaland, Douglas W. Woods, Joseph A. Himle, Shirin O Eskeland, Erna M Moen, Patrick A Vogel, Svein Haseth, Kjetil Mellingen, Benjamin HummelenAbstract:Abstract Background This study sought to investigate the effectiveness of group treatment for trichotillomania (TTM) in ordinary clinical settings. Treatment consisted of a combination of Habit Reversal Training (HRT) and acceptance and commitment treatment (ACT). Both short- and long-term effects were explored, as well as individual change trajectories. Methods The sample consist of fifty-three patients with TTM. Treatment outcomes were evaluated at post-treatment and at one-year follow-up using self-report questionnaires (Massachusetts General Hospital Hair Pulling Scale, MGH-HS), structured clinical interviews (National Institute of Mental Health Trichotillomania Severity Scale, NIMH-TSS), and the Clinical Global Impression scale for TTM (CGI-TTM). Results Analyses by mixed models for repeated measurements yielded a statistically significant effect of time (p Conclusions ACT-enhanced behavior therapy in a group format seems efficient for reducing symptoms of trichotillomania.
-
Treating Trichotillomania (Hair-Pulling Disorder) in a Child.
Journal of clinical psychology, 2016Co-Authors: Ivar Snorrason, Michael R. Walther, T. David Elkin, Douglas W. WoodsAbstract:Although cognitive behavioral treatments (CBTs) have been recommended as first-line interventions for trichotillomania (hair-pulling disorder [HPD]), research on CBT for young children with HPD is limited. We illustrate the use of family-based CBT for HPD in an 8-year-old boy. The client had a 5-year history of chronic HPD and several large bald spots on the crown of his head. Treatment primarily comprised Habit Reversal Training (HRT) and function-based interventions. The child showed significant improvement in HPD severity and impairment after 8 weekly sessions, although complete abstinence was not achieved. The findings underscore the importance of parental involvement in the treatment and show that children as young as 8 years of age can successfully use strategies taught in HRT.
-
Treatment of Tic Disorders and Trichotillomania
Oxford Handbooks Online, 2012Co-Authors: Martin E. Franklin, Emily J. Ricketts, Diana Antinoro, Douglas W. WoodsAbstract:This chapter briefly describes tic disorders and trichotillomania (TTM) and reviews the pharmacotherapy and psychosocial treatment outcome literature for each of these conditions. In contrast to anxiety or depression, distorted or maladaptive cognitions do not appear to play a central role in the etiology or maintenance of tic disorders and TTM, and therefore cognitive therapy is not emphasized in the psychosocial treatments studied to date. Treatment protocols are best characterized as “behavioral,” although some include ancillary cognitive interventions. Behavioral treatments that include Habit Reversal Training (HRT) appear to hold the greatest promise for each of these conditions, and these are described in some detail. Future directions in treatment research are suggested.
Joseph F. Mcguire - One of the best experts on this subject based on the ideXlab platform.
-
Psychoeducation About Tic Disorders and Treatment
The Clinician's Guide to Treatment and Management of Youth with Tourette Syndrome and Tic Disorders, 2018Co-Authors: Joseph F. McguireAbstract:Abstract Psychoeducation is an important first step of treatment. It presents the opportunity to educate the patient and family about the illness and address common questions related to etiology, clinical course, prognosis, and treatment. This chapter provides an overview of psychoeducation for families and youth with Tourette disorder and other tic disorders. It presents the neurobehavioral model of Tourette disorder and outlines the orientation of patients and families to treatment with Habit Reversal Training and/or pharmacotherapy. The chapter concludes with a discussion of common myths and misconceptions related to Tourette disorder and its evidence-based treatment.
