A placebo-controlled trial of cognitive-behavioral therapy and clomipramine in trichotillomania
Abstract
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 trichotillomania. 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 condition. 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.
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These findings are in line with most previous research.
“These findings are in line with most previous research (Woods et al., 2006b; Ninan et al., 2000; van Minnen et al., 2003; Schuck et al., 2011) and call for further development and improvement of TTM- and SPD-treatments.”
From Internet-delivered acceptance-based behavior therapy for trichotillomania and skin-picking disorder in a psychiatric setting: A feasibility trial (2022) · cites this paper as Ninan et al., 2000
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Farhat, L. C., Olfson, E., Li, F., Telang, S., & Bloch, M. H. (2019) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2018.10.009 · Cited by 32 · see citing works
Investigating healthcare providers' knowledge of trichotillomania and its treatment
Marcks, B. A., Wetterneck, C. T., & Woods, D. W. (2006) · Cognitive Behaviour Therapy · doi:10.1080/16506070510010657a · Cited by 32 · see citing works
“Furthermore, recent studies have demonstrated that behavior therapy is superior to pharmacotherapy in reducing pulling (Ninan et al., 2000; van Minnen, Hoogduin, Keijsers, Hellenbrand, & Hendriks, 2003).”
BackgroundHeinicke, M. R., Stiede, J. T., Miltenberger, R. G., & Woods, D. W. (2020) · Journal of Applied Behavior Analysis · doi:10.1002/jaba.745 · Cited by 32 · see citing works
“Lastly, HRT has also been evaluated in combination with other interventions, the most common being traditional cognitive behavior therapy (Ninan et al., 2000) and two of its offshoots: acceptance and commitment therapy (Crosby et al., 2012; Flessner et al., 2008; Haaland et al., 2017; Twohig &…”
MethodKetamine in Bipolar Disorder: A Review
Wilkowska, A., Szałach, Ł. P., & Cubała, W. J. (2020) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s282208 · Cited by 34 · see citing works
Recent Advances in the Understanding and Treatment of Trichotillomania
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“Results showed that HRT+cognitive therapy was more effective than the placebo or clomipramine (Ninan et al., 2000).”
BackgroundAtypical antipsychotics and suicide in mood and anxiety disorders
Sharma, V. (2003) · Bipolar Disorders · doi:10.1111/j.1399-2406.2003.00062.x · Cited by 32 · see citing works
Recent advances in the treatment of trichotillomania (hair‐pulling disorder)
Everett, G. J., Jafferany, M., & Skurya, J. (2020) · Dermatologic Therapy · doi:10.1111/dth.13818 · Cited by 14 · see citing works
“Clomipramine was found to decrease symptoms of TTM more than placebo, but not significantly so.(31) Sani et al have pointed out that the average dosage used in the Ninan et al trial (116.”
MethodTrauma and trichotillomania: A tenuous relationship
Houghton, D., Mathew, A., Twohig, M., Saunders, S., Franklin, M., Compton, S., Neal-Barnett, A., & Woods, D. W. (2016) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2016.09.003 · Cited by 9 · see citing works
Update on the Etiology and Treatment of Schizophrenia and Bipolar Disorder
Buckley, P. F. (2008) · CNS Spectrums · doi:10.1017/s1092852900028212 · Cited by 29 · see citing works
Bipolar disorder: Improving diagnosis and optimizing integrated care
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Shareh, H. (2018) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465817000546 · Cited by 25 · see citing works
Predictors of Relapse Following Treatment of Trichotillomania
Falkenstein, M. J., Rogers, K., Malloy, E., & Haaga, D. (2014) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2014.09.001 · Cited by 27 · see citing works
Affective and Sensory Correlates of Hair Pulling in Pediatric Trichotillomania
Meunier, S. A., Tolin, D., & Franklin, M. (2009) · Behavior Modification · doi:10.1177/0145445508326260 · Cited by 28 · see citing works
Salazar-Ospina, A., Amariles, P., Hincapié-García, J. A., González-Avendaño, S., Benjumea, D., Faus, M. J., & Rodriguez, L. F. (2016) · Journal of Managed Care & Specialty Pharmacy · doi:10.18553/jmcp.2017.23.1.74 · Cited by 26 · see citing works
Slikboer, R., Nedeljkovic, M., Bowe, S., & Moulding, R. (2017) · Clinical Psychologist · doi:10.1111/cp.12074 · Cited by 26 · see citing works
“Ninan et al. (2000) used a combination of HRT and stress management versus Clomipramine (ES = 2.60); Van Minnen et al. (2003) compared BT with fluoxetine (ES = 1.60).”
BackgroundMethodResultInfluentialAsplund, M., Lenhard, F., Andersson, E., & Ivanov, V. Z. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100573 · Cited by 25 · see citing works
- Authors
- Ninan, P. T., Rothbaum, B. O., Marsteller, F. A., Knight, B. T., & Eccard, M. B.
- Affiliations
- Emory University (US)
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2000-01-15
- Volume
- 61
- Issue
- 1
- Pages
- 47-50
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2993744382
- Cited by
- 303
- References
- 0
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 6 · 2023: 25 · 2022: 2 · 2021: 8 · 2020: 8 · 2019: 15 · 2018: 14 · 2017: 13 · 2016: 10 · 2015: 17 · 2014: 14 · 2013: 10 · 2012: 37
- FWCI
- 6.29
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- trichotillomania, cognitive behavioral therapy, clomipramine, habit reversal, serotonin-norepinephrine reuptake inhibitors, placebo response, treatment efficacy
- MeSH terms
- Adult, Clomipramine, Double-Blind Method, Female, Humans, Male, Middle Aged, Placebos, Psychiatric Status Rating Scales, Severity of Illness Index, Trichotillomania, Cognitive Behavioral Therapy, Treatment Outcome, Selective Serotonin Reuptake Inhibitors
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