A placebo-controlled trial of cognitive-behavioral therapy and clomipramine in trichotillomania

Background: The major treatments reported to be effective in the treatment of trichotillomania are cognitive-behavioral therapy (CBT) with habit rever sal 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 pl acebo in the treatment of trichotillomania. Method: Twenty-three patients with trichotillomania as determined by the St ructured Clinical Interview for DSM-III-R entered and 16 completed a 9-week , placebo-controlled, randomized, parallel-treatment study of CBT and clomi pramine. Efficacy was evaluated by the Trichotillomania Severity Scale, the Trichotillomania Impairment Scale, and the Clinical Global Impressions-Imp rovement scale, which were conducted by an independent assessor blinded to the treatment condition. Results: CBT had a dramatic effect in reducing symptoms of trichotillomania and was significantly more effective than clomipramine (p = .016) or place bo (p = .026). Clomipramine resulted in symptom reduction greater than that with placebo, but the difference fell short of statistical significance. P lacebo response was minimal. Conclusion: Clinicians should be aware of the potential treatments availabl e for trichotillomania. A larger and more definitive study comparing CBT an d a serotonin-norepinephrine reuptake inhibitor is indicated.