TY - JOUR
T1 - Treating trichotillomania
T2 - A meta-analysis of treatment effects and moderators for behavior therapy and serotonin reuptake inhibitors
AU - McGuire, Joseph F.
AU - Ung, Danielle
AU - Selles, Robert R.
AU - Rahman, Omar
AU - Lewin, Adam B.
AU - Murphy, Tanya K.
AU - Storch, Eric A.
N1 - Funding Information:
Ms. Ung, Mr. Selles, and Dr. Rahman report no relevant disclosures. Mr. McGuire receives support from the National Institute of Mental Health ( MH093381 ) of the National Institutes of Health under award R01MH093381. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health. Dr. Lewin has served as a consultant for Otsuka America Pharmaceutical and ProPhase, Inc. He has received grant support from International Obsessive Compulsive Disorder Foundation ; National Alliance for Research on Schizophrenia and Depression ; University of South Florida Research Foundation, Inc . He has received travel support from University of South Florida Research Foundation, Inc. Dr. Murphy has received research funding from National Institutes of Health , Centers for Disease Control and Prevention , Otsuka Pharmaceuticals , NARSAD , IOCDF , Ortho-McNeil Janssen Pharmaceuticals , Shire Pharmaceuticals , Pfizer and Indevus Pharmaceuticals . She has received travel support from the Tourette Syndrome Association and honorarium from grand rounds lectures. Dr. Storch has received grant funding in the last 2 years from the National Institutes of Health, Centers for Disease Control and Prevention, Agency for Healthcare Research and Quality , National Alliance for Research on Schizophrenia and Affective Disorders , International OCD Foundation, Tourette Syndrome Association, and Janssen Pharmaceuticals . He receives textbook honorarium from Springer publishers, American Psychological Association, and Lawrence Erlbaum. Dr. Storch has been an educational consultant for Rogers Memorial Hospital. He is a consultant for Prophase, Inc. and CroNos, Inc., and is on the Speaker's Bureau and Scientific Advisory Board for the International OCD Foundation. He receives research support from the All Children's Hospital Guild Endowed Chair .
Publisher Copyright:
© 2014 Elsevier Ltd.
PY - 2014/11/1
Y1 - 2014/11/1
N2 - 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.
AB - 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.
KW - Behavior therapy
KW - Clomipramine
KW - Habit reversal training
KW - Hair pulling disorder
KW - Obsessive-compulsive spectrum disorders
KW - Selective serotonin reuptake inhibitors
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UR - http://www.scopus.com/inward/citedby.url?scp=84912574276&partnerID=8YFLogxK
U2 - 10.1016/j.jpsychires.2014.07.015
DO - 10.1016/j.jpsychires.2014.07.015
M3 - Article
C2 - 25108618
AN - SCOPUS:84912574276
SN - 0022-3956
VL - 58
SP - 76
EP - 83
JO - Journal of Psychiatric Research
JF - Journal of Psychiatric Research
ER -