You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Habit reversal versus supportive psychotherapy in Tourette's disorder: a randomized controlled trial and predictors of treatment response.
Abstract 1:
Tourette syndrome ( TS ) is characterized by chronic motor and vocal tics . Habit reversal therapy ( HR ) is a behavioral treatment for tics which has received recent empirical support . The present study compared the efficacy of HRT in reducing tics , improving life-satisfaction and psychosocial functioning in comparison with supportive psychotherapy ( SP ) in out patients with TS . In addition , we investigated whether impairments in response inhibition in patients with TS predict response to HR treatment which specifically aims to inhibit tics . Thirty adult out patients with DSM-IV TS were r and omized to 14 individual sessions of HR ( n = 15 ) ; or SP ( n = 15 ) . HR but not SP reduced tic severity over the course of the treatment . Both groups improved in life-satisfaction and psychosocial functioning during active treatment . Reductions in tic severity ( HR ) and improvements in life-satisfaction and psychosocial functioning ( HR and SP ) remained stable at the 6-month follow-up . The extent of pre-treatment response inhibition impairment in the HR group predicted reductions in tic-severity from pre- to post-treatment . Our results suggest that HR has specific tic-reducing effects although SP is effective in improving life-satisfaction and psychosocial functioning . Assessment s of response inhibition may be of value for predicting treatment response to HR


Title 2:
Cognitive behavioral management of Tourette's syndrome and chronic tic disorder in medicated and unmedicated samples.
Abstract 2:
OBJECTIVE Cognitive behavior therapy ( CBT ) and medication can be administered in combination in treating tic disorders but there are no studies evaluating the effectiveness of CBT with and without medication . The current study compares the efficacy of CBT in combination with medication and without medication . METHOD CBT was administered in a consecutively referred sample of 76 people diagnosed either with Gilles de la Tourette Syndrome or chronic tic disorder . The sample was divided into a medicated and a non-medicated group . Twenty three were stabilized on medication and 53 were not receiving medication . Measures administered pre- and post-CBT in both groups included : main outcome measure of Tourette Syndrome Global Scale and measures of mood . RESULTS Repeated measures analysis of variance on the initial sample revealed no difference between medicated and non-medicated groups in outcome . A further analysis comparing the 23 receiving medication with 23 not receiving medication matched on baseline clinical variables also yielded no significant group differences , either in treatment outcome on main tic outcome measures or on other clinical ly relevant question naires . DISCUSSION CBT for tic disorders is an effective treatment administered either in combination with medication or alone


Title 3:
A randomized pilot trial comparing videoconference versus face-to-face delivery of behavior therapy for childhood tic disorders.
Abstract 3:
Comprehensive Behavioral Intervention for  Tics ( CBIT ) has been shown to be effective for reducing tics in children with chronic tic disorder . Unfortunately , there remain significant barriers to dissemination . The aim of the current study was to examine the effectiveness of CBIT delivered over videoconference .  Twenty children were r and omly assigned to receive CBIT over videoconference or via traditional face-to-face delivery . Results show that both treatment delivery modalities result ed in significant tic reduction with no between group differences . Furthermore , acceptability and therapist-client alliance ratings were strong for both groups . Together , these results suggest that videoconference is a viable option for disseminating CBIT


Title 4:
Exposure with response prevention versus habit reversal in Tourettes's syndrome: a controlled study.
Abstract 4:
The intentional nature of tics provides the opportunity to apply behavioural interventions aim ed at tic reduction through interruption of stimulus-response sequences . The aim of this study has been to evaluate the effect of exposure and response prevention ( ER ) versus habit reversal ( HR ) in 43 Tourette 's syndrome ( TS ) patients . The three outcome measures were : the Yale Global Tic Severity Scale ( YGTSS ) , 15-min tic frequency registration s monitored at the institute and 15-min home tic frequency registration s. Both treatment conditions result ed in statistically significant improvements on all outcome measures ( p < 0.001 ) . No significant differences were found between the treatment conditions on any of the outcome measures , although there was a tendency in favour of ER on the YGTSS ( p = 0.05 ) . These results suggest that , at least in the short term , TS tic symptoms can be treated effectively with both types of treatment


