INTEGRATING EXPOSURE AND RESPONSE PREVENTION AND HABIT REVERSAL TECHNIQUES TO TREAT A TOURETTIC SUBTYPE OF OBSESSIVE-COMPULSIVE DISORDER (TOURETTIC OCD). (TORCH)

Obsessive-Compulsive Disorder and Tic Disorders frequently co-occur, and a subgroup of patients - those with a Tourettic Subtype of OCD (TOCD) - present with symptoms of both conditions simultaneously. Standard interventions typically address one condition or the other, but rarely both together. This study aims to test whether a combined psychological therapy integrating Exposure and Response Prevention (ERP) and Habit Reversal (HbRT) is more effective at reducing symptoms than either therapy delivered alone, in adults with TOCD.

Study Overview

• Status: Recruiting
• Conditions: Tic Disorders; Tourette Disorder; Gilles de la Tourette Syndrome; Tourettes Syndrome; Tourette Disease; Tic Disorder, Combined Vocal and Multiple Motor; Tic Disorder, Chronic Motor or Vocal; Obsessive - Compulsive Disorder
• Intervention / Treatment: Behavioral: Exposure and Response Prevention (ERP); Behavioral: Habit Reversal Training (HbRT; Behavioral: Psychoeducation and Supportive Intervention

Detailed Description

Participants are randomly allocated to one of four groups: (1) combined ERP and HbRT, (2) ERP alone, (3) HbRT alone, or (4) a supportive psychoeducation control. All participants receive 12 weekly one-to-one sessions (either in-person or remotely) of approximately fifty minutes. Symptoms (as measured by the YGTSS and YBOCS) are assessed by an independent clinician at the start of treatment, at week-12, and again at week-24.

• Study Type: Interventional
• Enrollment (Estimated): 40
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Dipesh Patel, MPhil / PhD; Phone Number: +44 (0)20 3456 7890; Email: dipesh.patel.23@ucl.ac.uk

Study Locations

• United Kingdom
  • London
    • London, London, United Kingdom, WC1N 3BG
      • Recruiting
      • University College London Queen Square Institute of Neurology
      • Contact: Dipesh Patel, MPhil / PhD; Phone Number: +44 (0)20 3456 7890; Email: dipesh.patel.23@ucl.ac.uk
      • Principal Investigator: Himanshu Tyagi, PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Age > 18 years.
2. Either Gender
3. Confirmation of a primary diagnosis of either:

a. Tourette's Disorder (DSM-5 307.23 F95.2) b. Persistent Motor or Vocal Tic Disorder (DSM-5 307.22 F95.1) c. Provisional Tic Disorder (DSM-5 307.21 F95.0) d. Other Specified Tic Disorder (DSM-5 307.20 F95.8) e. Unspecified Tic Disorder (DSM-5 307.20 F95.9) f. Obsessive-Compulsive Disorder (DSM-5 300.3 F42.2) [d] Medication use is not an exclusion criterion (type of medication and daily dosages are to remain unchanged throughout the trial intervention period) [e] Ability to provide sustained informed consent [f] A minimum score of 16 on YBOCS [g] A minimum score of 5 on the Premonitory Urge for Tics Scale (PUTS)

Exclusion Criteria:

