The goal of the research is to design, develop and test a inconspicuous, awareness-enhancement and monitoring device (AEMD) which will assist the treatment of trichotillomania (TTM), a disorder involving recurrent pulling of one’s hair resulting in noticeable hair loss. TTM is associated with significant impairments in social functioning and often has a profound negative impact on self-esteem and well being. Best practice treatment for TTM involves a form of behavioral therapy known as habit reversal therapy (HRT). HRT requires persons with trichotillomania to be aware of their hair pulling behaviors, yet the majority of persons with TTM pull most of their hair outside of their awareness . HRT also requires TTM sufferers to record the frequency and duration of their hair pulling behaviors yet it is obviously impossible for a person to monitor behaviors that they are unaware of. Our Phase I efforts have produced a prototype device (AEMD) that solves these two problems. The prototype AEMD signals the TTM sufferer if their hand approaches their hair, thereby bringing pulling-related behavior into awareness. The prototype AEMD also logs the time, date, duration, and user classification of hair pulling related events and can later transfer the logged data to a personal computer for analysis and data presentation. We continue to refine this device and seek to integrate it with smart-phones to better understand activities and locations associated with hair pulling or other body-focused repetitive behaviors (e.g., skin picking). In the future, we seek to pool data from users to get a better sense of common situations and other factors associated with elevated pulling rates. We intend to develop other electronic tools to detect, monitor and intervene with other mental disorders in the future.
Daniel Almirall, Ph.D., is Assistant Professor in the Survey Research Center and Faculty Associate in the Population Studies Center in the Institute for Social Research at the University of Michigan.
Prof. Almirall’s current methodological research interests lie in the broad area of causal inference. He is particularly interested in methods for causal inference using longitudinal data sets in which treatments, covariates, and outcomes are all time-varying. He is also interested in developing statistical methods that can be used to form adaptive interventions, sometimes known as dynamic treatment regimes. An adaptive intervention is a sequence of individually tailored decisions rules that specify whether, how, and when to alter the intensity, type, or delivery of treatment at critical decision points in the medical care process. Adaptive interventions are particularly well-suited for the management of chronic diseases, but can be used in any clinical setting in which sequential medical decision making is essential for the welfare of the patient. They hold the promise of enhancing clinical practice by flexibly tailoring treatments to patients when they need it most, and in the most appropriate dose, thereby improving the efficacy and effectiveness of treatment.
Study Design Interests: In addition to developing new statistical methodologies, Prof. Almirall devotes a portion of his research to the design of sequential multiple assignment randomized trials (SMARTs). SMARTs are randomized trial designs that give rise to high-quality data that can be used to develop and optimize adaptive interventions.
Substantive Interests: As an investigator and methodologist in the Institute for Social Research, Prof. Almirall takes part in research in a wide variety of areas of social science and treatment (or interventions) research. He is particularly interested in the substantive areas of mental health (depression, anxiety) and substance abuse, especially as related to children and adolescents.