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Published in: European Child & Adolescent Psychiatry 1/2019

Open Access 01-01-2019 | Original Contribution

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

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

Published in: European Child & Adolescent Psychiatry | Issue 1/2019

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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.
Literature
1.
go back to reference Jankovic J (1997) Tourette syndrome. Phenomenology and classification of tics. Neurol Clin 15:267–275 (PMID: 9115460) CrossRefPubMed Jankovic J (1997) Tourette syndrome. Phenomenology and classification of tics. Neurol Clin 15:267–275 (PMID: 9115460) CrossRefPubMed
3.
go back to reference Cath DC, Hedderly T, Ludolph AG, Stern JS, Murphy T, Hartmann A, Czernecki V, Robertson MM, Martino D, Munchau A, Rizzo R, ESSTS Guidelines Group (2011) European clinical guidelines for Tourette syndrome and other tic disorders. Part I: assessment. Eur Child Adoelsc Psychiatry 20(4):155–171. https://doi.org/10.1007/s00787-011-0164-6 CrossRef Cath DC, Hedderly T, Ludolph AG, Stern JS, Murphy T, Hartmann A, Czernecki V, Robertson MM, Martino D, Munchau A, Rizzo R, ESSTS Guidelines Group (2011) European clinical guidelines for Tourette syndrome and other tic disorders. Part I: assessment. Eur Child Adoelsc Psychiatry 20(4):155–171. https://​doi.​org/​10.​1007/​s00787-011-0164-6 CrossRef
8.
go back to reference Azrin NH, Nunn RG (1973) Habit reversal: a method of eliminating nervous habits and tics. Behav Res Ther 11:619–628CrossRefPubMed Azrin NH, Nunn RG (1973) Habit reversal: a method of eliminating nervous habits and tics. Behav Res Ther 11:619–628CrossRefPubMed
9.
go back to reference Hollis C, Pennant M, Cuenca J, Glazebrook C, Kendall T, Whittingyon C, Stockton S, Larsson L, Bunton P, Dobson S, Groom M, Hedderly T, Heyman I, Jackson GM, Jackson S, Murphy T, Rickards H, Roberson M, Stern J (2016) Clinical effectiveness and patient perspectives of different treatment strategies for tics in children and adolescents with Tourette syndrome: a systematic review and qualitative analysis. Health Technol Assess 20(4):1366–5278. https://doi.org/10.3310/hta20040 CrossRef Hollis C, Pennant M, Cuenca J, Glazebrook C, Kendall T, Whittingyon C, Stockton S, Larsson L, Bunton P, Dobson S, Groom M, Hedderly T, Heyman I, Jackson GM, Jackson S, Murphy T, Rickards H, Roberson M, Stern J (2016) Clinical effectiveness and patient perspectives of different treatment strategies for tics in children and adolescents with Tourette syndrome: a systematic review and qualitative analysis. Health Technol Assess 20(4):1366–5278. https://​doi.​org/​10.​3310/​hta20040 CrossRef
10.
go back to reference Whittington C, Pennant M, Kendall T, Grazebrook C, Trayner P, Groom M, Hedderly T, Heyman I, Jackson G, Jackson S, Murphy T, Rickards H, Robertson M, Stren J, Hollis C (2016) Practitioner review: treatments for Tourette syndrome in children and young people—a systematic review. J Child Psychol Psychiatry 57(9):988–1004. https://doi.org/10.1111/jcpp.12556 CrossRefPubMed Whittington C, Pennant M, Kendall T, Grazebrook C, Trayner P, Groom M, Hedderly T, Heyman I, Jackson G, Jackson S, Murphy T, Rickards H, Robertson M, Stren J, Hollis C (2016) Practitioner review: treatments for Tourette syndrome in children and young people—a systematic review. J Child Psychol Psychiatry 57(9):988–1004. https://​doi.​org/​10.​1111/​jcpp.​12556 CrossRefPubMed
11.
go back to reference Woods DW, Piacentini JC, Chang SW, Deckersbach T, Ginsberg GS, Peterson AL, Scahill LD, Walkup JT, Wilhelm S (2003) Managing Tourette syndrome: a behavioral intervention for children and adults. University Press, Oxford Woods DW, Piacentini JC, Chang SW, Deckersbach T, Ginsberg GS, Peterson AL, Scahill LD, Walkup JT, Wilhelm S (2003) Managing Tourette syndrome: a behavioral intervention for children and adults. University Press, Oxford
14.
go back to reference Piacentini J, Woods DW, Scahill L, Wilhelm S, Peterson AL, Chang S, Ginsburg GS, Deckersbach T, Dziura J, Levi-Pearl S, Walkup JT (2010) Behavior therapy for children with Tourette disorder: a randomized controlled trial. JAMA 303:1929–1937CrossRefPubMedPubMedCentral Piacentini J, Woods DW, Scahill L, Wilhelm S, Peterson AL, Chang S, Ginsburg GS, Deckersbach T, Dziura J, Levi-Pearl S, Walkup JT (2010) Behavior therapy for children with Tourette disorder: a randomized controlled trial. JAMA 303:1929–1937CrossRefPubMedPubMedCentral