-
preliminary randomized controlled trial of Habit Reversal Training for treatment of hair pulling in youth
Journal of Child and Adolescent Psychopharmacology, 2017Co-Authors: Omar Rahman, Eric A. Storch, Joseph F. Mcguire, Adam B. LewinAbstract:Abstract Objectives: This study evaluated the treatment efficacy of Habit Reversal Training (HRT) relative to treatment as usual (TAU) for children and adolescents aged 7–17 years with a primary diagnosis of trichotillomania (TTM). Method: An initial assessment consisting of semistructured interviews and rating scales was conducted. Participants (N = 40, 85% female) meeting diagnostic criteria for TTM were randomized to either 8 weekly sessions of HRT by trained therapists or 8 weeks of TAU. One week after the final HRT session or final TAU week, patients completed a posttreatment assessment, followed by 1- and 3-month follow-up assessments. All assessments were conducted by a trained rater who was blinded to treatment condition. Results: The group by time analysis of variance yielded a significant interaction on the National Institute of Mental Health—Trichotillomania Severity Scale Total Score (F1,38 = 16.47, p < 0.001, η2p = 0.30). The mean score decreased from 12.67 ± 4.60 at baseline to 5.62 ± 4.38 a...
-
Preliminary Randomized Controlled Trial of Habit Reversal Training for Treatment of Hair Pulling in Youth.
Journal of child and adolescent psychopharmacology, 2016Co-Authors: Omar Rahman, Eric A. Storch, Joseph F. Mcguire, Adam B. LewinAbstract:Abstract Objectives: This study evaluated the treatment efficacy of Habit Reversal Training (HRT) relative to treatment as usual (TAU) for children and adolescents aged 7–17 years with a primary diagnosis of trichotillomania (TTM). Method: An initial assessment consisting of semistructured interviews and rating scales was conducted. Participants (N = 40, 85% female) meeting diagnostic criteria for TTM were randomized to either 8 weekly sessions of HRT by trained therapists or 8 weeks of TAU. One week after the final HRT session or final TAU week, patients completed a posttreatment assessment, followed by 1- and 3-month follow-up assessments. All assessments were conducted by a trained rater who was blinded to treatment condition. Results: The group by time analysis of variance yielded a significant interaction on the National Institute of Mental Health—Trichotillomania Severity Scale Total Score (F1,38 = 16.47, p
-
Behavior Therapy for Youth With Tourette Disorder.
Journal of clinical psychology, 2016Co-Authors: Joseph F. McguireAbstract:Persistent tic disorders and Tourette disorder (TD) are neuropsychiatric conditions that commonly co-occur among youth with obsessive-compulsive disorder. Although historically managed with pharmacological agents such as antipsychotics and alpha-2 agonists, behavioral interventions like Habit Reversal Training (HRT) and the comprehensive behavioral intervention for tics have demonstrated considerable efficacy in reducing tic symptom severity. This case study illustrates the implementation of behavior therapy in reducing tic symptom severity of an adolescent with TD. Arlene was a 14-year-old girl with TD who presented with moderate tic symptom severity that caused her physical, academic, and social impairment. In addition to concurrent pharmacotherapy, Arlene completed a 20-session weekly course of HRT, and experienced a clinically meaningful reduction in tic symptom severity and tic-related impairment. This example provides further evidence of the benefit of behavior therapy in reducing tic symptom severity and highlights key considerations for treatment of youth with TD.
-
Treating Tics and Tourette’s Disorder in School Settings
Canadian Journal of School Psychology, 2015Co-Authors: Michael L. Sulkowski, Joseph F. Mcguire, Andrew TesoroAbstract:Children with Tourette’s Disorder (TD) and other forms of tic disorders display a range of academic and psychosocial impairments that place them at risk for experiencing long-term negative life outcomes. Fortunately, effective treatments and interventions such as Habit Reversal Training (HRT) have been developed and implemented in clinical settings to help these children. However, relatively few youth with tics and related sequelae receive effective treatments for their symptoms, often because of various treatment barriers (e.g., travel difficulties, limitations in trained practitioners). To overcome some of these barriers, educators and school-based mental health practitioners can provide a range of academic, social-emotional, and mental health supports to address the needs of youth with tics in school settings. In support of this notion, this article discusses various ways that members of school communities can help support the academic and social-emotional success of students with tics and related impa...
