Key Takeaways
Extended Takeaways
- Symptom improvement was already detectable by weeks 5–7, with RBFBS scores falling by −1.65 points, 18.32% for trichotillomania and −1.55 points, 17.51% for ED, suggesting clinicians may be able to identify early benefit within the first 2 assessment intervals.
- At weeks 14–16, mean scores improved but remained in the moderate range on the RBFBS (5.27 for trichotillomania; 5.13 for ED), so patients should be counseled that meaningful response may occur before symptoms reach mild levels.
- Greater session exposure was associated with lower symptom severity for both disorders, with session count predicting improvement in trichotillomania (b=−0.11, SE=0.04, t932.45 =−2.84, P=.005) and ED (b=−0.12, SE=0.03, t926.54 =−3.68, P<.001), supporting continued HRT skill practice over time.
- Outcomes differed by developmental stage: trichotillomania effect sizes were adults g = 1.12 [0.96, 1.27], adolescents g = 0.81 [0.46, 1.15], and children g = 0.78 [0.47, 1.09], while ED effect sizes were adults g = 1.23 [1.07, 1.39], adolescents g = 0.68 [0.33, 1.03], and children g = 1.54 [0.99, 2.09].
- Secondary gains were broader than BFRB symptoms but smaller in magnitude, with depression, anxiety, and stress effects of g=0.26–0.29, g =0.22–0.26, and g=0.27–0.28, plus quality-of-life and disability changes of g =−0.26 to −0.25 and g =0.25–0.30; comorbid mood or anxiety symptoms may still require targeted treatment.
- Among patients who remained in follow-up, symptom reduction was maintained or increased through week 52, reaching 45.5% for trichotillomania at weeks 41–52 (n=122; g=1.51 [95% CI, 1.23–1.79]) and 44.1% for excoriation at weeks 41–52 (n=134; g=1.56 [95% CI, 1.29–1.84]).