15.
go back to reference Wilhelm S, Peterson AL, Piacentini J, Woods DW, Deckersbach T, Sukhodolsky DG, Chang S, Liu H, Dziura J, Walkup JT, Scahill L (2012) Randomized trial of behavior therapy for adults with Tourette syndrome. Arch Gen Psychiatry 69:795–803CrossRefPubMedPubMedCentral Wilhelm S, Peterson AL, Piacentini J, Woods DW, Deckersbach T, Sukhodolsky DG, Chang S, Liu H, Dziura J, Walkup JT, Scahill L (2012) Randomized trial of behavior therapy for adults with Tourette syndrome. Arch Gen Psychiatry 69:795–803CrossRefPubMedPubMedCentral
16.
go back to reference Franklin ME, Best Stephanie H, Wilson Michelle A, Loew Benjamin, Compton Scott N (2011) Habit reversal training and acceptance and commitment therapy for Tourette syndrome: a pilot project. J Dev Phys Disabil 23:49–60CrossRef Franklin ME, Best Stephanie H, Wilson Michelle A, Loew Benjamin, Compton Scott N (2011) Habit reversal training and acceptance and commitment therapy for Tourette syndrome: a pilot project. J Dev Phys Disabil 23:49–60CrossRef
17.
go back to reference O’Connor K, Gareau D, Borgeat F (1997) A comparison of a behavioural and a cognitive-behavioural approach to the management of chronic tic disorders. Clin Psychol Psychother 4:105–117CrossRef O’Connor K, Gareau D, Borgeat F (1997) A comparison of a behavioural and a cognitive-behavioural approach to the management of chronic tic disorders. Clin Psychol Psychother 4:105–117CrossRef
18.
go back to reference Verdellen CWJ, van de Griendt J, Kriens S, van Oostrum I, Chang I (2011) Tics—therapist manual and workbook for children. Boom Cure and Care, Amsterdam Verdellen CWJ, van de Griendt J, Kriens S, van Oostrum I, Chang I (2011) Tics—therapist manual and workbook for children. Boom Cure and Care, Amsterdam
19.
go back to reference Verdellen CW, Keijsers GP, Cath DC, Hoogduin CA (2004) Exposure with response prevention versus habit reversal in Tourettes’s syndrome: a controlled study. Behav Res Ther 42(5):501–511CrossRefPubMed Verdellen CW, Keijsers GP, Cath DC, Hoogduin CA (2004) Exposure with response prevention versus habit reversal in Tourettes’s syndrome: a controlled study. Behav Res Ther 42(5):501–511CrossRefPubMed
24.
go back to reference Nissen JN, Kaergaard M, Laursen L (2018) Manual for treatment of tics. Akademisk Forlag, Copenhagen Nissen JN, Kaergaard M, Laursen L (2018) Manual for treatment of tics. Akademisk Forlag, Copenhagen
25.
go back to reference Leckman JF, Riddle MA, Hardin MT, Ort SI, Swartz KL, Stevenson J, Cohen DJ (1989) The Yale Global tic severity scale: initial testing of a clinician-rated scale of tic severity. J Am Acad Child Adolesc Psychiatry 28:566–573 (PMID: 2768151) CrossRefPubMed Leckman JF, Riddle MA, Hardin MT, Ort SI, Swartz KL, Stevenson J, Cohen DJ (1989) The Yale Global tic severity scale: initial testing of a clinician-rated scale of tic severity. J Am Acad Child Adolesc Psychiatry 28:566–573 (PMID: 2768151) CrossRefPubMed
26.
go back to reference Kompoliti K, Goetz CG (1997) Tourette syndrome. Clinical rating and quantitative assessment of tics. Neurol Clin 15(2):239–254 (PMID: 9106419) CrossRefPubMed Kompoliti K, Goetz CG (1997) Tourette syndrome. Clinical rating and quantitative assessment of tics. Neurol Clin 15(2):239–254 (PMID: 9106419) CrossRefPubMed
28.
go back to reference Achenbach TM (1994) Child behavior checklist and related instruments. In: Maurish ME (ed) The use of psychological testing for treatment planning and outcome assessment. Lawrence Erlbaum Associates, Hillsdale Achenbach TM (1994) Child behavior checklist and related instruments. In: Maurish ME (ed) The use of psychological testing for treatment planning and outcome assessment. Lawrence Erlbaum Associates, Hillsdale
29.
go back to reference Dunn W (2014) Sensory profile 2 manual. The Psychological Corporation. Pearson, San Antonio Dunn W (2014) Sensory profile 2 manual. The Psychological Corporation. Pearson, San Antonio
30.
go back to reference Birmaher B, Brent DA, Chiapetta L, Bridge J, Monga S, Baugher M (1999) Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): a replication study. J Am Acad Child Adolesc Psychiatry 38(10):1230–1236 (PMID: 10517055) CrossRefPubMed Birmaher B, Brent DA, Chiapetta L, Bridge J, Monga S, Baugher M (1999) Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): a replication study. J Am Acad Child Adolesc Psychiatry 38(10):1230–1236 (PMID: 10517055) CrossRefPubMed
