Randomized Control Studies of First-Line Behavioral Therapies in Primary Tic Disorders

Randomized control studies of first-line behavioral therapies in primary tic disorders

Behavioral Idea and Evidence Guideline Treatment historical Recommendation background Study Number of Participants Results Habit reversal training Tics are habit Randomized control studies First line treatment (HRT) and cognitive disorders according to 1-3 behavioral intervention Azrin et al. 1980 4 n=22 (10 HRT, 12 MPN) HRT vs. MNP: (CBIT) HRT showed an average tic reduction of >90% during 18-months follow- up and was superior compared to MPN (30%). Azrin and Peterson 1990 5 n=10 (5 HRT, 5 waiting HRT vs. waiting list: list) Significant tic reduction (93% at home, 93.5% at clinic) in children and adults in HRT group. O'Connor et al. 1997 6 n=14 (7 HRT, 7 cognitive HRT vs. Cognitive- treatment) Behavioral Approach: Both groups showed similarly reduced tic frequency (54% & 57%). O'Connor et al. 2001 7 n=69 (chronic tics, 47 HRT-based cognitive- HRT-based cognitive- behavioral program vs. behavioral program, 22 waiting list: waiting list) 88% patients with significant reduction compared to no change in waiting list group, maintained after 2 months follow-up Wilhelm et al. 2003 8 n=29 (16 HRT, 13 HRT vs. Supportive supportive Psychotherapy: psychotherapy) Significant improvement in the habit reversal group, maintained at 10- month follow-up. Verdellen et al., 2004 9 n=43 (22 HRT, 21 HRT vs. ERP: Significant exposure and response improvement for both prevention) groups Deckersbach et al., 2006 n= 30 (15 HRT, 15 HRT vs. Supportive 10 supportive Psychotherapy: HRT only psychotherapy) reduced tic severity. Both groups improved life- satisfaction and psychosocial functioning. Effects maintained at 6 months follow-up. Piacentini et al., 2010 11 n= 126 (61 HRT/CBIT, 65 HRT/CBIT vs. Supportive supportive Psychotherapy: psychotherapy) Significant improvement in HRT/CBIT (52.5%) compared to supportive psychotherapy (18.5%). Maintained in 87% at 6- months follow-up. Wilhelm et al. 2012 12 n= 122 (63 HRT/CBIT, 59 HRT/CBIT vs. Supportive supportive Psychotherapy: psychotherapy) Significant improvement in HRT (38.1%) compared to supportive psychotherapy (6.4%). Maintained at 6-months follow-up. Himle et al. 2012 13 n= 18 analyzed (10 Telehealth HRT/CBIT vs. telehealth, 8 face-to-face face-to-face HRT/CBIT: HRT/CBIT) Both treatments resulted in significant tic reduction with no between group differences. Acceptability and therapist-client alliance ratings were strong for both groups. Seragni et al. 2015 14 n= 21 (11 HRT, 10 HRT vs. Treatment as treatment as usual) usual: Tic reduction and improved global functioning in both groups, without significant changes in terms of Quality of Life (high drop-out quote) McGuire et al., 2015 15 n=240 (baseline; 122 HRT/CBIT vs. supportive HRT/CBIT) psychotherapy: HRT/CBIT outperformed supportive psychotherapy across tic type and presence of urges. Baseline urge presence was associated with tic remission for CBIT but not psychotherapy. Specific bothersome tics were more likely to remit with CBIT relative to supportive psychotherapy. Yates et al. 2016 16 n= 33 (17 HRT, 16 HRT vs. Education (both education) applied as group treatment): HRT led to greater reductions in tic severity than education. Ricketts et al. 2016 17 n = 20 (12 HRT/CBIT, 8 Internet protocol- waiting list) delivered HRT/CBIT vs. waiting list: significantly greater reductions in clinician-rated and parent-reported tic severity in CBIT-VoIP relative to waitlist. One- third (n = 4) were considered treatment responders. Behavioral Treatment Idea and Evidence Recommendation historical background Study Number of Participants Results Exposure and Response Tics are Randomized control studies First line recommendation Prevention (ERP) conditioned according to [1] responses to Verdellen et al., 2004 9 n=43 (22 HRT, 21 HRT vs. ERP: significant urges exposure and response improvement for both prevention) groups (both methods are similarly effective).

Table e-2: Summary of randomized control studies of first-line behavioral therapies in primary tic disorders.

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