European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part II: psychological interventions

Eur Child Adolesc Psychiatry. 2022 Mar;31(3):403-423. doi: 10.1007/s00787-021-01845-z. Epub 2021 Jul 27.


Part II of the European clinical guidelines for Tourette syndrome and other tic disorders (ECAP journal, 2011) provides updated information and recommendations for psychological interventions for individuals with tic disorders, created by a working group of the European Society for the Study of Tourette Syndrome (ESSTS). A systematic literature search was conducted to obtain original studies of psychological interventions for tic disorders, published since the initial European clinical guidelines were issued. Relevant studies were identified using computerized searches of the MEDLINE and PsycINFO databases for the years 2011-2019 and a manual search for the years 2019-2021. Based on clinical consensus, psychoeducation is recommended as an initial intervention regardless of symptom severity. According to a systematic literature search, most evidence was found for Habit Reversal Training (HRT), primarily the expanded package Comprehensive Behavioral Intervention for Tics (CBIT). Evidence was also found for Exposure and Response Prevention (ERP), but to a lesser degree of certainty than HRT/CBIT due to fewer studies. Currently, cognitive interventions and third-wave interventions are not recommended as stand-alone treatments for tic disorders. Several novel treatment delivery formats are currently being evaluated, of which videoconference delivery of HRT/CBIT has the most evidence to date. To summarize, when psychoeducation alone is insufficient, both HRT/CBIT and ERP are recommended as first-line interventions for tic disorders. As part of the development of the clinical guidelines, a survey is reported from ESSTS members and other tic disorder experts on preference, use and availability of psychological interventions for tic disorders.

Keywords: Behavior therapy; Comprehensive behavioral intervention for tics; Exposure and response prevention; Habit reversal training; Tic disorders; Tourette syndrome; Treatment guidelines.

Publication types

  • Practice Guideline

MeSH terms

  • Behavior Therapy
  • Humans
  • Psychosocial Intervention
  • Tic Disorders*
  • Tics* / therapy
  • Tourette Syndrome* / psychology
  • Tourette Syndrome* / therapy