1 - (SYM 28) A GIMME Network Examination of Trichotillomania Treatment Processes: Gathering Indionomic Insights to Inform a Personalized Therapeutic Framework for Trichotillomania

Background: Trichotillomania, characterized by repeated hair pulling with associated distress and impairment, persists as a challenge despite evidence-based treatments, with patients often relapsing. Research has documented individual differences in behavioral profiles, such as focused versus automatic subtypes of hair pulling, as well as variation in emotional triggers and consequences (Woods et al., 2006; Hicks et al., 2023). These findings highlight heterogeneity among trichotillomania sufferers and suggest a need for personalized treatment approaches. Our study employed GIMME to assess treatment-relevant network paths in trichotillomania at the group and individual levels, aiming to inform tailored therapeutic approaches and case conceptualizations.

Method: Data from 54 participants meeting criteria for trichotillomania were collected over a 30-day period using ecological momentary assessment. Participants were prompted to complete three surveys per day, with the average participant completing 70.5 observations. GIMME searched for network paths at the individual level, while also considering potential group-level effects. This was followed by a two-stage random-effects meta-analysis to examine heterogeneity in direct process to hair pulling relationships. We then showcased individual networks by summarizing centrality indices and providing narrative case studies of selected participants.

Results: Significant group-level network paths emerged where the urge to do something with one’s hands was linked to the urge to pull hair, which was closely linked to the action itself. Individual-level analysis showed considerable variability in the direct processes leading to hair pulling, as indicated by the two-stage random-effects meta-analysis. Centrality analysis identified valued action and tactile engagement with hair as the most influential processes across the sample, albeit with variability among other processes for a substantial subset of participants. The observed heterogeneity warranted a holistic review of individual networks. Case-conceptualizations were provided for several different participant networks.

Conclusion: Although network findings reveal a set of pathways applicable at the group level, suggesting a component of nomothetic treatment, the heterogeneity observed across networks underscores the need for individualized treatment plans for those with trichotillomania. Implications for next steps (e.g., clinical trial) and clinical applications will be discussed.