Combined habit reversal training and exposure response prevention in a group setting compared to individual training: a randomized controlled clinical trial

Judith B Nissen,Per Hove Thomsen,Martin Kaergaard,Erik Parner,Lisbeth Laursen

doi:10.1007/s00787-018-1187-z

Judith B Nissen, Per Hove Thomsen + Show 3 more

Open Access

https://doi.org/10.1007/s00787-018-1187-z

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Abstract

Chronic tic disorders may have a huge influence on quality of life. Habit reversal training (HRT) and exposure response prevention (ERP) are effective treatments. In a blinded assessed, open trial, this study evaluates the effectiveness of a newly developed Scandinavian tic treating manual designed to treat adolescents with a chronic tic disorder, combining HRT and ERP. The study compared the efficacy of treatment based on the same manual delivered either individually or in groups. The study was an open randomized controlled clinical trial in which adolescents were randomized to either individual or group therapy. Both therapies included nine sessions. The parents were offered group-based psycho-education. The exclusion criteria were chosen to design a study that would be close to clinical practice. This is the first Scandinavian study that examines the effectiveness of a treatment manual combining HRT and ERP delivered in an individual and group setting. The study showed a significant reduction of the Total Tic score on the Yale Global Tic Severity Scale both in the individual (effect size 1.21) and group setting (effect size 1.38). A total of 66.7% of participants were considered responders. There was no statistical significant difference between the individual and group setting apart from the functional impairment score. The reductions were comparable with those shown in other studies. The participants applied both HRT and ERP, and the majority (36/59) reported an increased post-treatment experience of control. The newly designed Scandinavian manual was equally effective in the individual and group setting with effect sizes comparable with those shown in other studies.

Highlights

Chronic tic disorders (CTD), including Tourette syndrome, are neuropsychiatric, neurodevelopmental disorders with a prevalence of 0.5–1%
The present study shows that treatment combining habit reversal treatment (HRT) and ERT training is effective in both groups and as an individual treatment
The decrease from baseline to end point on the Total Tic score of Yale Global Tics Severity Scale (YGTSS) of 9.48 points and 7.48 points (8.48 points for all participants) is comparable or slightly greater than the effects shown in previous studies [13, 19]

Summary

Introduction

Chronic tic disorders (CTD), including Tourette syndrome, are neuropsychiatric, neurodevelopmental disorders with a prevalence of 0.5–1%. As part of the general assessment at baseline, parents were asked questions covering occupation and educational background as well as questions aimed at identifying the presence of parental psychopathology and any family history of tic or other psychiatric and/or somatic disorders. Both the patients and the parents were asked questions aimed at determining the age of onset and describing preceding, reducing and exacerbating factors, as well as the general course of the disorder. The validity and reliability of SP are acceptable [29]

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