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Abstract Background and aims Limited treatment options are available for trichotillomania TTM and most have modest outcomes.

Suboptimal treatment results may be due to the failure of existing approaches to address all TTM styles. MAC participants had active treatment after the week control condition. Follow-up study assessments were conducted three and six months after the maintenance period.

Results Open trial treatment resulted in significant improvement in TTM severity, emotion regulation ER capacity, experiential avoidance, anxiety and depression with changes generally maintained over time. In the randomized controlled trial, those with active treatment had greater improvement than those in the MAC condition for both TTM severity and ER capacity.

Correlations between changes in TTM severity and ER capacity were not reported at post-treatment but did occur in maintenance and follow-up indicating reduced TTM severity with improved ER capacity. Future studies should compare this approach to other credible treatment interventions and investigate the efficacy of this approach in more naturalistic samples with greater comorbidity.

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