Martin E. Franklin - One of the best experts on this subject based on the ideXlab platform.
-
Treatment of an Adult with Trichotillomania
Clinical Handbook of Obsessive-Compulsive and Related Disorders, 2015Co-Authors: Martin E. Franklin, Madelyn J. SilberAbstract:Trichotillomania (TTM) is an impulse-control disorder characterized by the pulling of scalp, facial, and/or body hair, resulting in noticeable hair loss. It is associated with significant functional impairment, such as poor school and work performance, disruption in family functioning, and social impairment. This chapter will focus on adults with TTM through a review of the relevant research, an overview of the nature of the problem, and a description and assessment of a clinical case. A detailed treatment overview will follow, describing the use of Habit Reversal Training (HRT) for reducing symptoms and improving functioning, along with a discussion of complicating factors. Finally, the chapter will highlight key practice points for clinicians treating adult TTM patients.
-
The Encyclopedia of Clinical Psychology - Trichotillomania/Hair Pulling Disorder
The Encyclopedia of Clinical Psychology, 2015Co-Authors: Hana F. Zickgraf, Martin E. FranklinAbstract:Trichotillomania (TTM) is characterized by an inability to resist urges to pull hair from the scalp, eyebrows, eyelashes, pubic region, or other bodily regions, resulting in noticeable hair loss. Episodes of pulling are often linked to stress. TTM is associated with psychiatric comorbidity and significant functional impairment. Habit Reversal Training, a form of cognitive behavioral therapy, is recognized as an empirically supported treatment for TTM in adults; several pharmacotherapy options appear to hold promise as well. Although pediatric onset appears to be the norm, the literature on treatment for TTM in children and adolescents remains sparse. Initial indications suggest that Habit Reversal Training is efficacious for this age group, and relapse may be less common in youth than it appears to be in adults. Treatment in the community is often inadequate; dissemination of Habit Reversal Training remains a public health priority. Keywords: psychopathology; adolescence; anxiety; children; hair; pediatric; pulling; trichophagia; trichotillomania
-
Habit Reversal Training in trichotillomania: guide for the clinician
Expert review of neurotherapeutics, 2013Co-Authors: Sarah H. Morris, Hana F. Zickgraf, Hilary E. Dingfelder, Martin E. FranklinAbstract:Trichotillomania (hair-pulling disorder) involves repetitive hair pulling that can cause significant distress and impairment in functioning. Both children and adults suffer from the disorder. Habit Reversal Training (HRT) is the trichotillomania treatment with the most empirical support. HRT begins with developing an in-depth understanding of the client’s unique pulling behaviors. The major components of HRT can then be carried out in a way that targets the client’s specific needs. These include awareness Training and self-monitoring, stimulus control and competing response procedures. Within each of these components the client learns to recognize his or her pulling urges, avoid situations in which pulling is more likely and adopt behaviors that can be used instead of pulling. Future work will involve evaluating the efficacy of adding therapy models such as mindfulness meditation in order to further enhance the effectiveness of HRT, and studying the long-term efficacy of HRT for children and adults.
-
Treatment of Tic Disorders and Trichotillomania
Oxford Handbooks Online, 2012Co-Authors: Martin E. Franklin, Emily J. Ricketts, Diana Antinoro, Douglas W. WoodsAbstract:This chapter briefly describes tic disorders and trichotillomania (TTM) and reviews the pharmacotherapy and psychosocial treatment outcome literature for each of these conditions. In contrast to anxiety or depression, distorted or maladaptive cognitions do not appear to play a central role in the etiology or maintenance of tic disorders and TTM, and therefore cognitive therapy is not emphasized in the psychosocial treatments studied to date. Treatment protocols are best characterized as “behavioral,” although some include ancillary cognitive interventions. Behavioral treatments that include Habit Reversal Training (HRT) appear to hold the greatest promise for each of these conditions, and these are described in some detail. Future directions in treatment research are suggested.
