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

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

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.

Keywords: Exposure response prevention; Group; Habit reversal training; Manual; Pediatric; Tourette syndrome.

Conflict of interest statement

Conflict of interest

The authors declare that they have no competing interests.

Ethics approval

The study was approved by the National Ethical Committee (1-10-72-216-15) and the Danish Data Protection Agency (1-16-02-490-15).

Informed consent

Oral and written information was given to parents and patients, and written consent from patients over 15 years and parents was received.

Figures

Fig. 1
Fig. 1
Flowchart for inclusion and exclusion of participants in the tic treatment study
Fig. 2
Fig. 2
Total Tic score and functional impairment score from baseline to eighth session for each of individual therapy and group setting. *p < 0.05 significant score reductions from baseline to eighth session. YGTSS Yale Global Tics Severity Scale
Fig. 3
Fig. 3
PUTS scores and BATS scores at baseline, fourth, and eighth session for the individual therapy and group setting combined. *p < 0.05 significant score reductions from baseline to eighth session

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