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.