-
trichotillomania and its treatment a review and recommendations
Expert Review of Neurotherapeutics, 2011Co-Authors: Martin E. Franklin, Kathryn Zagrabbe, Kristin L BenavidesAbstract:Trichotillomania (TTM) is characterized as an impulse control disorder in which individuals fail to resist urges to pull out their own hair, and is associated with significant functional impairment and psychiatric comorbidity across the developmental spectrum. Onset in childhood or adolescence appears to be the norm, yet the research literature involving pediatric samples is particularly sparse. Efficacious treatments have been developed, in particular cognitive–behavioral interventions involving procedures collectively known as Habit Reversal Training, yet relapse in adults appears to be common. Recent developments in pharmacotherapies for TTM and in combining cognitive–behavioral therapy approaches with medication hold promise, and efforts to examine their relative and combined efficacy are needed. Dissemination of information about TTM and its treatment is a critical next step in the field, since many affected individuals and families cannot find local treatment providers with sufficient knowledge to d...
Eric A. Storch - One of the best experts on this subject based on the ideXlab platform.
-
preliminary randomized controlled trial of Habit Reversal Training for treatment of hair pulling in youth
Journal of Child and Adolescent Psychopharmacology, 2017Co-Authors: Omar Rahman, Eric A. Storch, Joseph F. Mcguire, Adam B. LewinAbstract:Abstract Objectives: This study evaluated the treatment efficacy of Habit Reversal Training (HRT) relative to treatment as usual (TAU) for children and adolescents aged 7–17 years with a primary diagnosis of trichotillomania (TTM). Method: An initial assessment consisting of semistructured interviews and rating scales was conducted. Participants (N = 40, 85% female) meeting diagnostic criteria for TTM were randomized to either 8 weekly sessions of HRT by trained therapists or 8 weeks of TAU. One week after the final HRT session or final TAU week, patients completed a posttreatment assessment, followed by 1- and 3-month follow-up assessments. All assessments were conducted by a trained rater who was blinded to treatment condition. Results: The group by time analysis of variance yielded a significant interaction on the National Institute of Mental Health—Trichotillomania Severity Scale Total Score (F1,38 = 16.47, p < 0.001, η2p = 0.30). The mean score decreased from 12.67 ± 4.60 at baseline to 5.62 ± 4.38 a...
-
Preliminary Randomized Controlled Trial of Habit Reversal Training for Treatment of Hair Pulling in Youth.
Journal of child and adolescent psychopharmacology, 2016Co-Authors: Omar Rahman, Eric A. Storch, Joseph F. Mcguire, Adam B. LewinAbstract:Abstract Objectives: This study evaluated the treatment efficacy of Habit Reversal Training (HRT) relative to treatment as usual (TAU) for children and adolescents aged 7–17 years with a primary diagnosis of trichotillomania (TTM). Method: An initial assessment consisting of semistructured interviews and rating scales was conducted. Participants (N = 40, 85% female) meeting diagnostic criteria for TTM were randomized to either 8 weekly sessions of HRT by trained therapists or 8 weeks of TAU. One week after the final HRT session or final TAU week, patients completed a posttreatment assessment, followed by 1- and 3-month follow-up assessments. All assessments were conducted by a trained rater who was blinded to treatment condition. Results: The group by time analysis of variance yielded a significant interaction on the National Institute of Mental Health—Trichotillomania Severity Scale Total Score (F1,38 = 16.47, p
-
A meta-analysis of behavior therapy for Tourette Syndrome.