1. Substance misuse (DSM 483)
2. Adult personality disorder (DSM 645) (301.0 - 301.9)
3. Schizophrenia (DSM 297.1 - 298.9)
4. Bipolar disorder (DSM 296.89 - 296.80)
5. Contraindications to participation in a trial (i.e., active suicidal ideations and/or requirement of an interpreter)
6. Other diagnostic contraindication(s)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Combined Exposure and Response Prevention and Habit Reversal; Participants allocated to this arm will receive a 12-week individual psychological intervention integrating Exposure and Response Prevention (ERP) and Habit Reversal Training (HRT). ERP will involve planned exposure to obsessional fears, distress, sensory discomfort, premonitory urges, and "not-just-right" experiences while reducing compulsions, avoidance, reassurance seeking, and other safety behaviours. HRT will include awareness training, identification of premonitory urges and tic-related cues, development and practice of competing responses, and strategies to support generalisation. Sessions will last approximately 50 minutes and will be delivered face-to-face or remotely.	Behavioral: Exposure and Response Prevention (ERP); Exposure and Response Prevention (ERP) is a behavioural intervention that involves gradual and systematic exposure to obsessional fears, distress, sensory discomfort, premonitory urges, and "not-just-right" experiences while refraining from compulsions, avoidance, reassurance seeking, and other safety behaviours. Treatment is delivered individually over 12 weekly 50-minute sessions, either face-to-face or remotely.; Behavioral: Habit Reversal Training (HbRT; Habit Reversal Training (HbRT) is a behavioural intervention that includes awareness training, identification of premonitory urges and antecedents to tic expression, development and practice of competing responses, and strategies to generalise skills across settings. Treatment is delivered individually over 12 weekly 50-minute sessions, either face-to-face or remotely.
Active Comparator: Standarised Exposure and Response Prevention Alone; Participants allocated to this arm will receive a 12-week individual psychological intervention based on Exposure and Response Prevention (ERP). Treatment will involve gradual and systematic exposure to obsessional fears, distress, sensory discomfort, premonitory urges, and "not-just-right" experiences while refraining from compulsions, avoidance, reassurance seeking, and other safety behaviours. The intervention aims to reduce obsessive-compulsive symptoms by promoting inhibitory learning and increasing tolerance of uncertainty and internal experiences. Sessions will last approximately 50 minutes and will be delivered face-to-face or remotely.	Behavioral: Exposure and Response Prevention (ERP); Exposure and Response Prevention (ERP) is a behavioural intervention that involves gradual and systematic exposure to obsessional fears, distress, sensory discomfort, premonitory urges, and "not-just-right" experiences while refraining from compulsions, avoidance, reassurance seeking, and other safety behaviours. Treatment is delivered individually over 12 weekly 50-minute sessions, either face-to-face or remotely.
Active Comparator: Standarised Habit Reversal Alone; Participants allocated to this arm will receive a 12-week individual psychological intervention based on Habit Reversal Training (HbRT). Treatment will include awareness training to improve recognition of tics and premonitory urges, identification of antecedents and contextual triggers, development and practice of competing responses, and strategies to promote generalisation of skills to everyday settings. The intervention aims to reduce tic severity and improve voluntary tic management. Sessions will last approximately 50 minutes and will be delivered face-to-face or remotely.	Behavioral: Habit Reversal Training (HbRT; Habit Reversal Training (HbRT) is a behavioural intervention that includes awareness training, identification of premonitory urges and antecedents to tic expression, development and practice of competing responses, and strategies to generalise skills across settings. Treatment is delivered individually over 12 weekly 50-minute sessions, either face-to-face or remotely.
Active Comparator: Psychoeducation / Supportive Intervention; Participants allocated to this arm will receive a 12-week individual psychological intervention consisting of psychoeducation and supportive therapy. Sessions will provide information about obsessive-compulsive disorder, tic disorders, Tourettic obsessive-compulsive disorder, stress, and wellbeing, together with supportive discussion and general problem-solving. This intervention will not include structured Exposure and Response Prevention, Habit Reversal Training, or other targeted behavioural techniques. Sessions will last approximately 50 minutes and will be delivered face-to-face or remotely.	Behavioral: Psychoeducation and Supportive Intervention; Psychoeducation and Supportive Therapy consists of structured education about obsessive-compulsive disorder, tic disorders, Tourettic obsessive-compulsive disorder, stress, and wellbeing, together with supportive discussion and general problem-solving. The intervention does not include Exposure and Response Prevention, Habit Reversal Training, or other targeted behavioural techniques. Treatment is delivered individually over 12 weekly 50-minute sessions, either face-to-face or remotely.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change From Baseline in Yale-Brown Obsessive Compulsive Scale Total Score	Obsessive-compulsive symptom severity will be measured using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). The Y-BOCS total score ranges from 0 to 40, with higher scores indicating greater obsessive-compulsive symptom severity. Change from baseline will be assessed at the end of treatment and follow-up.	Baseline, Week 12 and Week 24
Change From Baseline in Yale Global Tic Severity Scale Total Tic Severity Score	Tic symptom severity will be measured using the Yale Global Tic Severity Scale (YGTSS) Total Tic Severity Score. The score ranges from 0 to 50, with higher scores indicating greater tic severity. Change from baseline will be assessed at the end of treatment and follow-up.	Baseline, Week 12 and Week 24

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change From Baseline in Yale-Brown Obsessive Compulsive Scale Impairment Score	Functional impairment associated with obsessive-compulsive symptoms will be measured using the impairment items of the Yale-Brown Obsessive Compulsive Scale. Higher scores indicate greater impairment. Change from baseline will be assessed at the end of treatment and follow-up.	Baseline, Week 12 and Week 24
Change From Baseline in Yale Global Tic Severity Scale Impairment Score	Tic-related functional impairment will be measured using the Yale Global Tic Severity Scale Impairment Score. The score ranges from 0 to 50, with higher scores indicating greater impairment. Change from baseline will be assessed at the end of treatment and follow-up.	Baseline, Week 12 and Week 24

Collaborators and Investigators

• Sponsor: University College London Hospitals

Study record dates

Study Major Dates

• Study Start (Actual): July 8, 2026
• Primary Completion (Estimated): August 1, 2027
• Study Completion (Estimated): February 1, 2030

Study Registration Dates

• First Submitted: July 21, 2026
• First Submitted That Met QC Criteria: July 21, 2026
• First Posted (Actual): July 24, 2026

Study Record Updates

• Last Update Posted (Actual): July 24, 2026
• Last Update Submitted That Met QC Criteria: July 21, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: Tourette Syndrome; Tic Disorders; Obsessive-Compulsive Disorder; Tourettic Obsessive-Compulsive Disorder
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Mental Disorders; Genetic Diseases, Inborn; Neurodegenerative Diseases; Neurodevelopmental Disorders; Movement Disorders; Heredodegenerative Disorders, Nervous System; Basal Ganglia Diseases; Personality Disorders; Anxiety Disorders; Congenital, Hereditary, and Neonatal Diseases and Abnormalities; Compulsive Personality Disorder; Obsessive-Compulsive Disorder; Tic Disorders; Tourette Syndrome
• Other Study ID Numbers: ERP/HR TOCD RTC - 177187

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No