ONLINE-TICS: Internet-Delivered Behavioral Treatment for Patients with Chronic Tic Disorders

Abstract

Comprehensive Behavioral Intervention for Tics (CBIT) is considered a first-line therapy for tics. However, availability of CBIT is extremely limited due to a lack of qualified therapists. This study is a multicenter (n = 5), randomized, controlled, observer-blind trial including 161 adult patients with chronic tic disorders (CTD) to provide data on efficacy and safety of an internet-delivered, completely therapist-independent CBIT intervention (iCBIT Minddistrict®) in the treatment of tics compared to placebo and face-to-face (f2f) CBIT. Using a linear mixed model with the change to baseline of Yale Global Tic Severity Scale-Total Tic Score (YGTSS-TTS) as a dependent variable, we found a clear trend towards significance for superiority of iCBIT (n = 67) over placebo (n = 70) (−1.28 (−2.58; 0.01); p = 0.053). In addition, the difference in tic reduction between iCBIT and placebo increased, resulting in a significant difference 3 (−2.25 (−3.75; −0.75), p = 0.003) and 6 months (−2.71 (−4.27; −1.16), p < 0.001) after the end of treatment. Key secondary analysis indicated non-inferiority of iCBIT in comparison to f2f CBIT (n = 24). No safety signals were detected. Although the primary endpoint was narrowly missed, it is strongly suggested that iCBIT is superior compared to placebo. Remarkably, treatment effects of iCBIT even increased over time.

Tourette syndrome research highlights from 2021

“…The internet-delivered format has also recently been evaluated among adults. In a German RCT by Haas and colleagues , 79 161 adult TS/CTD individuals were randomized to unsupported internet-delivered CBIT ( n =67), unsupported internet-delivered psychoeducation ( n =70), or face-to-face CBIT ( n =24). The primary comparison between the two internet-delivered interventions showed a trend towards superiority of internet-delivered CBIT in reducing tic severity (as measured by the YGTSS-TTSS) at the primary endpoint (post-treatment).…”

A Randomized Controlled Trial Comparing Videoconference vs. Face-to-Face Delivery of Behavior Therapy for Youths With Tourette Syndrome in the Time of COVID-19

“…Previous studies regarding remote-BT conducted in pediatric TS patients are summarized in Table 3 . Other studies have also reported the efficacy and safety of internet-delivered BT in the treatment of tics compared to ftf-BT for adults with chronic tic disorders ( 34 , 35 ).…”

Digital and remote behavioral therapies for treating tic disorders: Recent advances and next steps

“…The final study was carried out by Haas et al (20) in Germany and the sample was 161 adults. This was the only study in the literature conducted in an adult population.…”

“…Initially, this should be offered to children and adolescents with tic disorders, as the research to date is less robust in adults with tics. Only one study in this review was conducted on adults with tics (20) and thus more research is needed to establish its efficacy before wider implementation.…”