A Placebo-Controlled Trial of Cognitive-Behavioral Therapy and Clomipramine in Trichotillomania
J Clin Psychiatry 2000;61(1):47-50
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Background: The major treatments reported
to be effective in the treatment of trichotillomania are
cognitive-behavioral therapy (CBT) with habit reversal and
serotonin-norepinephrine reuptake inhibitors such as
clomipramine. However, the 2 treatments have not been previously
compared with each other. This study examines the efficacy of CBT
and clomipramine compared with placebo in the treatment of
Method: Twenty-three patients with
trichotillomania as determined by the Structured Clinical
Interview for DSM-III-R entered and 16 completed a 9-week,
placebo-controlled, randomized, parallel-treatment study of CBT
and clomipramine. Efficacy was evaluated by the Trichotillomania
Severity Scale, the Trichotillomania Impairment Scale, and the
Clinical Global Impressions-Improvement scale, which were
conducted by an independent assessor blinded to the treatment
Results: CBT had a dramatic effect in
reducing symptoms of trichotillomania and was significantly more
effective than clomipramine (p = .016) or placebo (p = .026).
Clomipramine resulted in symptom reduction greater than that with
placebo, but the difference fell short of statistical
significance. Placebo response was minimal.
Conclusion: Clinicians should be aware of
the potential treatments available for trichotillomania. A larger
and more definitive study comparing CBT and a
serotonin-norepinephrine reuptake inhibitor is indicated.