A randomized waitlist-controlled pilot trial of voice over Internet protocol-delivered behavior therapy for youth with chronic tic disorders

Ricketts, Emily J
Goetz, Amy R
Capriotti, Matthew R
Bauer, Christopher C
Brei, Natalie G
Himle, Michael B
Espil, Flint M
Snorrason, Ívar
Ran, Dagong
Woods, Douglas W

¹Division of Child and Adolescent Psychiatry, University of California, Los Angeles, USA
²Department of Psychology, University of Wisconsin-Milwaukee, USA
³Department of Psychology, University of Utah, USA
⁴Department of Psychology, Texas A&M University, USA

Douglas W Woods, Department of Psychology, Texas A&M University, 4235 TAMU, College Station, TX 77843-4235, USA. Email: [email protected]

Received March 17, 2015

Accepted May 14, 2015

Journal of Telemedicine and Telecare 22(3):p 153-162, April 2016. | DOI: 10.1177/1357633X15593192

Introduction

Comprehensive Behavioral Intervention for Tics (CBIT) has been shown to be efficacious for chronic tic disorders (CTDs), but utilization is limited by a lack of treatment providers and perceived financial and time burden of commuting to treatment. A promising alternative to in-person delivery is voice over Internet protocol (VoIP), allowing for remote, real-time treatment delivery to patients’ homes. However, little is known about the effectiveness of VoIP for CTDs. Therefore, the present study examined the preliminary efficacy, feasibility, and acceptability of VoIP-delivered CBIT (CBIT-VoIP).

Methods

Twenty youth (8–16 years) with CTDs participated in a randomized, waitlist-controlled pilot trial of CBIT-VoIP. The main outcome was pre- to post-treatment change in clinician-rated tic severity (Yale Global Tic Severity Scale). The secondary outcome was clinical responder rate (Clinical Global Impressions – Improvement Scale), assessed using ratings of ‘very much improved’ or ‘much improved’ indicating positive treatment response.

Results

Intention-to-treat analyses with the last observation carried forward were performed. At post-treatment (10-weeks), significantly greater reductions in clinician-rated, (F(1,18) = 3.05, p < 0.05, partial η²= 0.15), and parent-reported tic severity, (F(1,18) = 6.37, p < 0.05, partial η²= 0.26) were found in CBIT-VoIP relative to waitlist. One-third (n = 4) of those in CBIT-VoIP were considered treatment responders. Treatment satisfaction and therapeutic alliance were high.

Discussion

CBIT can be delivered via VoIP with high patient satisfaction, using accessible, low-cost equipment. CBIT-VoIP was generally feasible to implement, with some audio and visual challenges. Modifications to enhance treatment delivery are suggested.