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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

The effectiveness of habit reversal therapy in the treatment of Tourette syndrome and other chronic tic disorders: a systematic review

N Dutta and AE Cavanna.

Review published: 2013.

CRD summary

The authors concluded that habit reversal therapy can significantly reduce tic severity in both adults and children with Tourette syndrome and other chronic tic disorders. This conclusion should be regarded as unreliable.

Authors' objectives

To evaluate the efficacy of habit reversal therapy in Tourette syndrome and other chronic tic disorders.

Searching

PubMed and PsycINFO (dates not given) were searched for papers in English; search terms were reported.

Study selection

Randomised controlled trials (RCTs) that compared habit reversal therapy versus a control treatment in Tourette syndrome and other chronic tic disorders in children or adults were eligible for inclusion. Studies were required to use standardised diagnostic criteria and outcome measures. Studies that used wait-list controls were excluded.

Included RCTs compared habit reversal therapy with supportive psychotherapy or exposure with response prevention. All RCTs included competing response training and awareness training within habit reversal therapy; most also incorporated relaxation training and/or function-based interventions. Participants included both males and females (69% male), with mean age ranging from 12 years to 36 years (two studies included only adults; one included only children). Most of the participants were diagnosed with Tourette syndrome (92%). Tic severity was measured with the Yale Global Tic Severity Scale in all trials.

It was unclear how many reviewers were involved with study selection.

Assessment of study quality

It did not appear that a structured quality assessment was carried out.

Data extraction

Details of the data extraction were not reported.

Methods of synthesis

Studies were described in the text and via tables. A narrative summary was presented.

Results of the review

Five studies were included in the review (353 participants) with follow-up ranging from three to 10 months. One trial appeared to be of a cross-over design.

In four studies, habit reversal therapy reduced tic severity compared with supportive psychotherapy both by the end of the trials and after follow-up. One study reported a larger reduction in tic severity when comparing habit reversal therapy with exposure and response prevention.

Authors' conclusions

Current evidence suggests that habit reversal therapy can significantly reduce tic severity in both adults and children with Tourette syndrome and other chronic tic disorders.

CRD commentary

The review addressed a clear question with restrictive inclusion criteria and a search of just two databases for papers English. No attempts were reported to reduce the potential impact of language and publication biases and it seemed likely that relevant papers were missed. No details of the review processes were reported so we could not rule out reviewer error and bias.

The studies were partially described but with insufficient detail to permit assessment of their reliability. The narrative synthesis and tables did not provide data on any statistically significant differences. The reviewers highlighted a range of potential weaknesses in the primary studies.

Overall, the data as presented do not support the strong conclusions offered by the authors and these should be considered as unreliable.

Implications of the review for practice and research

Practice: The evidence supports more widespread provision of habit reversal therapy for the treatment of tics; more specialists require training in this therapy.

Research: Further head-to-head studies were needed to compare the efficacy of habit reversal therapy with other behavioural or pharmacological interventions for tic management; trials should include quality of life measurements.

Funding

Tourette Syndrome Association-USA; Tourettes Action-UK

Bibliographic details

Dutta N, Cavanna AE. The effectiveness of habit reversal therapy in the treatment of Tourette syndrome and other chronic tic disorders: a systematic review. Functional Neurology 2013; 28(1): 7-12. [PMC free article: PMC3812724] [PubMed: 23731910]

Indexing Status

Subject indexing assigned by NLM

MeSH

Adolescent; Adult; Behavior Therapy /methods; Child; Diagnostic and Statistical Manual of Mental Disorders; Female; Habits; Humans; Male; Randomized Controlled Trials as Topic; Tic Disorders /psychology /therapy; Tourette Syndrome /psychology /therapy; Treatment Outcome; Young Adult

AccessionNumber

12013030961

Database entry date

02/05/2014

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 23731910

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