Clinical Summary
Clinical Summary: Therapist-Delivered Video Therapy Habit Reversal Training for Body-Focused Repetitive Behaviors: Clinical Outcomes From a Large Real-World Sample of Youth and Adults
Many patients with trichotillomania or excoriation disorder never reach evidence-based care despite substantial distress, impairment, and common psychiatric comorbidity. This study addresses whether therapist-delivered video habit reversal training with messaging and app-based support produces meaningful real-world improvement across children, adolescents, and adults.
Design
This was a retrospective, observational longitudinal analysis of clinical data
N
1,071 eligible patients with either trichotillomania or ED
Population
including children, adolescents, and adults with primary diagnoses of their respective conditions
Duration
between May 2021 and February 2025
Key Findings
- By weeks 14–16, trichotillomania symptoms improved from a mean of 7.84 (SD 2.29) to 5.27 (SD 2.73), a −2.56-point, 29.90% reduction (Hedges g=1.01, 95% CI, [0.88–1.14], n=422; F(2, 985.9) = 245.58, P < .001).
- By weeks 14–16, ED symptoms improved from a mean of 7.89 (SD 2.14) to 5.13 (SD 2.57), a −2.74-point, 32.79% reduction (Hedges g=1.16, 95% CI, [1.02–1.30], n=409; F2,955.75 =321.99, P<.001).
- Clinically meaningful response (≥35% improvement) at weeks 14–16 was achieved by 44.1% (186/422) of trichotillomania patients and 48.7% (199/409) of ED patients; 90.5% improved at all in both groups (382/422 and 370/409, respectively).
- More treatment exposure was associated with lower symptom severity: for trichotillomania, session count predicted lower severity (b=−0.11, SE=0.04, t932.45 =−2.84, P=.005), and for ED the association was similar (b=−0.12, SE=0.03, t926.54 =−3.68, P<.001).
- Among patients with follow-up data, gains were maintained or increased through week 52: trichotillomania showed 45.5% mean symptom reduction at weeks 41–52 (n=122; g=1.51 [95% CI, 1.23–1.79]) and excoriation showed 44.1% reduction (n=134; g=1.56 [95% CI, 1.29–1.84]).
Clinical Bottom Line
Therapist-delivered video HRT with integrated digital support produced large symptom reductions for both trichotillomania and excoriation disorder in routine care, with benefit seen by weeks 5–7 and maintained through follow-up among those still assessed. For patients who cannot access in-person specialty care, this is a practical evidence-based treatment option to offer.
Practice Implications
- Consider therapist-delivered video HRT for patients with trichotillomania or ED when geography, provider scarcity, or scheduling barriers limit access to in-person specialty treatment.
- Set expectations that improvement can appear early but is often incomplete by weeks 14–16: mean RBFBS scores were still 5.27 for trichotillomania and 5.13 for ED, within the moderate severity range.
- Encourage continued session attendance and between-session skill use, because greater session count was associated with lower symptom severity in both trichotillomania (b=−0.11, P=.005) and ED (b=−0.12, P<.001).
- Treat comorbid mood and anxiety symptoms directly when clinically indicated, since secondary improvements were smaller, with depression, anxiety, and stress effects of g=0.26–0.29, g =0.22–0.26, and g=0.27–0.28.
