title: Preliminary Randomized Controlled Trial of Habit Reversal Training for Treatment of Hair Pulling in Youth.
abstract: This study evaluated the treatment efficacy of habit reversal training (HRT) relative to treatment as usual (TAU) for children and adolescents aged 7-17 years with a primary diagnosis of trichotillomania (TTM).
  
  
  
  An initial assessment consisting of semistructured interviews and rating scales was conducted. Participants (N = 40, 85% female) meeting diagnostic criteria for TTM were randomized to either 8 weekly sessions of HRT by trained therapists or 8 weeks of TAU. One week after the final HRT session or final TAU week, patients completed a posttreatment assessment, followed by 1- and 3-month follow-up assessments. All assessments were conducted by a trained rater who was blinded to treatment condition.
  
  
  
  The group by time analysis of variance yielded a significant interaction on the National Institute of Mental Health-Trichotillomania Severity Scale Total Score (F1,38= 16.47, p < 0.001, η2p= 0.30). The mean score decreased from 12.67 ± 4.60 at baseline to 5.62 ± 4.38 at posttreatment in the HRT group (t20= 5.99, p < 0.001, d = 1.31), whereas the TAU group changed from 10.42 ± 4.35 to 9.32 ± 4.11 (t18= 1.34, p = 0.20, d = 0.31). The Massachusetts General Hospital-Hair Pulling Scale Total Score decreased from 15.14 ± 3.86 at baseline to 7.14 ± 5.54 at posttreatment in the HRT group (t20= 6.16, p < 0.001, d = 1.34); the TAU group changed from 14.16 ± 4.51 to 12.26 ± 4.34 (t18= 1.50, p = 0.15, d = 0.34). On the Clinical Global Impressions-Improvement, 16/21 participants (76%) were rated as treatment responders in the HRT group versus 4/19 (21%) in the TAU group (χ2= 12.13, p < 0.001, V = 0.55). At 1-month follow-up, 10-12 treatment responders who completed the assessment maintained improvement. At 3-month follow-up, six of eight maintained improvement.
  
  
  
  HRT can be an effective treatment for TTM in youth.
authors.affiliation: 1 Department of Pediatrics, University of South Florida , Tampa, Florida.|2 Department of Psychiatry and Behavioral Neurosciences, University of South Florida , Tampa, Florida.
authors.forename: Omar
authors.initials: O
authors.lastname: Rahman
authors.affiliation: 3 Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles , Los Angeles, California.
authors.forename: Joseph
authors.initials: J
authors.lastname: McGuire
authors.affiliation: 1 Department of Pediatrics, University of South Florida , Tampa, Florida.|2 Department of Psychiatry and Behavioral Neurosciences, University of South Florida , Tampa, Florida.|4 Department of Health Policy and Management, University of South Florida , Tampa, Florida.|5 Rogers Behavioral Health-Tampa Bay , Tampa, Florida.|6 All Children's Hospital-Johns Hopkins Medicine , St. Petersburg, Florida.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Storch
authors.affiliation: 1 Department of Pediatrics, University of South Florida , Tampa, Florida.|2 Department of Psychiatry and Behavioral Neurosciences, University of South Florida , Tampa, Florida.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Lewin
mesh_terms: D000293:Adolescent; D001521:Behavior Therapy / Q000379:methods*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006184:Habits; D006801:Humans; D008297:Male; D012193:Reversal Learning; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014256:Trichotillomania / Q000628:therapy*
keywords: habit reversal training; hair pulling; trichotillomania