Efficacy of habit reversal training for the treatment of tics in patients with Tourette syndrome and other tic disorders

Introduction. Among hyperkinetic movement disorders, tic disorders can prove particularly challenging in terms of their clinical management. Habit reversal therapy (HRT) has been recommended as a behavioral intervention for the treatment of tics in patients diagnosed with Tourette syndrome (TS) or other tic disorders. This systematic literature review assessed the efficacy of HRT, either as a stand-alone or as the key component of a wider Comprehensive Behavioral Intervention for Tics (CBIT).

Methods. A comprehensive search was conducted according to the PRISMA guidelines across four databases (PubMed, PsycINFO, EMBASE, and OVID MEDLINE) for randomized controlled trials (RCTs) published between 2000 and 2024.

Results. Ten high-quality RCTs met stringent inclusion criteria. The geographical distribution of the studies was skewed, with 6/10 studies originating from North America. The findings consistently showed significant reductions in tic severity across children, adolescents, and adults with TS or other tic disorders treated with HRT. Treatment gains were consistently maintained at follow-up periods ranging from 3 to 10 months. Several studies reported additional benefits, including improvements in cognitive function and emotional regulation. Modified protocols, such as shortened interventions and group delivery formats, showed promising results for increasing accessibility while maintaining efficacy. No significant adverse effects were reported across studies.

Discussion. This review found robust evidence supporting the efficacy of HRT as a behavioral intervention delivered by trained psychologists for the treatment of tics. HRT has the potential to provide effective, safe, and possibly long-lasting benefits for tic management across different age groups. Future research should focus on larger-scale studies with extended follow-up periods, investigation of treatment response predictors, and strategies for widespread implementation across multiple geographical regions.