Therapist-Delivered Video Therapy Habit Reversal Training for Body-Focused Repetitive Behaviors: Clinical Outcomes From a Large Real-World Sample of Youth and Adults.

Objective: To examine the effectiveness of therapist-delivered video therapy habit reversal training (HRT) in large real-world samples of children, adolescents, and adults with trichotillomania and excoriation disorder (ED). Methods: The sample included 543 patients with trichotillomania (57 children, 75 adolescents, 411 adults) and 528 patients with ED (40 children, 46 adolescents, 442 adults). Treatment followed a protocol of weekly HRT sessions, transitioning to biweekly sessions. The Repetitive Body Focused Behavior Scale was administered at baseline, weeks 5-7, and weeks 14-16 and during maintenance periods through week 52. Results: Mean treatment duration was 14.64±2.50 weeks (7.71±2.61 sessions) for trichotillomania and 14.54±2.69 weeks (7.73±2.68 sessions) for excoriation. At weeks 14-16, trichotillomania showed a median 33.33% severity reduction (interquartile range [IQR]=11.11%-54.55%; 44.08% achieving ≥35% reduction) with large effects (Hedges g = 1.01, 95% CI [0.88-1.14]). Excoriation showed a median 33.33% reduction (IQR=12.50%-57.14%; 48.66% achieving ≥35% reduction) with large effects (Hedges g = 1.16, 95% CI [1.02-1.30]). Improvements were maintained through week 52 (trichotillomania: g=1.51 [CI, 1.23-1.79]; excoriation: g=1.56 [1.29-1.84]). Both conditions showed improvements in depression, anxiety, and stress (g=0.22-0.29). All age groups improved, with effect sizes ranging from g=0.78-1.12 for trichotillomania and g=0.68-1.54 for excoriation. Conclusion: This analysis shows promising evidence that therapist-delivered video therapy HRT is associated with reductions in both hair-pulling and skin-picking severity and improvements in related symptoms in a real-world setting. The large treatment effects and improvements across the lifespan for both conditions suggest this delivery format may help address barriers to accessing evidence-based care for body-focused repetitive behaviors.