Online behavioral therapy effective for children with tics

Reuters Health - 23/09/2021 - Children with Tourette syndrome or chronic tic disorder may experience more symptom improvement with remotely-delivered exposure and response prevention (ERP) therapy than with psychoeducation, a recent study suggests.

Researchers randomized 224 children aged 9 to 17 years with Tourette syndrome or chronic tic disorder to receive 10 weeks of online ERP therapy delivered by a therapist (n=112) or to join an active control group (n=112) receiving psychoeducation.

At baseline, participants had a Yale Global Tic Severity Scale (YGTSS) Total Tic Severity Score (TTSS) of more than 15, or more than 10 if the only tics present in the past seven days were motor or vocal tics. The primary endpoint was change in YGTSS-TTSS at three months after randomization; mean baseline scores were 28.4 in both groups.

At three months, the mean score dropped to 23.9 in the intervention group, compared with 26.8 in the control group, researchers report in The Lancet Psychiatry.

"Our prediction was that ERP would be more effective than psychoeducation in reducing tics, however, this has not been previously demonstrated in a clinical trial," said lead study author Chris Hollis, chair of Child & Adolescent Psychiatry and Digital Mental Health at the University of Nottingham in the UK.

ERP is a behavioral intervention explicitly designed to reduce the frequency and intensity of tics, Hollis said. In contrast, psychoeducation provides general information about tics and associated problems, but does not teach strategies to directly tackle or reduce tics.

"The reason for selecting online psychoeducation as an 'active control' was that we wanted to ensure that the benefits of online ERP were due to the specific content of the intervention rather than non-specific effects of going online and having therapist support," Hollis said.

In clinical practice, the study results suggest that remote online ERP for tics has the potential to dramatically expand access to care, Hollis said. He said his practice offers psychoeducation first, then offers remote online behavioral therapy as a second step when indicated and desired by patients.

Face-to-face therapy is offered to patients with more severe or complex tics or for those who fail to progress with online therapy, Hollis said.

"This allows a more efficient use of a scarce face to face therapy provision," Hollis said.

One limitation of the study is that it wasn't designed to separate out the effects of online therapy from the effects of ERP, the research team notes.

Even so, the results are promising because tic disorders have limited options for treatments that do not include medications, said Robert Lundin of the Waikato District Health Board and the University of Auckland, in New Zealand.

"At a time when mental health services around the world are under a considerable strain and face-to-face interactions are limited, ERP has been shown to effectively reduce symptoms of tic disorders in an online format," Lundin, who wasn't involved in the study, said by email.

"The major potential gains, if the intervention can be made available in a commercial or healthcare-led format, is that many more patients can be reached through online scalability at a lower cost to the provider and more importantly reach patients in rural areas where other interventions are not available," Lundin said.

SOURCE: https://bit.ly/3u6U1wV The Lancet Psychiatry, online September 1, 2021.

By Lisa Rapaport



Posted on 23 September 20211 October 2021