Habit Reversal Training for Tic Disorders: Clinical Outcomes from a Large Sample of Youth and Adults Treated with Therapist-delivered Video Therapy

Tic disorders, including persistent motor and vocal tic disorders and Tourette syndrome, are neurodevelopmental conditions affecting youth and adults. Habit reversal training (HRT) is a behavioral intervention with demonstrated efficacy from in-person studies, but little information exists about its effectiveness as a remotely-delivered treatment. We examined the effectiveness of therapist-delivered video therapy (HRT) with digital support across the lifespan in a sample of 167 patients with tic disorders (76 children, 38 adolescents, 53 adults). HRT sessions were delivered as one-on-one therapist-delivered video HRT with between-session support including messaging with the therapist, digital support tools, and an online peer community. Tic clinical assessments were administered at baseline, near sessions 7 and 14, and the final treatment session. At session 14, tic symptoms showed a median 39.0% severity reduction (youth: 40.9%; adults: 38.1%). Improvements were maintained through the final treatment sessions, with a median reduction of 44.4% from baseline (youth: 43.5%; adults: 55.4%). This observational analysis demonstrates that therapist-delivered video HRT can effectively reduce tic severity, with maintenance and further improvement of symptoms over an extended treatment duration, in a real-world setting. The virtual delivery format may help address barriers to accessing evidence-based care for tic disorders across the lifespan. Strengths and limitations of this studyO_LILarge naturalistic sample (N=167) provides real-world effectiveness data for therapist-delivered video HRT across developmental stages from children to adults C_LIO_LIVideo therapy format with digital support eliminates geographical barriers while allowing treatment delivery in patients natural environments C_LIO_LIRetrospective observational design without control group precludes causal inferences about treatment effectiveness compared to alternative interventions C_LIO_LISelf-report and parent-report outcome measures may introduce reporting bias C_LIO_LIValidated clinical response thresholds are available only for youth measures (PTQ) but not for adult measures (ATQ), limiting interpretation of treatment response rates across age groups C_LI