Habit reversal versus supportive psychotherapy in Tourette's disorder: A randomized controlled trial and predictors of treatment response

Deckersbach, Thilo; Rauch, Scott L.; Buhlmann, Ulrike; Wilhelm, Sabine

doi:10.1016/j.brat.2005.08.007

Cited by 175 publications

(115 citation statements)

References 21 publications

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“…Deckersbach et al 6 conducted an unblinded RCT of HRT, compared with supportive psychotherapy, in 30 adults with TS. Subjects received 14 sessions of therapy during a 5-month period.…”

Section: Behavioural Interventions For Ticsmentioning

confidence: 99%

Canadian Guidelines for the Evidence-Based Treatment of Tic Disorders: Behavioural Therapy, Deep Brain Stimulation, and Transcranial Magnetic Stimulation

Mckinlay²,

et al. 2012

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This clinical guideline provides recommendations for nonpharmacological treatments for tic disorders. We conducted a systematic literature search for clinical trials on the treatment of tics. One evidence-based review (including 30 studies) and 3 studies on behavioural interventions, 3 studies on deep brain stimulation (DBS), and 3 studies on transcranial magnetic stimulation (TMS) met our inclusion criteria. Based on this evidence, we have made strong recommendations for the use of habit reversal therapy and exposure and response prevention, preferably embedded within a supportive, psychoeducational program, and with the option to combine either of these approaches with pharmacotherapy. Although evidence exists for the efficacy of DBS, the quality of this evidence is poor and the risks and burdens of the procedure are finely balanced with the perceived benefits. Our recommendation is that this intervention continues to be considered an experimental treatment for severe, medically refractory tics that have imposed severe limitations on quality of life. We recommend that the procedure should only be performed within the context of research studies and by physicians expert in DBS programming and in the management of tics. There is no evidence to support the use of TMS in the treatment of tics. However, the procedure is associated with a low rate of known complications and could continue to be evaluated within research protocols. The recommendations we provide are based on current knowledge, and further studies may result in their revision in future. W W WCe guide clinique offre des recommandations de traitements non pharmacologiques pour lesdésordres de tic. Nous avons mené une recherche systématique dans la littérature d'essais cliniques sur le traitement des tics. Une revue fondée sur des données probantes (incluant 30 études) et 3 études sur les interventions comportementales, 3 études sur la stimulation cérébrale profonde (SCP), et 3 études sur la stimulation magnétique transcranienne (SMT) satisfaisaient à nos critères d'inclusion. D'après ces données probantes, nous avons fait des recommandations fermes pour l'utilisation de la thérapie de renversement d'habitudes, et de l'exposition et prévention de la réponse,

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“…Deckersbach et al 6 conducted an unblinded RCT of HRT, compared with supportive psychotherapy, in 30 adults with TS. Subjects received 14 sessions of therapy during a 5-month period.…”

Section: Behavioural Interventions For Ticsmentioning

confidence: 99%

Canadian Guidelines for the Evidence-Based Treatment of Tic Disorders: Behavioural Therapy, Deep Brain Stimulation, and Transcranial Magnetic Stimulation

Mckinlay²,

et al. 2012

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“…l CBIT compared with SP (one child 156 and one adult study 166 ) l HRT compared with SP (two adult studies 167,168 ) l HRT compared with waiting list control (one child study 169 ) l HRT compared with negative practice (one mixed study 170 ) l HRT compared with ERP (one child study 171 ) l Videoconference CBIT compared with face-to-face CBIT (one child study 172 ) l Relaxation training compared with minimal therapy (one child study 173 ) l AC training compared with TAU (one child study 174 ) l Parent training compared with TAU (one child study 164 ).…”

Section: Included Studiesmentioning

confidence: 99%

“…Two of the studies investigated CBIT 156,166 and three investigated HRT. [167][168][169] Two studies were conducted in child populations 156,169 and three in adults. [166][167][168] In four studies, HRT or CBIT was compared with SP 156,[166][167][168] and in the other, HRT was compared with a waiting list control group.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…In these studies, 25-53% of participants were on other medications. In studies for which the type of current medication was reported, 156,166,168 there were most commonly antipsychotics, noradrenergic agents (clonidine or guanfacine) or SSRIs.…”

mentioning

confidence: 99%

“…Treatment duration varied between studies and lasted for 10 weeks in two studies 156,166 and 20 weeks in the other two studies. 167,168 Outcome was assessed post intervention and, in three studies, 156,166,168 mid-way through treatment. The study that used a waiting list as the control group 169 delivered an average of 20 sessions of HRT over 8-11 months but the waiting list control was only for 3 months (in this review, outcome assessment at 3 months is used for both study arms so that intervention/control findings are compared at the same time point).…”

mentioning

confidence: 99%

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Clinical effectiveness and patient perspectives of different treatment strategies for tics in children and adolescents with Tourette syndrome: a systematic review and qualitative analysis

