title: 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.
authors.affiliation: Department of Psychology, University of South Florida, United States; Department of Pediatrics, University of South Florida, United States. Electronic address: jfmcguire@mail.usf.edu.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: McGuire
authors.affiliation: Department of Psychology, University of South Florida, United States; Department of Pediatrics, University of South Florida, United States.
authors.forename: Danielle
authors.initials: D
authors.lastname: Ung
authors.affiliation: Department of Psychology, University of South Florida, United States; Department of Pediatrics, University of South Florida, United States.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Selles
authors.affiliation: Department of Pediatrics, University of South Florida, United States.
authors.forename: Omar
authors.initials: O
authors.lastname: Rahman
authors.affiliation: Department of Psychology, University of South Florida, United States; Department of Pediatrics, University of South Florida, United States; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, United States.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Lewin
authors.affiliation: Department of Pediatrics, University of South Florida, United States; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, United States.
authors.forename: Tanya K
authors.initials: TK
authors.lastname: Murphy
authors.affiliation: Department of Psychology, University of South Florida, United States; Department of Pediatrics, University of South Florida, United States; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, United States; Rogers Behavioral Health - Tampa Bay, United States; All Children's Hospital - Johns Hopkins Medicine, United States.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Storch
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001521:Behavior Therapy / Q000379:methods*; D002997:Clomipramine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome; D014256:Trichotillomania / Q000188:drug therapy* / Q000534:rehabilitation*; D055815:Young Adult
chemical_list: D002997:Clomipramine; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Behavior therapy; Clomipramine; Habit reversal training; Hair pulling disorder; Obsessive–compulsive spectrum disorders; Selective serotonin reuptake inhibitors
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