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Practice Guideline
. 2022 Mar;31(3):403-423.
doi: 10.1007/s00787-021-01845-z. Epub 2021 Jul 27.

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

Per Andrén #  1 , Ewgeni Jakubovski #  2 , Tara L Murphy  3 , Katrin Woitecki  4 , Zsanett Tarnok  5 , Sharon Zimmerman-Brenner  6 , Jolande van de Griendt  7 , Nanette Mol Debes  8 , Paula Viefhaus  4 , Sally Robinson  9 , Veit Roessner  10 , Christos Ganos  11 , Natalia Szejko  12   13   14 , Kirsten R Müller-Vahl  2 , Danielle Cath  15 , Andreas Hartmann  16 , Cara Verdellen  17
Affiliations
Practice Guideline

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

Per Andrén et al. Eur Child Adolesc Psychiatry. 2022 Mar.

Abstract

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.

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Conflict of interest statement

CG received research grants from the VolkswagenStiftung (Freigeist Fellowship) and the German Parkinson Society and was also supported by the Deutsche Forschungsgemeinschaft (GA2031/1-1 and GA2031/1-2) and Actelion Pharmaceuticals. He also received financial support/honoraria to speak at meetings by Actelion pharmaceuticals and as ad hoc advisory board for Lundbeck. AH has received consultancy honoraria from Lundbeck and Noema Pharma. He has received research grants from the Association Française pour le Syndrome Gilles de la Tourette (AFSGT). DC received grant from the EU (TS EUROTRAIN), grant nr. 316978), several grants from ZONMW and MAGW (the Netherlands), from TSA-USA (2008), from Sunovion (DS028 (2019). From Espria fonds, Drenthe, the Netherlands. She has received speakers’ fees from ECNP, Psyfar, Benecke, Pfizer. KMV has received financial or material research support from the EU (FP7-HEALTH-2011 No. 278367, FP7-PEOPLE-2012-ITN No. 316978), the German Research Foundation (DFG: GZ MU 1527/3-1), the German Ministry of Education and Research (BMBF: 01KG1421), the National Institute of Mental Health (NIMH), the Tourette Gesellschaft Deutschland e.V., the Else-Kröner-Fresenius-Stiftung, and Abide Therapeutics, Almirall Hermal GmbH, GW pharmaceuticals, Lundbeck, Syneos Health, and Therapix Biosciences Ltd.She has received consultant's honoraria from Abide Therapeutics, Bionorica Ethics GmbH, CannaMedical Pharma GmbH, Canopy Grouth, Columbia Care, CTC Communications Corp., Eurox Deutschland GmbH, Global Praxis Group Limited, Lundbeck, Resalo Vertrieb GmbH, Sanity Group, Synendos Therapeutics AG, and Tilray. She is/was a consultant or advisory board member for Abide Therapeutics, The Academy of Medical Cannabis Limited, Alirio, Aphria Deutschland GmbH, CannaMedical Pharma GmbH, Boehringer Ingelheim International GmbH, Bionorica Ethics GmbH, CannaXan GmbH, Canopy Growth, Columbia Care, CTC Communications Corp., Leafly Deutschland GmbH, Lundbeck, Nomovo Pharm, Nuvelution TS Pharma Inc., Resalo Vertrieb GmbH, Sanity Group, Syqe Medical Ltd., Therapix Biosciences Ltd., Tilray, Wayland Group, Zynerba Pharmaceuticals, and CTC Communications Corporation. She has received speaker’s fees from Aphria Deutschland GmbH, Cogitando GmbH, Emalex, Eurox group, Ever pharma GmbH, PR Berater, Tilray, and Wayland Group. She has received royalties from Medizinisch Wissenschaftliche Verlagsgesellschaft Berlin, Elsevier, and Kohlhammer. She holds shares of Nomovo Pharm. She served as a Guest Editor for Frontiers in Neurology on the research topic “The neurobiology and genetics of Gilles de la Tourette syndrome: new avenues through large-scale collaborative projects” and is Associate Editor for “Cannabis and Cannabinoid Research”, Editorial Board Member for “Medical Cannabis and Cannabinoids” and “MDPI-Reports”, and scientific board member for “Zeitschrift für Allgemeinmedizin”. VR has received payment for consulting and writing activities from Lilly, Novartis, and Shire Pharmaceuticals, lecture honoraria from Lilly, Novartis, Shire Pharmaceuticals, and Medicine Pharma, and support for research from Shire Pharmaceuticals and Novartis. He has carried out clinical trials in cooperation with the Novartis, Shire, Servier and Otsuka companies. All other authors have no conflicts to declare.

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