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

Trial Summary

What is the purpose of this trial?

The primary aim of this study is to learn more about premonitory urges (PU) when using Habit Reversal Training (HRT) to treat tics. The main focus of this study is to investigate if and when PU change during tic treatment sessions and between tic treatment sessions. Participants will: * Attend 5 study visits (approximately 1 to 1.5 hours each) for an intake, habit reversal training for 3 separate tics, and a post assessment * Attend 5 practice sessions (approximately 30 minutes each) over a week for 3 weeks (total 15 practice sessions) * Study visits and practice sessions will take place in person and online via secure videoconference

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 data supports the effectiveness of the treatment Habit Reversal Training for Tics?

Research shows that habit reversal training is one of the most successful behavioral treatments for tic disorders, and it is considered probably effective, almost meeting the criteria for a well-established treatment. It has been recognized as a first-line therapy for tics, with studies indicating its efficacy in reducing tic symptoms. ^{1 2 3 4 5}

Is Habit Reversal Training safe for humans?

Habit Reversal Training (HRT) is generally considered safe and well-tolerated for treating tic disorders in children and adolescents, with no serious side effects reported in the studies reviewed. ^{1 3 6 7 8}

How is Habit Reversal Training different from other treatments for tic disorders?

Habit Reversal Training is unique because it focuses on increasing awareness of tics and teaching a competing response to replace the tic, rather than using medication. This behavioral approach is manualized and involves cognitive-behavioral techniques, making it different from standard drug treatments. ^{1 2 3 9 10}

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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 (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]

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]

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 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]

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]

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 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]

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]

References

1. Switzerland 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]. [2012]

2. Switzerland pubmed.ncbi.nlm.nih.gov

[Effects of habit reversal training in children with chronic tic disorder - a pilot study]. [2018]

3. United States pubmed.ncbi.nlm.nih.gov

Habit reversal treatment of tic disorders: a methodological critique of the literature. [2005]

4. United States pubmed.ncbi.nlm.nih.gov

Habit reversal versus supportive psychotherapy for Tourette's disorder: a randomized controlled trial. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Behavioral Interventions for Children and Adults with Tic Disorder. [2023]

6. England pubmed.ncbi.nlm.nih.gov

Evaluation of a cognitive-behavioural program for the management of chronic tic and habit disorders. [2022]

7. Italy pubmed.ncbi.nlm.nih.gov

Habit reversal training in children and adolescents with chronic tic disorders: an Italian randomized, single-blind pilot study. [2018]

8. United States pubmed.ncbi.nlm.nih.gov

Habit reversal training for tic disorders in children and adolescents. [2007]

9. United States pubmed.ncbi.nlm.nih.gov

Applying behavior analysis to clinical problems: review and analysis of habit reversal. [2018]

10. Netherlands pubmed.ncbi.nlm.nih.gov

Habit reversal: a review of applications and variations. [2019]