Integrating Exposure and Response Prevention and Habit Reversal Techniques to Treat a Tourettic Subtype of Obsessive-Compulsive Disorder (Tourettic OCD)

University College London Hospitals40 enrolled

Overview

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.

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.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

Obsessive - Compulsive Disorder Tic Disorder, Chronic Motor or Vocal

Interventions

Exposure and Response Prevention (ERP)BEHAVIORAL

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.

Habit Reversal Training (HbRTBEHAVIORAL

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.

Psychoeducation and Supportive InterventionBEHAVIORAL

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.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 65 Years

Medical Language ↔ Plain English

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.

Locations (2)

University College London Hospitals NHS Foundation Trust

London, London, United Kingdom

RECRUITING

University College London Queen Square Institute of Neurology

London, London, United Kingdom

RECRUITING

Outcomes

Primary Outcomes

Change From Baseline in Yale-Brown Obsessive Compulsive Scale Total Score

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.

Time frame: Baseline, Week 12 and Week 24

Change From Baseline in Yale Global Tic Severity Scale Total Tic Severity Score

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.

Time frame: Baseline, Week 12 and Week 24

Secondary Outcomes

Change From Baseline in Yale Global Tic Severity Scale Global Severity Score

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.

Time frame: Baseline, Week 12 and Week 24

Integrating Exposure and Response Prevention and Habit Reversal Techniques to Treat a Tourettic Subtype of Obsessive-Compulsive Disorder (Tourettic OCD)

Overview

Conditions

Interventions

Eligibility

Locations (2)

Outcomes

Primary Outcomes

Secondary Outcomes

Central Contacts