Single Modality Versus Dual Modality Treatment for Trichotillomania: Sertraline, Behavioral Therapy, or Both?
J Clin Psychiatry 2006;67(7):1086-1092
© Copyright 2017 Physicians Postgraduate Press, Inc.
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Background: Trichotillomania is a
psychiatric condition characterized by chronic hair
pulling. Both cognitive behavioral therapy (CBT) and
the selective serotonin reuptake inhibitors
(SSRIs) have shown promise in the treatment of
trichotillomania, with comparison studies favoring
CBT over pharmacotherapy. However, no randomized, controlled studies to date have compared the
efficacy of individual SSRI or CBT treatment to
the combination of both treatment modalities.
Method: In this study, which ran from
February 2000 through April 2003, subjects who met DSM-IV criteria for trichotillomania were
randomly assigned to treatment with sertraline or placebo in a double-blind study design.
Following 12 weeks of active pharmacotherapy,
subjects not demonstrating significant
trichotillomania symptom improvement had habit reversal
training (HRT) added to their treatment regimen.
Primary outcome measures were the Hair Pulling
Scale and the Clinical Global Impressions scale.
Results: Thirteen subjects completing the
22-week study received single modality treatment
of either sertraline or HRT, and 11 received both modalities of treatment. Trichotillomania
symptoms in both groups improved, although the
dual modality treatment group demonstrated larger gains and were much more likely to reach
responder status at final evaluation.
Conclusion: These results suggest that
the combination of sertraline and HRT may be more efficacious in the treatment of
trichotillomania than either approach alone.