Implementation and Evaluation of Therapeutic Online Coaching Using Habit Reversal Training in Children With Tourette’s Disorder – A Pilot Study

Cognitive-behavioral interventions can be difficult to implement in daily routine, which is often essential for generalizing treatment effects to natural settings. Furthermore, there is a lack of adequate care options concerning habit reversal training for children with Tourette’s disorder. The objective of this study is to evaluate therapeutic online coaching via videoconferencing in the natural environment of children with Tourette’s disorder in addition to face-to-face therapy (blended therapy). Online coaching took place twice a week for a maximum of 12 weeks. In a single-case study (n = 5; patients aged 8–11 years), the first results were obtained for exploratory purposes, especially with regard to the feasibility and reduction of symptoms and impairment. Various outcome measures were assessed (severity of symptoms, impairment, practical implementation, and satisfaction). Despite some principal limitations, the findings provide first hints that blended therapy is feasible and improves symptoms in some children with tics.Clinical Trial Registration: [https://clinicaltrials.gov/], identifier [DRKS00017199].

HABIT REVERSAL USED TO TREAT ONYCHOPHAGIA: A CASE REPORT

Chronic nail biting (onychophagia) is a common habit which negatively impacts on the quality of life of those affected, has a negative social impact, and is accompanied with disabling inflammatory processes like gingivitis and paronychia. Habit reversal is a behaviour treatment procedure used to help patients get rid of the habit. The presented case report describes how a six-month period of habit reversal prescribed by the dermatologist was used to treat a 42-year male suffering from life-long onychophagia. During the treatment period, the patient experienced both an improved growth of nails and an improvement in quality of life, but never got fully cured from the habit. Finally, suggestions for an improved treatment success by prescribing habit reversal in specialized onychophagia clinics run by a multidisciplinary team (consisting of e.g., dermatologists, psychiatrists, and psychologists) who ensure regular follow-ups and patient compliance is provided.

Obsessive-Compulsive Disorder and Tic Disorder/Tourette Syndrome

The Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A) have clinical relevance for youth with obsessive-compulsive disorder (OCD) and Tourette syndrome, particularly when comorbid anxiety and depression are present. Within this population, the UP-C/A can be applied either as standalone interventions or in conjunction with exposure and response prevention or habit reversal techniques. However, their efficacy and utility in these populations have never been examined in a randomized controlled trial. This chapter outlines recommendations for how to apply the UP-C/A to youth with OCD and related disorders. For example, applying module content in a flexible order is recommended, such as generating a list of emotional behaviors early in treatment, and checking in about opposite actions throughout treatment. Introducing nonjudgmental awareness and exposures early in treatment is also recommended.