Journal of psychiatric research, 2013Co-Authors: Joseph F. Mcguire, John Piacentini, Tanya K. Murphy, Adam B. Lewin, Erin A. Brennan, Brent J. Small, Eric A. StorchAbstract:Individual randomized controlled trials (RCTs) of Habit Reversal Training and a Comprehensive Behavioral Intervention for Tics (collectively referred to as behavior therapy, BT) have demonstrated efficacy in reducing tic severity for individuals with Tourette Syndrome and Chronic Tic Disorders (collectively referred to as TS), with no examination of treatment moderators. The present meta-analysis synthesized the treatment effect sizes (ES) of BT relative to comparison conditions, and examined moderators of treatment. A comprehensive literature search identified eight RCTs that met inclusion criteria, and produced a total sample of 438 participants. A random effects meta-analysis found a medium to large ES for BT relative to comparison conditions. Participant mean age, average number of therapy sessions, and the percentage of participants with co-occurring attention deficit hyperactivity disorder (ADHD) were found to moderate treatment effects. Participants receiving BT were more likely to exhibit a treatment response compared to control interventions, and identified a number needed to treat (NNT) of three. Sensitivity analyses failed to identify publication bias. Overall, BT trials yield medium to large effects for TS that are comparable to treatment effects identified by meta-analyses of antipsychotic medication RCTs. Larger treatment effects may be observed among BT trials with older participants, more therapeutic contact, and less co-occurring ADHD.
-
Exposure and Response Prevention and Habit Reversal Training: Commonalities, Differential Use, and Combined Applications
Journal of Contemporary Psychotherapy, 2013Co-Authors: Michael L. Sulkowski, Marni L. Jacob, Eric A. StorchAbstract:Obsessive-compulsive spectrum disorders (OCSDs) have compulsive (i.e., anxiety reductive) and impulsive (i.e., driven by emotional or involuntary impulses) features. The best established psychological treatments for these disorders are behavioral/cognitive-behavioral in nature. More specifically, exposure and response prevention (ERP) (with or without cognitive therapy) and Habit Reversal Training (HRT) are commonly indicated in the treatment of OCSDs. This paper reviews the use of various components of these therapeutic approaches to treat compulsive and impulsive symptomology in individuals with variants of these disorders. Specifically, ERP monotherapy for compulsive (e.g., obsessive-compulsive, body dysmorphic) and impulsive symptoms (e.g., tics, trichotillomania) is discussed as well as a combined treatment approach that integrates elements of ERP and HRT for individuals displaying mixed symptomology. A case example is also provided that illustrates the successful application of various components of ERP and HRT to treat OCSD symptoms. Lastly, other potential OCSD treatments are discussed.
-
Application of Habit Reversal Training for the Treatment of Tics in Early Childhood
Clinical Case Studies, 2011Co-Authors: Marissa Alexis Feldman, Eric A. Storch, Tanya K. MurphyAbstract:Habit-Reversal Training (HRT) has demonstrated efficacy in adults and in children above 9 years of age with tic disorders. However, less is known about the utility of this treatment with children y...
Nancy J. Keuthen - One of the best experts on this subject based on the ideXlab platform.
-
assessment and treatment of trichotillomania hair pulling disorder and excoriation skin picking disorder
Clinics in Dermatology, 2018Co-Authors: Grant Jones, Nancy J. Keuthen, Erica GreenbergAbstract:Recommendations are provided for the assessment and treatment of trichotillomania (hair pulling disorder, or HPD) and excoriation disorder (skin picking disorder, or SPD), two body-focused repetitive behavior (BFRB) disorders, based on their severity, comorbidities, and behavioral style. Habit Reversal Training (HRT) and stimulus control are first-line behavioral treatments that can be used in cases of all severity levels and may be particularly helpful when pulling or picking is performed with lowered awareness/intention. Acceptance and commitment therapy (ACT) and dialectical behavior therapy (DBT) are behavioral treatments that can be employed to augment HRT/stimulus control, especially when negative emotions trigger the pulling or picking. There are currently no FDA-approved pharmacologic treatments for HPD or SPD, though certain medications/supplements have shown varying degrees of efficacy in trials. N-acetylcysteine (NAC) should be considered for all severity levels and styles given its moderate gain/low side effect profile. Other pharmacologic interventions, including selective serotonin reuptake inhibitors (SSRIs), should be considered in cases with significant comorbidities or previous behavioral/NAC treatment failure.
