Gilles de la Tourette Syndrome, Obsessive - Compulsive Disorder, Tic Disorder, Chronic Motor or Vocal, Tic Disorder, Combined Vocal and Multiple Motor, Tic Disorders, Tourette Disease, Tourette Disorder, Tourettes Syndrome
Conditions
Keywords
Obsessive-Compulsive Disorder, Tic Disorders, Tourette Syndrome, Tourettic Obsessive-Compulsive Disorder, Exposure and Response Prevention, Habit Reversal Training
Brief summary
Obsessive-Compulsive Disorder and Tic Disorders frequently co-occur, and a subgroup of patients - those with a Tourettic Subtype of OCD (TOCD) - present with concurrent obsessive-compulsive and tic symptoms. Existing psychological interventions typically target one condition or the other, but rarely both together. This study aims to test whether a combined psychological therapy integrating Exposure and Response Prevention (ERP) and Habit Reversal (HbRT) is more effective at reducing symptoms than either therapy delivered alone, in adults with TOCD.
Detailed description
Participants are randomly allocated to one of four groups: (1) combined ERP and HbRT, (2) ERP alone, (3) HbRT alone, or (4) a supportive psychoeducation control. All participants receive 12 weekly one-to-one sessions (either in-person or remotely) of approximately fifty minutes. Symptoms will be assessed using the Yale Global Tic Severity Scale (YGTSS) and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) by an independent clinician at the start of treatment, at Week 12, and again at Week 24.
Interventions
BEHAVIORALExposure and Response Prevention (ERP)
Exposure and Response Prevention (ERP) is a behavioural intervention that involves gradual and systematic exposure to obsessional fears, distress, sensory discomfort, premonitory urges, and "not-just-right" experiences while refraining from compulsions, avoidance, reassurance seeking, and other safety behaviours. Treatment is delivered individually over 12 weekly 50-minute sessions, either face-to-face or remotely.
BEHAVIORALHabit Reversal Training (HbRT
Habit Reversal Training (HbRT) is a behavioural intervention that includes awareness training, identification of premonitory urges and antecedents to tic expression, development and practice of competing responses, and strategies to generalise skills across settings. Treatment is delivered individually over 12 weekly 50-minute sessions, either face-to-face or remotely.
BEHAVIORALPsychoeducation and Supportive Intervention
Psychoeducation and Supportive Therapy consists of structured education about obsessive-compulsive disorder, tic disorders, Tourettic obsessive-compulsive disorder, stress, and wellbeing, together with supportive discussion and general problem-solving. The intervention does not include Exposure and Response Prevention, Habit Reversal Training, or other targeted behavioural techniques. Treatment is delivered individually over 12 weekly 50-minute sessions, either face-to-face or remotely.
Sponsors
University College London Hospitals
University College, London
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Intervention model description
Participants are randomly allocated to one of four groups: (1) combined ERP and HbRT, (2) ERP alone, (3) HbRT alone, or (4) a supportive psychoeducation control.
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
1. Age 18 years or older 2. All genders 3. Confirmation of a primary diagnosis of either: a. Tourettes Disorder / Tourette Syndrome b. Persistent Motor or Vocal Tic Disorder / Chronic Motor or Vocal Tic Disorder c. Provisional Tic Disorder / Transient Motor Tics d. Other Specified Tic Disorder e. Unspecified Tic Disorder f. Obsessive-Compulsive Disorder \[d\] Participants taking psychotropic medication are eligible provided medication type and dose remain stable throughout the intervention period \[e\] Ability to provide sustained informed consent \[f\] A minimum score of 16 on YBOCS \[g\] A minimum score of 5 on the Premonitory Urge for Tics Scale (PUTS)
Exclusion criteria
1. Substance misuse 2. Current diagnosis of a personality disorder 3. Schizophrenia 4. Bipolar disorder 5. Contraindications to participation in a trial (i.e., active suicidal ideations and/or requirement of an interpreter) 6. Any psychiatric or neurological condition that, in the opinion of the investigators, would interfere with participation or interpretation of study outcomes.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Yale-Brown Obsessive Compulsive Scale Total Score | Baseline, Week 12 and Week 24 | Obsessive-compulsive symptom severity will be assessed using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Total scores range from 0 to 40, with higher scores indicating greater obsessive-compulsive symptom severity. Change from baseline will be assessed at Week 12 and Week 24. |
| Change From Baseline in Yale Global Tic Severity Scale Total Tic Severity Score | Baseline, Week 12 and Week 24 | Tic symptom severity will be assessed using the Yale Global Tic Severity Scale (YGTSS) Total Tic Severity Score. Scores range from 0 to 50, with higher scores indicating greater tic symptom severity. Change from baseline will be assessed at Week 12 and Week 24. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in Yale Global Tic Severity Scale Global Severity Score | Baseline, Week 12 and Week 24 | Overall tic symptom severity and tic-related impairment will be assessed using the Yale Global Tic Severity Scale (YGTSS) Total Score. The Global Score is calculated by summing the Total Tic Severity Score (0-50) and the Impairment Score (0-50), resulting in a global score ranging from 0 to 100. Higher scores indicate greater overall tic severity and impairment. Change from baseline will be assessed at Week 12 and Week 24. |
Countries
United Kingdom
Contacts
CONTACTDipesh Patel, MPhil / PhD
Outcome results
None listed