Hollis

Pennant

Cuenca

et al. 2016

Health Technol Assess

127

109

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BackgroundTourette syndrome (TS) is a neurodevelopmental condition characterised by chronic motor and vocal tics affecting up to 1% of school-age children and young people and is associated with significant distress and psychosocial impairment.ObjectiveTo conduct a systematic review of the benefits and risks of pharmacological, behavioural and physical interventions for tics in children and young people with TS (part 1) and to explore the experience of treatment and services from the perspective of young people with TS and their parents (part 2).Data SourcesFor the systematic reviews (parts 1 and 2), mainstream bibliographic databases, The Cochrane Library, education, social care and grey literature databases were searched using subject headings and text words for tic* and Tourette* from database inception to January 2013.Review/research methodsFor part 1, randomised controlled trials and controlled before-and-after studies of pharmacological, behavioural or physical interventions in children or young people (aged < 18 years) with TS or chronic tic disorder were included. Mixed studies and studies in adults were considered as supporting evidence. Risk of bias associated with each study was evaluated using the Cochrane tool. When there was sufficient data, random-effects meta-analysis was used to synthesize the evidence and the quality of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. For part 2, qualitative studies and survey literature conducted in populations of children/young people with TS or their carers or in health professionals with experience of treating TS were included in the qualitative review. Results were synthesized narratively. In addition, a national parent/carer survey was conducted via the Tourettes Action website. Participants included parents of children and young people with TS aged under 18 years. Participants (young people with TS aged 10–17 years) for the in-depth interviews were recruited via a national survey and specialist Tourettes clinics in the UK.ResultsFor part 1, 70 studies were included in the quantitative systematic review. The evidence suggested that for treating tics in children and young people with TS, antipsychotic drugs [standardised mean difference (SMD) –0.74, 95% confidence interval (CI) –1.08 to –0.41;n = 75] and noradrenergic agents [clonidine (Dixarit®, Boehringer Ingelheim) and guanfacine: SMD –0.72, 95% CI –1.03 to –0.40;n = 164] are effective in the short term. There was little difference among antipsychotics in terms of benefits, but adverse effect profiles do differ. Habit reversal training (HRT)/comprehensive behavioural intervention for tics (CBIT) was also shown to be effective (SMD –0.64, 95% CI –0.99 to –0.29;n = 133). For part 2, 295 parents/carers of children and young people with TS contributed useable survey data. Forty young people with TS participated in in-depth interviews. Four studies were in the qualitative review. Key themes were difficulties in accessing specialist care and behavioural interventions, delay in diagnosis, importance of anxiety and emotional symptoms, lack of provision of information to schools and inadequate information regarding medication and adverse effects.LimitationsThe number and quality of clinical trials is low and this downgrades the strength of the evidence and conclusions.ConclusionsAntipsychotics, noradrenergic agents and HRT/CBIT are effective in reducing tics in children and young people with TS. The balance of benefits and harms favours the most commonly used medications: risperidone (Risperdal®, Janssen), clonidine and aripiprazole (Abilify®, Otsuka). Larger and better-conducted trials addressing important clinical uncertainties are required. Further research is needed into widening access to behavioural interventions through use of technology including mobile applications (‘apps’) and video consultation.Study registrationThis study is registered as PROSPERO CRD42012002059.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Randomized Trial of Behavior Therapy for Adults With Tourette Syndrome

Wilhelm

Peterson

Piacentini

et al. 2012

Arch Gen Psychiatry

Self Cite

272

279

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Context Tics in Tourette syndrome begin in childhood, peak in early adolescence, and often decline by early adulthood. However, some adult patients continue to have impairing tics. Medications for tics are often effective but can cause adverse effects. Behavior therapy may offer an alternative but has not been examined in a large-scale controlled trial in adults. Objective To test the efficacy of a comprehensive behavioral intervention for tics in adults with Tourette syndrome of at least moderate severity. Design A randomized, controlled trial with posttreatment evaluations at 3 and 6 months for positive responders. Setting Three outpatient research clinics. Subjects Subjects (N = 122; 78 males, age 16 to 69 years) with Tourette syndrome or chronic tic disorder. Interventions Eight sessions of Comprehensive Behavioral Intervention for Tics or 8 sessions of supportive treatment delivered over 10 weeks. Subjects showing a positive response were given 3 monthly booster sessions. Main Outcome Measures Total Tic score of the Yale Global Tic Severity Scale and the Improvement scale of the Clinical Global Impression rated by a clinician blind to treatment assignment. Results Behavior therapy was associated with a significantly greater decrease on the Yale Global Tic Severity Scale (24.0 ± 6.47 to 17.8 ± 7.32) from baseline to endpoint compared to the control treatment (21.8 ± 6.59 to 19.3 ± 7.40) (P < .001; effect size = 0.57). Twenty-four of 63 subjects (38.1%) in CBIT were rated as Much Improved or Very Much Improved on the Clinical Global Impression-Improvement scale compared to 6.8% (4 of 63) in the control group (P < .0001). Attrition was 13.9% with no difference across groups. Subjects in behavior therapy available for assessment at 6 months posttreatment showed continued benefit. Conclusions Comprehensive behavior therapy is a safe and effective intervention for adults with Tourette syndrome.

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Habit reversal versus supportive psychotherapy in Tourette's disorder: A randomized controlled trial and predictors of treatment response

Cited by 175 publications

References 21 publications

Canadian Guidelines for the Evidence-Based Treatment of Tic Disorders: Behavioural Therapy, Deep Brain Stimulation, and Transcranial Magnetic Stimulation

Canadian Guidelines for the Evidence-Based Treatment of Tic Disorders: Behavioural Therapy, Deep Brain Stimulation, and Transcranial Magnetic Stimulation

Clinical effectiveness and patient perspectives of different treatment strategies for tics in children and adolescents with Tourette syndrome: a systematic review and qualitative analysis

Randomized Trial of Behavior Therapy for Adults With Tourette Syndrome

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