-
cognitive behavioral treatment for trichotillomania hair pulling disorder and excoriation skin picking disorder
2016Co-Authors: Nancy J. Keuthen, Aisha UsmaniAbstract:Trichotillomania and pathological skin picking have long been viewed as obsessive–compulsive spectrum disorders. Now known as Trichotillomania (Hair-Pulling Disorder) and Excoriation (Skin-Picking) Disorder, both are included in the OCD and Related Disorders section in DSM-5. This chapter briefly focuses on prevalence, phenomenology, and etiology of these disorders. Cognitive behavioral mechanisms and empirically supported cognitive behavioral treatments are explained in detail, including Habit Reversal Training (HRT) and stimulus control, as well as augmenting strategies from acceptance and commitment therapy (ACT) to dialectical behavior therapy (DBT). Finally, the application of treatment principles is highlighted with a case presentation.
-
current treatment practices for children and adults with trichotillomania consensus among experts
Cognitive and Behavioral Practice, 2010Co-Authors: Christopher A Flessner, Fred Penzel, Nancy J. KeuthenAbstract:Abstract Very little is known regarding the efficacy of pharmacological and psychosocial treatments for children and adults with trichotillomania (TTM). Given this dearth of information, the present investigation sought to examine the treatment practices of members of the nationally recognized Trichotillomania Learning Center–Scientific Advisory Board (TLC-SAB) and practitioners known by members of the TLC-SAB to possess extensive experience working with this population. The responses of 67 practitioners to an Internet-based survey were examined. Our results clearly indicate that cognitive-behavioral treatment (CBT) is the treatment of choice for both children and adults with TTM. In particular, several components of CBT (i.e., awareness Training, self-monitoring, competing response Training, Habit Reversal Training, and stimulus control) are implemented most often. Selective serotonin reuptake inhibitors (SSRIs, e.g., citalopram, fluoxetine) and serotonin-norepinepherine reuptake inhibitors (SNRIs, e.g., venlafaxine, duloxetine) were prescribed most frequently; however, these results are preliminary given our small sample of prescribing practitioners (n = 11). Taken together, these findings are a critical starting point to advancing the understanding of efficacious interventions for the treatment of individuals with TTM. Clinical and research implications, future areas of research, and study limitations are discussed.
-
single modality versus dual modality treatment for trichotillomania sertraline behavioral therapy or both
The Journal of Clinical Psychiatry, 2006Co-Authors: Darin D. Dougherty, Michael A Jenike, Nancy J. KeuthenAbstract:Background: Trichotillomania is a psychiatric condition characterized by chronic hair pulling. Both cognitive behavioral therapy (CBT) and the selective serotonin reuptake inhibitors (SSRIs) have shown promise in the treatment of trichotillomania, with comparison studies favoring CBT over pharmacotherapy. However, no randomized, controlled studies to date have compared the efficacy of individual SSRI or CBT treatment to the combination of both treatment modalities. Method: In this study, which ran from February 2000 through April 2003, subjects who met DSM-IV criteria for trichotillomania were randomly assigned to treatment with sertraline or placebo in a double-blind study design. Following 12 weeks of active pharmacotherapy, subjects not demonstrating significant trichotillomania symptom improvement had Habit Reversal Training (HRT) added to their treatment regimen. Primary outcome measures were the Hair Pulling Scale and the Clinical Global Impressions scale. Results: Thirteen subjects completing the 22-week study received single modality treatment of either sertraline or HRT, and 11 received both modalities of treatment. Trichotillomania symptoms in both groups improved, although the dual modality treatment group demonstrated larger gains and were much more likely to reach responder status at final evaluation. Conclusion: These results suggest that the combination of sertraline and HRT may be more efficacious in the treatment of trichotillomania than either approach alone.
