Preliminary Randomized Controlled Trial of Habit Reversal Training for Treatment of Hair Pulling in Youth

Abstract

Objectives:

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).

Method:

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.

Results:

The group by time analysis of variance yielded a significant interaction on the National Institute of Mental Health—Trichotillomania Severity Scale Total Score (F _1,38 = 16.47, p < 0.001, η ² _p = 0.30). The mean score decreased from 12.67 ± 4.60 at baseline to 5.62 ± 4.38 at posttreatment in the HRT group (t ₂₀ = 5.99, p < 0.001, d = 1.31), whereas the TAU group changed from 10.42 ± 4.35 to 9.32 ± 4.11 (t ₁₈ = 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 (t ₂₀ = 6.16, p < 0.001, d = 1.34); the TAU group changed from 14.16 ± 4.51 to 12.26 ± 4.34 (t ₁₈ = 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 (χ ² = 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.

Conclusions:

HRT can be an effective treatment for TTM in youth.