Mapping the evidence on cognitive behavioral therapy for trichotillomania: a scoping review
Rabia H. HaddadPurpose
This paper aims to systematically map and evaluate the evidence on the efficacy of cognitive behavioral therapy (CBT) interventions for trichotillomania, including randomized controlled trials (RCTs), quasi-experimental designs and observational studies, while exploring treatment formats, outcomes and clinical implications.
Design/methodology/approach
A systematic search was conducted in PubMed, PsycINFO and Scopus up to June 2025, using terms related to trichotillomania and CBT. Eligible studies included those investigating CBT-based interventions with quantitative or qualitative outcomes. Data were extracted on study design, sample characteristics, interventions, outcome measures and findings. Study quality was appraised using the Cochrane Risk of Bias tool and the Newcastle–Ottawa Scale.
Findings
In all, 25 studies met the inclusion criteria, comprising 15 RCTs, 6 quasi-experimental studies and 4 observational designs. Across studies, CBT – most notably HRT – consistently demonstrated significant reductions in hair-pulling frequency and severity, with average symptom reduction ranging between 40% and 60%. Improvements in secondary outcomes such as anxiety, depression and quality of life were also reported. Both individual and group formats were effective, with individual therapy yielding slightly larger effect sizes. Emerging evidence supports the feasibility of telehealth and digital CBT, though further validation is needed. Variability in treatment response, small sample sizes and limited follow-up periods were key limitations.
Originality/value
The findings of this review support CBT, and particularly HRT, as the gold-standard psychological treatment for trichotillomania. While robust evidence demonstrates its efficacy, challenges remain regarding treatment accessibility, personalization and long-term maintenance. Future research should prioritize large-scale trials, predictors of treatment response, relapse prevention and innovative delivery models, including digital platforms.