A meta-analysis of behavior therapy for Tourette Syndrome

Joseph F McGuire; John Piacentini; Erin A Brennan; Adam B Lewin; Tanya K Murphy; Brent J Small; Eric A Storch

doi:10.1016/j.jpsychires.2013.12.009

A meta-analysis of behavior therapy for Tourette Syndrome

J Psychiatr Res. 2014 Mar:50:106-12. doi: 10.1016/j.jpsychires.2013.12.009. Epub 2013 Dec 28.

Authors

Joseph F McGuire¹, John Piacentini², Erin A Brennan³, Adam B Lewin⁴, Tanya K Murphy⁵, Brent J Small⁶, Eric A Storch⁴

Affiliations

¹ Department of Psychology, University of South Florida, 4202 E. Fowler Avenue, PCD 4118G, Tampa, FL 33620, USA; Department of Pediatrics, University of South Florida Tampa, FL, USA. Electronic address: jfmcguire@mail.usf.edu.
² Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA.
³ Department of Pediatrics, University of South Florida Tampa, FL, USA.
⁴ Department of Psychology, University of South Florida, 4202 E. Fowler Avenue, PCD 4118G, Tampa, FL 33620, USA; Department of Pediatrics, University of South Florida Tampa, FL, USA; Departments of Psychiatry and Behavioral Neurosciences, University of South Florida Tampa, FL, USA.
⁵ Department of Pediatrics, University of South Florida Tampa, FL, USA; Departments of Psychiatry and Behavioral Neurosciences, University of South Florida Tampa, FL, USA.
⁶ School of Aging Studies, University of South Florida Tampa, FL, USA.

PMID: 24398255
DOI: 10.1016/j.jpsychires.2013.12.009

Abstract

Individual randomized controlled trials (RCTs) of habit reversal training and a Comprehensive Behavioral Intervention for Tics (collectively referred to as behavior therapy, BT) have demonstrated efficacy in reducing tic severity for individuals with Tourette Syndrome and Chronic Tic Disorders (collectively referred to as TS), with no examination of treatment moderators. The present meta-analysis synthesized the treatment effect sizes (ES) of BT relative to comparison conditions, and examined moderators of treatment. A comprehensive literature search identified eight RCTs that met inclusion criteria, and produced a total sample of 438 participants. A random effects meta-analysis found a medium to large ES for BT relative to comparison conditions. Participant mean age, average number of therapy sessions, and the percentage of participants with co-occurring attention deficit hyperactivity disorder (ADHD) were found to moderate treatment effects. Participants receiving BT were more likely to exhibit a treatment response compared to control interventions, and identified a number needed to treat (NNT) of three. Sensitivity analyses failed to identify publication bias. Overall, BT trials yield medium to large effects for TS that are comparable to treatment effects identified by meta-analyses of antipsychotic medication RCTs. Larger treatment effects may be observed among BT trials with older participants, more therapeutic contact, and less co-occurring ADHD.

Keywords: Chronic Tic Disorder; Comprehensive Behavioral Intervention for Tics; Habit reversal training; Tourette disorder; Treatment outcome.

Publication types

Meta-Analysis
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Age Factors
Analysis of Variance
Attention Deficit Disorder with Hyperactivity / complications
Behavior Therapy*
Child
Humans
Odds Ratio
Randomized Controlled Trials as Topic
Tourette Syndrome / complications
Tourette Syndrome / therapy*
Treatment Outcome
Young Adult