Habit Reversal Training for Tics

Overseen By Michael Himle, PhD

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: University of Utah

Disqualifiers: Unmanaged ADHD, OCD, anxiety, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 5

Duration: 3 weeks

6 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how Habit Reversal Training (HRT) can help manage tics, focusing on changes in premonitory urges (the sensation before a tic occurs) during and between treatment sessions. Participants will attend training sessions and practice the techniques at home, both in-person and online. This trial may suit individuals with at least three motor or vocal tics who experience a strong urge before they occur. As an unphased trial, this study provides a unique opportunity to contribute to the understanding and improvement of tic management techniques.

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but it does require that there are no planned changes in your medication or dosage during the study.

What prior data suggests that Habit Reversal Training is safe for treating tics?

Research has shown that Habit Reversal Training (HRT) is a safe and effective method for reducing tics. One study found that participants experienced about a 39% decrease in tic severity after several sessions, meaning their tics were less intense and occurred less frequently. Other studies confirm that HRT significantly benefits both children and adults with tic disorders, such as Tourette Syndrome.

HRT is generally well-tolerated, with few serious side effects. It focuses on teaching skills to better manage tics, involving practice with a therapist and independently. This makes it a promising option for those seeking to safely reduce the impact of tics. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Habit Reversal Training (HRT) is unique because it focuses on empowering individuals with tics to recognize and control their own behaviors through practice and awareness, rather than relying on medication. While traditional treatments for tics often involve medications like antipsychotics or behavioral therapies like Comprehensive Behavioral Intervention for Tics (CBIT), HRT stands out by providing targeted, therapist-guided sessions that teach specific skills tailored to each individual's tics. Researchers are excited about HRT because it promotes self-management and skill-building, offering a non-pharmacological approach that can be personalized and practiced independently.

What evidence suggests that Habit Reversal Training is effective for treating tics?

Research has shown that Habit Reversal Training (HRT), which participants in this trial will receive, reduces the severity of tics. One study found that participants experienced an average 39% decrease in tic severity, with benefits lasting well beyond the treatment period. Another study demonstrated that HRT led to greater improvements compared to only receiving education about tics. Long-term evidence suggests that people who complete HRT continue to experience fewer severe tics. Overall, HRT is highly effective in both the short and long term for treating tics. ^{1 6 7 8 9}

Are You a Good Fit for This Trial?

This trial is for individuals with Tourette Syndrome or chronic tics. Participants will need to commit to attending 5 study visits and 12 practice sessions, which can be in person or online. The specific eligibility criteria are not provided, but typically include a diagnosis of the condition being studied.

Inclusion Criteria

Participants who meet criteria for a DSM-5-TR diagnosis of a TD

Report experiencing a PU for each of their target tics with a minimum rating of a 4/8 on a subjective rating (i.e., the Urge Thermometer; Silverman & Albano, 1996) for each tic

The targeted tics occur, on average, at least once per minute during a 10-minute direct observation

Exclusion Criteria

The presence of any comorbid conditions that are considered a primary treatment concern and/or could interfere with study participation or treatment (i.e., unmanaged ADHD, OCD, anxiety)

A Yale Global Tic Severity Score of 40+ (or 20+ if they present with a primary motor or vocal tic disorder)

My doctor thinks my tics are due to a psychological condition.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1 week

1 visit (in-person)

Treatment

Participants receive habit reversal training for 3 separate tics over 3 weeks, including 3 therapist-guided sessions and 15 practice sessions

3 weeks

3 visits (in-person), 15 practice sessions (in-person and virtual)

Post Assessment

Participants undergo a post assessment to evaluate treatment outcomes

1 week

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment

1 week

What Are the Treatments Tested in This Trial?

Interventions

• Habit Reversal Training

Trial Overview The trial is testing Habit Reversal Training (HRT) as a treatment for tics associated with Tourette Syndrome. It aims to understand how premonitory urges—sensations that precede tic occurrence—change during and between HRT sessions.

How Is the Trial Designed?

Group I: HRT Experimental Treatment 1 Intervention

Participants will receive 3 therapist-guided sessions of habit reversal training (1 hour each) for 3 separate identified tics. Participant will also participate in 5 practice sessions per week (approximately 30 minutes sessions each; over the course of 3 weeks) in which participants will practice the skills learned in session with a study team member)

Who Is Running the Clinical Trial?

University of Utah

Lead Sponsor

Trials

1,169

Recruited

1,623,000+

Published Research Related to This Trial

In a study of 32 patients with Tourette's disorder, those who underwent 14 sessions of habit reversal therapy showed significant improvement in tic severity compared to those receiving supportive psychotherapy.

The benefits of habit reversal therapy were not only immediate but also sustained, as improvements were maintained at a 10-month follow-up, suggesting its long-term efficacy as a behavioral treatment for Tourette's disorder.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Habit reversal versus supportive psychotherapy for Tourette's disorder: a randomized controlled trial. Wilhelm, S., Deckersbach, T., Coffey, BJ., et al.[2022]

Habit reversal treatment, which includes awareness training and the use of a competing response, is effective for managing tics and other nervous habits.

The review also highlights that variations of the habit reversal procedure can be beneficial in treating stuttering, suggesting its broader applicability in addressing different types of nervous habits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Habit reversal: a review of applications and variations. Woods, DW., Miltenberger, RG.[2019]

Habit reversal training (HRT) was tested in a pilot study with 21 children and adolescents with Tourette Syndrome, showing some effectiveness in reducing tic severity compared to usual care, although the differences were minor.