Title 5:
Behavior therapy for children with Tourette disorder: a randomized controlled trial.
Abstract 5:
CONTEXT Tourette disorder is a chronic and typically impairing childhood-onset neurologic condition . Antipsychotic medications , the first-line treatments for moderate to severe tics , are often associated with adverse effects . Behavioral interventions , although promising , have not been evaluated in large-scale controlled trials . OBJECTIVE To determine the efficacy of a comprehensive behavioral intervention for reducing tic severity in children and adolescents . DESIGN , SETTING , AND PARTICIPANTS R and omized , observer-blind , controlled trial of 126 children recruited from December 2004 through May 2007 and aged 9 through 17 years , with impairing Tourette or chronic tic disorder as a primary diagnosis , r and omly assigned to 8 sessions during 10 weeks of behavior therapy ( n = 61 ) or a control treatment consisting of supportive therapy and education ( n = 65 ) . Responders received 3 monthly booster treatment sessions and were reassessed at 3 and 6 months following treatment . INTERVENTION Comprehensive behavioral intervention . MAIN OUTCOME MEASURES Yale Global Tic Severity Scale ( range 0 - 50 , score > 15 indicating clinical ly significant tics ) and Clinical Global Impressions-Improvement Scale ( range 1 [ very much improved ] to 8 [ very much worse ] ) . RESULTS Behavioral intervention led to a significantly greater decrease on the Yale Global Tic Severity Scale ( 24.7 [ 95 % confidence interval { CI } , 23.1 - 26.3 ] to 17.1 [ 95 % CI , 15.1 - 19.1 ] ) from baseline to end point compared with the control treatment ( 24.6 [ 95 % CI , 23.2 - 26.0 ] to 21.1 [ 95 % CI , 19.2 - 23.0 ] ) ( P < .001 ; difference between groups , 4.1 ; 95 % CI , 2.0 - 6.2 ) ( effect size = 0.68 ) . Significantly more children receiving behavioral intervention compared with those in the control group were rated as being very much improved or much improved on the Clinical Global Impressions-Improvement scale ( 52.5 % vs 18.5 % , respectively ; P < .001 ; number needed to treat = 3 ) . Attrition was low ( 12/126 , or 9.5 % ) ; tic worsening was reported by 4 % of children ( 5/126 ) . Treatment gains were durable , with 87 % of available responders to behavior therapy exhibiting continued benefit 6 months following treatment . CONCLUSION A comprehensive behavioral intervention , compared with supportive therapy and education , result ed in greater improvement in symptom severity among children with Tourette and chronic tic disorder . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00218777


Title 6:
An evaluation of behavioral treatments for Tourette syndrome.
Abstract 6:
The present study evaluated the effectiveness of self-monitoring , relaxation training and habit reversal in the treatment of 6 Tourette Syndrome ( TS ) subjects with multiple motor and vocal tics .  A counterbalanced design was employed and tic frequencies were measured in the clinic setting using videotapes taken through a one-way mirror . Tics were reduced by an average of 55 % with habit reversal , 44 % with self-monitoring , and 32 % with relaxation training and each behavioral procedure was the most effective treatment for at least one subject . All three treatment approaches may have some utility in the behavioral treatment of TS


