The efficacy of psychotherapeutic and pharmacological interventions for trichotillomania: A review and meta-analysis.

This study provides an updated meta-analytic review of the efficacy of pharmacological and psychotherapeutic interventions for trichotillomania (TTM) based on randomized clinical trials. Both standard and network meta-analyses were conducted. Based on extensive searches, 29 trials met the inclusion criteria for standard meta-analysis and 30 met the criteria for network meta-analysis. When considering both the magnitude of effect sizes and replication, strong support was found for the efficacy of three interventions: behavioral therapy with habit reversal, Acceptance and Commitment Therapy-enhanced habit reversal therapy, and N-acetylcysteine. It is noteworthy that other promising interventions exhibited relatively large effect sizes; however, these interventions lacked replication, suggesting the need for subsequent clinical trials. In general, psychotherapeutic interventions that involved habit reversal were found to be superior to interventions without habit reversal. Finally, in contrast to previous reviews, the current study did not find consistent support for the efficacy of clonazepam. Limitations and directions for future research are discussed.