Group treatment for trichotillomania: cognitive-behavioral therapy versus supportive therapy

Trichotillomania is a psychiatric condition characterized by the chronic pulling and plucking of one's own hair. Cognitive-behavioral therapy shows promise as a treatment for trichotillomania and might be preferable to pharmacotherapy. However, there have been no randomized, controlled studies of the efficacy of group cognitive-behavioral therapy.

We evaluated 44 subjects, recruited from April 2009 to May 2010, all of whom met DSM-IV criteria for a diagnosis of trichotillomania. Subjects were randomized to receive 22 sessions of either group cognitive-behavioral therapy or group supportive therapy (control). Treatment evaluation was non-blind and used self-report scales. The primary outcome measure was the improvement of hair-plucking behavior as assessed by the Massachusetts General Hospital Hairpulling Scale. Secondary measures included scores on the Beck Depression Inventory, the Beck Anxiety Inventory, and the Social Adjustment Scale-Self-Report.

Both groups showed significant posttreatment improvement in the scores from the Massachusetts General Hospital Hairpulling Scale (F = 23.762, P < .001) and the Beck Depression Inventory (F = 6.579, P = .003). The decrease in hair-plucking behavior over time was significantly greater in the study group than in the control group (F = 3.545, P < .038). There were no significant differences between the pretreatment and posttreatment time points or between the groups in the scores from the Beck Anxiety Inventory and the Social Adjustment Scale-Self-Report.

We conclude that group cognitive-behavioral therapy is a valid treatment for trichotillomania. This treatment model should be further revised and expanded to address comorbidities such as anxiety and social maladjustment.

ClinicalTrials.gov identifier: NCT01968343.