Comparison of cognitive-behavioral treatments for tics and Tourette syndrome in youth and adults: A randomized controlled trial

Abstract

BackgroundCurrent guidelines recommend the Comprehensive Behavioral Intervention for Tics (CBIT) to manage tics, which aims to reverse tic habits. Though CBIT has shown significant tic reduction in many, some patients remain non-responders. The Cognitive Psychophysiological treatment (CoPs) offers an alternative approach, focusing on modifying cognitive, behavioral, and physiological processes. Previous studies highlighted CoPs' effectiveness in reducing tics and improving neurocognitive performance. This paper presents the first direct trial comparing CoPs and CBIT. Aims and hypothesesOur goal was to compare CBIT and CoPs in children and adults. We hypothesized that the CoPs group would show superior clinical improvement than the CBIT group. MethodNinety-eight participants were randomized into each of the two modalities, including 61 children and 37 adults ProcedureParticipants were evaluated pre-post, and at one- and six-months post-treatment using standardized scales. The manualized treatments included 12 to 14 sessions for an average duration (from randomization to follow-up) of 41 weeks. AnalysesA linear mixed model was used to test treatment effects on outcome measures. ResultsOf 120 initial participants, 98 were randomized to CBIT or CoPs. About 23% shifted to teletherapy due to COVID-19. Both treatments lowered YGTSS scores, with no modality differences. The CoPs group showed significant GAF score increases, and teletherapy participants had higher scores than in-person. Clinical change between CBIT and CoPs was similar. ConclusionBoth CoPs and CBIT effectively address tic severity. While CoPs offer a holistic restructuring approach, it was not found superior to CBIT, underscoring the need for continued research for tic treatment.