title: Single modality versus dual modality treatment for trichotillomania: sertraline, behavioral therapy, or both?
abstract: BACKGROUND
  Trichotillomania is a psychiatric condition characterized by chronic hair pulling. Both cognitive behavioral therapy (CBT) and the selective serotonin reuptake inhibitors (SSRIs) have shown promise in the treatment of trichotillomania, with comparison studies favoring CBT over pharmacotherapy. However, no randomized, controlled studies to date have compared the efficacy of individual SSRI or CBT treatment to the combination of both treatment modalities.
  
  
  METHODS
  In this study, which ran from February 2000 through April 2003, subjects who met DSM-IV criteria for trichotillomania were randomly assigned to treatment with sertraline or placebo in a double-blind study design. Following 12 weeks of active pharmacotherapy, subjects not demonstrating significant trichotillomania symptom improvement had habit reversal training (HRT) added to their treatment regimen. Primary outcome measures were the Hair Pulling Scale and the Clinical Global Impressions scale.
  
  
  RESULTS
  Thirteen subjects completing the 22-week study received single modality treatment of either sertraline or HRT, and 11 received both modalities of treatment. Trichotillomania symptoms in both groups improved, although the dual modality treatment group demonstrated larger gains and were much more likely to reach responder status at final evaluation.
  
  
  CONCLUSIONS
  These results suggest that the combination of sertraline and HRT may be more efficacious in the treatment of trichotillomania than either approach alone.
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. ddougherty@partners.org
authors.forename: Darin D
authors.initials: DD
authors.lastname: Dougherty
authors.forename: Rebecca
authors.initials: R
authors.lastname: Loh
authors.forename: Michael A
authors.initials: MA
authors.lastname: Jenike
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Keuthen
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010919:Placebos; D011569:Psychiatric Status Rating Scales; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D020280:Sertraline / Q000627:therapeutic use*; D016896:Treatment Outcome; D014256:Trichotillomania / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*
chemical_list: D010919:Placebos; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline