Last week, I had the opportunity to present HabitAware's ongoing NIMH-funded research at the Body-Focused Repetitive Behaviors (BFRB) UK Conference at Oxford University, a gathering of experts from all backgrounds: lived experience advocates, specialist mental health clinicians, dermatologists, and multidisciplinary researchers. The study is a collaboration with Dr. Christopher Flessner and his team at Kent State University, and getting to share it at an international conference was an exciting milestone for us!
If you or someone you love pulls hair, you probably already know how hard it is to get help. There aren't enough therapists who specialize in hair pulling disorder (trichotillomania). Even when people do access treatment, it’s HARD! One of the biggest obstacles is that pulling can happen almost automatically. You look down and realize you've been pulling for 10 minutes without noticing. Another challenge to treatment is that you see your therapist once a week, but pulling can happen anywhere, any time. Your therapist isn’t there to suggest skills or strategies when the urges show up.
These are the problems we are focused on tackling with our research. We created and tested a comprehensive Keen bracelet and app program. It included the Keen2 awareness bracelet paired with a NEW behavioral strategy smartphone app (not publicly available). The idea was to create something that supports you in using the key skills for you, in the right moment, even when a therapist isn't in the room.
Here's how it worked:
The first four weeks were about building awareness. We asked 10 participants (adults with hair pulling disorder) to wear the Keen bracelet daily. When the bracelet detected a hair-pulling gesture, it vibrated - an awareness nudge to say, “this is happening right now.” At the same time, participants were asked to notice and log the context around their pulling in the app: Where were they? What were they doing? How were they feeling? Bored at a desk, anxious in traffic, winding down before bed… when those details were logged, it started to build the participants’ (and the app’s) understanding of their particular pulling triggers.
The second four weeks were where things got exciting. Using what the app had learned about each person's unique pulling patterns, it began sending personally-matched behavioral strategy suggestions that were delivered right before a predicted pulling episode. Rather than generic reminders at random times, these were timed suggestions informed by that person’s own data. For example, if the app expected a participant might start pulling soon, triggered by a long period of working at their desk, it might suggest taking a short walk, to move their body and interrupt the pattern.
This was an early-stage open trial - a first step in a small sample, designed to ask whether this approach is safe, workable, and worth pursuing further. And the results were genuinely encouraging. Here’s what we found:
People used it and liked it. Nearly two-thirds of the 8 participants who completed study assessments reported that they followed the app's behavioral strategy suggestions most of the time. And when asked whether they'd recommend this system to a friend or family member who pulls, all 8 participants said yes.
Pulling decreased. Across measures of hair-pulling severity and impairment rated both by clinicians and participants themselves, we saw reductions over the course of the 8 week study. Hair-pulling severity dropped by roughly 36–40% on average, and impairment related to pulling decreased by about 47%. These changes reached statistical significance, meaning they're unlikely to be due to chance.
Stay tuned! These encouraging findings suggest that a larger, more rigorous test is clearly warranted. We are now completing a randomized controlled trial, the gold standard in clinical research. We're enrolling 90 adults with hair pulling disorder in the U.S., and participants are randomly assigned to different conditions so we can understand what's driving the results. We're working hard, and our hope is that once this larger trial is complete, we can bring this updated Keen system to you.
— Hilary and The HabitAware Team
