Treating trichotillomania: A meta-analysis of treatment effects and moderators for behavior therapy and serotonin reuptake inhibitors

Abstract

Few randomized controlled trials (RCTs) exist examining the efficacy of behavior therapy (BT) or serotonin reuptake inhibitors (SRIs) for the treatment of trichotillomania (TTM), with no examination of treatment moderators. The present meta-analysis synthesized the treatment effect sizes (ES) of BT and SRI relative to comparison conditions, and examined moderators of treatment. A comprehensive literature search identified 11 RCTs that met inclusion criteria. Clinical characteristics (e.g., age, comorbidity, therapeutic contact hours), outcome measures, treatment subtypes (e.g., SRI subtype, BT subtype), and ES data were extracted. The standardized mean difference of change in hair pulling severity was the outcome measure. A random effects meta-analysis found a large pooled ES for BT (ES= 1.41, p< 0.001). BT trials with greater therapeutic contact hours exhibited larger ES (p= 0.009). Additionally, BT trials that used mood enhanced therapeutic techniques exhibited greater ES relative to trials including only traditional BT components (p= 0.004). For SRI trials, a random effects meta-analysis identified a moderate pooled ES (ES= 0.41, p= 0.02). Although clomipramine exhibited larger ES relative to selective serotonin reuptake inhibitors, the difference was not statistically significant. Publication bias was not identified for either treatment. BT yields large treatment effects for TTM, with further examination needed to disentangle confounded treatment moderators. SRI trials exhibited a moderate pooled ES, with no treatment moderators identified. Sensitivity analyses highlighted the need for further RCTs of SRIs, especially among youth with TTM.

Trikotillomani

“…I en metaanalyse av syv kontrollerte randomiserte studier av atferdsterapi og seks av antidepressiver fant man gjennomsnittlig god effektstørrelse for atferdsterapi (1,41) og lav til moderat effektstørrelse for antidepressiver (0, 41) (10). I studiesammenheng er antidepressiver gitt over 10-12 uker, og det er usikkert om effekten vedvarer over tid.…”

“…Vaneendringstrening er effektivt både for barn og voksne med trikotillomani (10). Placebosituasjonen i studier av atferdsterapi varierer fra å gi en annen type atferdsintervensjon til ventelistekontroll.…”

Evidence-Based Psychosocial Treatments for Pediatric Body-Focused Repetitive Behavior Disorders

“…Several recent meta-analyses have evaluated the efficacy of interventions for adults with TTM (Bloch et al, 2007;McGuire et al, 2014) and ExD (Gelinas & Gagnon, 2013), but similar analyses have not been performed for pediatric populations.…”

“…It is important to note that although some forms of medication have been shown to be at least partially effective for treating BFRBs (Bloch et al, 2007;Gelinas & Gagnon, 2013;McGuire et al, 2014), such studies are not reviewed in this text.…”

“…The results of this critical evidence base review of psychosocial treatments for pediatric BFRBs reflect the disappointing state of the current literature. Although the evidence for treatments in adult populations has grown enough to merit meta-analyses (Bloch et al, 2007;Gelinas & Gagnon, 2013;McGuire et al, 2014), treatments for pediatric populations remain on tenuous empirical footing.…”