31.
go back to reference Birmaher B, Khetarpal S, Brent D, Cully M, Balach L, Kaufman J, Neer SM (1997) The Screen for Child Anxiety Related Emotional Disorders (SCARED): scale construction and psychometric characteristics. J Am Acad Child Adolesc Psychiatry 36(4):545–553 (PMID: 9100430) CrossRefPubMed Birmaher B, Khetarpal S, Brent D, Cully M, Balach L, Kaufman J, Neer SM (1997) The Screen for Child Anxiety Related Emotional Disorders (SCARED): scale construction and psychometric characteristics. J Am Acad Child Adolesc Psychiatry 36(4):545–553 (PMID: 9100430) CrossRefPubMed
32.
go back to reference Muris P, Mayer B, Bartelds E, Tierney S, Bogie N (2001) The revised version of the Screen for Child Anxiety Related Emotional Disorders (SCARED-R): treatment sensitivity in an early intervention trial for childhood anxiety disorders. Br J Clin Psychol 4:323–336CrossRef Muris P, Mayer B, Bartelds E, Tierney S, Bogie N (2001) The revised version of the Screen for Child Anxiety Related Emotional Disorders (SCARED-R): treatment sensitivity in an early intervention trial for childhood anxiety disorders. Br J Clin Psychol 4:323–336CrossRef
33.
go back to reference Angold A, Costello EJ, Messer SC, Pickles A (1995) Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. Int J Methods Psychiatr Res 5:237–249 Angold A, Costello EJ, Messer SC, Pickles A (1995) Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. Int J Methods Psychiatr Res 5:237–249
34.
go back to reference Messer SC, Angold A, Costello EJ, Loeber R, van Kammen W, Stouthamer-Loeber M (1995) Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents: factor composition and structure across development. Int J Methods Psychiatr Res 5(4):251–262 Messer SC, Angold A, Costello EJ, Loeber R, van Kammen W, Stouthamer-Loeber M (1995) Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents: factor composition and structure across development. Int J Methods Psychiatr Res 5(4):251–262
35.
go back to reference Wood A, Kroll L, Moore A, Harrington R (1995) Properties of the mood and feelings questionnaire in adolescent psychiatric outpatients: a research note. J Child Psychol Psychiatry 136(2):327–334CrossRef Wood A, Kroll L, Moore A, Harrington R (1995) Properties of the mood and feelings questionnaire in adolescent psychiatric outpatients: a research note. J Child Psychol Psychiatry 136(2):327–334CrossRef
36.
go back to reference Woods DW, Piacentini J, Himle MB, Chang S (2005) Premonitory Urge for Tics Scale (PUTS): initial psychometric results and examination of the premonitory urge phenomenon in youths with Tic disorders. J Dev Behav Pediatr 26(6):397–403 (PMID: 16344654) CrossRefPubMed Woods DW, Piacentini J, Himle MB, Chang S (2005) Premonitory Urge for Tics Scale (PUTS): initial psychometric results and examination of the premonitory urge phenomenon in youths with Tic disorders. J Dev Behav Pediatr 26(6):397–403 (PMID: 16344654) CrossRefPubMed
42.
go back to reference Sallee FR, Kurlan R, Goetz CG, Singer H, Scahill L, Law G, Dittman VM, Chappell PB (2000) Ziprasidone treatment of children and adolescents with Tourette’s syndrome: a pilot study. J Am Acad Child Adolesc Psychiatry 39:292–299CrossRefPubMed Sallee FR, Kurlan R, Goetz CG, Singer H, Scahill L, Law G, Dittman VM, Chappell PB (2000) Ziprasidone treatment of children and adolescents with Tourette’s syndrome: a pilot study. J Am Acad Child Adolesc Psychiatry 39:292–299CrossRefPubMed
43.
go back to reference Scahill L, Leckman J, Schultz R, Katsowich L, Peterson B (2003) A placebo-controlled trial of risperidone in Tourette syndrome. Neurology 60:1130–1135CrossRefPubMed Scahill L, Leckman J, Schultz R, Katsowich L, Peterson B (2003) A placebo-controlled trial of risperidone in Tourette syndrome. Neurology 60:1130–1135CrossRefPubMed
Metadata
Title
Combined habit reversal training and exposure response prevention in a group setting compared to individual training: a randomized controlled clinical trial
Authors
Judith B. Nissen
Martin Kaergaard
Lisbeth Laursen
Erik Parner
Per Hove Thomsen
Publication date
01-01-2019
Publisher
Springer Berlin Heidelberg
Published in
European Child & Adolescent Psychiatry / Issue 1/2019
Print ISSN: 1018-8827
Electronic ISSN: 1435-165X
DOI
https://doi.org/10.1007/s00787-018-1187-z

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