Title 7:
Randomized trial of behavior therapy for adults with Tourette syndrome.
Abstract 7:
CONTEXT Tics in Tourette syndrome begin in childhood , peak in early adolescence , and often decrease by early adulthood . However , some adult patients continue to have impairing tics . Medications for tics are often effective but can cause adverse effects . Behavior therapy may offer an alternative but has not been examined in a large-scale controlled trial in adults . OBJECTIVE To test the efficacy of a comprehensive behavioral intervention for tics in adults with Tourette syndrome of at least moderate severity . DESIGN A r and omized controlled trial with posttreatment evaluations at 3 and 6 months for positive responders . SETTING Three outpatient research clinics . PATIENTS Patients ( N = 122 ; 78 males ; age range , 16 - 69 years ) with Tourette syndrome or chronic tic disorder were recruited between December 27 , 2005 , and May 21 , 2009 . INTERVENTIONS Patients received 8 sessions of comprehensive behavioral intervention for tics or 8 sessions of supportive treatment for 10 weeks . Patients with a positive response were given 3 monthly booster sessions . MAIN OUTCOME MEASURES Total tic score on the Yale Global Tic Severity Scale and the Clinical Global Impression-Improvement scale rated by a clinician masked to treatment assignment . RESULTS Behavior therapy was associated with a significantly greater mean ( SD ) decrease on the Yale Global Tic Severity Scale ( 24.0 [ 6.47 ] to 17.8 [ 7.32 ] ) from baseline to end point compared with the control treatment ( 21.8 [ 6.59 ] to 19.3 [ 7.40 ] ) ( P < .001 ; effect size = 0.57 ) . Twenty-four of 63 patients ( 38.1 % ) were rated as much improved or very much improved on the Clinical Global Impression-Improvement scale compared with 4 of 63 ( 6.4 % ) in the control group ( P < .001 ) . Attrition was 13.9 % , with no difference across groups . Patients receiving behavior therapy who were available for assessment at 6 months after treatment showed continued benefit . CONCLUSION Comprehensive behavior therapy is a safe and effective intervention for adults with Tourette syndrome . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00231985


Title 8:
Behavior Therapy for Tics in Children: Acute and Long-Term Effects on Psychiatric and Psychosocial Functioning
Abstract 8:
Children ( n = 126 ) ages 9 to 17 years with chronic tic or Tourette disorder were r and omly assigned to receive either behavior therapy or a control treatment over 10 weeks . This study examined acute effects of behavior therapy on secondary psychiatric symptoms and psychosocial functioning and long-term effects on these measures for behavior therapy responders only . Baseline and end point assessment s conducted by a masked independent evaluator assessed several secondary psychiatric symptoms and measures of psychosocial functioning . Responders to behavior therapy at the end of the acute phase were reassessed at 3-month and 6-month follow-up . Children in the behavior therapy and control conditions did not differentially improve on secondary psychiatric or psychosocial outcome measures at the end of the acute phase . At 6-month posttreatment , positive response to behavior therapy was associated with decreased anxiety , disruptive behavior , and family strain and improved social functioning .  Behavior therapy is a tic-specific treatment for children with tic disorders


Title 9:
Habit reversal versus supportive psychotherapy for Tourette's disorder: a randomized controlled trial.
Abstract 9:
OBJECTIVE The authors investigated the efficacy of habit reversal for Tourette 's disorder , which is characterized by multiple motor and vocal tics . METHOD Thirty-two patients with Tourette 's disorder were r and omly assigned to 14 sessions of either habit reversal or supportive psychotherapy . Habit reversal consisted of awareness training , self-monitoring , relaxation training , competing response training , and contingency management .  Changes in severity of Tourette 's disorder and psychosocial impairment were investigated over the course of the 14-session treatment for the 29 patients who completed at least eight treatment sessions . RESULTS In contrast to the 13 patients in the supportive psychotherapy group , the 16 patients in the habit reversal group improved significantly . The habit reversal patients remained significantly improved over pretreatment at 10-month follow-up . CONCLUSIONS Habit reversal may be an effective behavioral treatment for Tourette 's disorder
This systematic review and meta- analysis demonstrates that behavior therapies based on Habit Reversal Therapy , including the Comprehensive Behavioral Intervention for Tics are effective in reducing tic severity when compared with supportive psychotherapy .
When these behavior therapies are unavailable , Exposure with Response Prevention may also be effective .
Both face-to-face and telehealth delivery methods for behavior therapy improve tic severity , and broader distribution of behavior therapy through increased training or telehealth methods is encouraged .