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

Abstract 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 study Large naturalistic sample (N=167) provides real-world effectiveness data for therapist-delivered video HRT across developmental stages from children to adults Video therapy format with digital support eliminates geographical barriers while allowing treatment delivery in patients’ natural environments Retrospective observational design without control group precludes causal inferences about treatment effectiveness compared to alternative interventions Self-report and parent-report outcome measures may introduce reporting bias Validated 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