Behavior therapy for pediatric trichotillomania: Rationale and methods for a randomized controlled trial

• We present rationale, design, & methods of a randomized controlled trial (RCT).
• RCT to evaluate behavior therapy (BT) vs. supportive counseling (SC) for pediatric TTM.
• Primary aim: examine effect of treatment on TTM symptom reduction at post-treatment.
• Secondary aims: evaluate maintenance of BT gains through naturalistic follow-up phase○predictors of acute & long-term response to BT.○efficacy of BT for patients who initially receive SC.

There is a dearth of knowledge on trichotillomania in youth, which is particularly problematic given that trichotillomania typically develops in childhood or early adolescence. Early identification and treatment may prevent adult morbidity and impairment. This paper presents the rationale, design, and methods of a randomized controlled trial (RCT) that will investigate the efficacy of behavior therapy (BT) vs. supportive counseling (SC) for youth (ages 10–17) with trichotillomania (TTM). This study seeks to replicate and extend findings from a smaller RCT which compared BT to a minimal attention control condition and indicated an advantage for BT. Participants will be randomized to BT or SC. After eight weeks of treatment, participants in the BT condition will enter an eight week maintenance phase and participants in the SC condition will be offered BT. The primary aim is to examine the effect of treatment on TTM symptom reduction at post-treatment. Secondary aims include evaluation of the maintenance of BT gains through a naturalistic follow-up phase, predictors of acute and long-term response to BT (including psychiatric comorbidity, initial severity, family psychopathology, and pulling subtype), and the efficacy of BT for patients who initially receive SC, and to benchmark those outcomes against those achieved by patients who are initially randomized to BT. Given how little research has been devoted to pediatric TTM and its treatment, this study represents an essential step in identifying and implementing efficacious treatments for youth with TTM.