Both HRT and usual care groups experienced improvements in tic severity and global functioning, but there were no significant changes in quality of life, and a notable number of participants dropped out of the study.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Habit reversal training in children and adolescents with chronic tic disorders: an Italian randomized, single-blind pilot study. Seragni, G., Chiappedi, M., Bettinardi, B., et al.[2018]

Behavioral interventions, such as habit reversal, Comprehensive Behavioral Intervention for Tics, and exposure and response prevention, are recognized as effective first-line therapies for treating tic disorders, supported by strong empirical evidence.

The article discusses the efficacy of these treatments and explores how they can be delivered in various formats, highlighting the need for further research into the mechanisms that drive their effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Behavioral Interventions for Children and Adults with Tic Disorder. Woods, DW., Himle, MB., Stiede, JT., et al.[2023]

A pilot study involving 16 children with chronic tic disorders showed positive acceptance and initial efficacy of a new habit reversal training program based on cognitive-behavioral therapy.

The study compared an intense therapy phase to a minimal intervention phase, suggesting that the new program may be beneficial, but further research is needed to confirm its effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Effects of habit reversal training in children with chronic tic disorder - a pilot study]. Woitecki, K., Döpfner, M.[2018]

Habit reversal training (HRT) is a promising nonpharmacological intervention for chronic tic disorders, including Tourette's syndrome, particularly in children and adolescents, as it is well-tolerated and shows efficacy based on a growing body of evidence.

Given the concerns about the side effects and unpredictable efficacy of pharmacological treatments, HRT offers a valuable alternative approach to managing tic behaviors without the risks associated with long-term medication use.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Habit reversal training for tic disorders in children and adolescents. Piacentini, J., Chang, S.[2007]

Habit reversal (HR) is a commonly used and effective behavioral intervention for tic disorders, with 12 studies reviewed showing its potential efficacy.

Despite nearly three decades of research, most studies on HR for tics have significant methodological flaws, leading to a classification of 'probably efficacious' rather than 'well-established' according to the Task Force guidelines.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Habit reversal treatment of tic disorders: a methodological critique of the literature. Carr, JE., Chong, IM.[2005]

A manualized cognitive-behavioral program based on habit reversal was effective in managing chronic tic disorder (CTD) and habit disorder (HD), with 65% of participants reporting 75-100% control over their tics after a 4-month treatment.

At a 2-year follow-up, 52% of participants maintained 75-100% control, and significant improvements were observed in self-esteem, anxiety, and depression, indicating the program's broader psychological benefits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of a cognitive-behavioural program for the management of chronic tic and habit disorders. O'Connor, KP., Brault, M., Robillard, S., et al.[2022]

In a pilot study involving 16 children with chronic tic disorders, habit reversal training effectively reduced comorbid symptoms such as ADHD, anxiety, OCD, and depression.

The study found a significant correlation between tic symptoms and comorbid symptoms, particularly in parent ratings, suggesting that treating tic symptoms can also positively impact associated mental health issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Changes in comorbid symptoms and subjective interference in a habit reversal therapy in children with chronic tic disorder - a pilot study]. Woitecki, K., Döpfner, M.[2012]

Habit reversal is an effective multicomponent procedure for treating nervous habits, tics, and stuttering, as developed by Azrin and Nunn in the 1970s.

The article reviews research on habit reversal, highlighting its limitations and the need for further investigation into the behavioral processes involved, suggesting that while effective, there is still much to learn about its general applicability.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Applying behavior analysis to clinical problems: review and analysis of habit reversal. Miltenberger, RG., Fuqua, RW., Woods, DW.[2018]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC3812724/

The effectiveness of habit reversal therapy in the treatment ... As shown by all the studies that provided long-term data, patients followed up after undergoing HRT appeared to experience continued reduction of tic severity.

2. medrxiv.org medrxiv.org/content/10.1101/2025.09.11.25335505v1.full-text

Habit Reversal Training for Tic Disorders At session 14, tic symptoms showed a median 39.0% severity reduction (youth: 40.9%; adults: 38.1%). Improvements were maintained through the ...

3. kosinmedj.org kosinmedj.org/journal/view.php?number=1332

a structured review of HRT, ERP, and CBIT The findings indicate robust short- and long-term efficacy for HRT and CBIT, whereas ERP shows promising short-term outcomes but a relative ...

4. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0005796716300390

Habit reversal training and educational group treatments ... HRT led to greater reductions in tic severity than Education. Implications, such as cost-effectiveness of treatment delivery, are discussed. Introduction.

5. movementdisorders.onlinelibrary.wiley.com movementdisorders.onlinelibrary.wiley.com/doi/10.1002/mdc3.14260

Combined Habit Reversal Therapy and Acceptance and ... The HRT + ACT protocol effectively reduced tic severity, with benefits lasting 12 months. These results support further trials to compare HRT + ACT with HRT ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7331356/

Review of habit reversal training for tic disorders - PMC The results showed that HRT significantly reduces tic severity in children and adults with TS and CTD. A study by Yates et al randomly divided 33 CTD and TS ...

7. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0272735811000754

The efficacy of habit reversal therapy for tics ... A meta-analysis based on 575 participants in 18 studies found Habit Reversal Therapy (HRT) to be an efficacious intervention for a wide variety of maladaptive ...

8. clinicaltrials.gov clinicaltrials.gov/study/NCT00218777

NCT00218777 | Cognitive Behavior Therapy and Habit ... This study will determine the effectiveness of cognitive behavior therapy (CBT) with habit reversal training (HRT) in treating chronic tic disorders (CTDs) in ...

9. neurologyopen.bmj.com neurologyopen.bmj.com/content/5/Suppl_1/A36.3

2698 Combined habit reversal training and acceptance ... Conclusion Results suggest that the combined HRT/ACT treatment protocol is effective in reducing tic severity in adults with Tourette Syndrome, ...