title: A randomized waitlist-controlled pilot trial of voice over Internet protocol-delivered behavior therapy for youth with chronic tic disorders.
abstract: BACKGROUND
  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 η(2 )= 0.15), and parent-reported tic severity, (F(1,18) = 6.37, p < 0.05, partial η(2 )= 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Child and Adolescent Psychiatry, University of California, Los Angeles, USA Department of Psychology, University of Wisconsin-Milwaukee, USA.
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Ricketts
authors.affiliation: Department of Psychology, University of Wisconsin-Milwaukee, USA.
authors.forename: Amy R
authors.initials: AR
authors.lastname: Goetz
authors.affiliation: Department of Psychology, University of Wisconsin-Milwaukee, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Capriotti
authors.affiliation: Department of Psychology, University of Wisconsin-Milwaukee, USA.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Bauer
authors.affiliation: Department of Psychology, University of Wisconsin-Milwaukee, USA.
authors.forename: Natalie G
authors.initials: NG
authors.lastname: Brei
authors.affiliation: Department of Psychology, University of Utah, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Himle
authors.affiliation: Department of Psychology, University of Wisconsin-Milwaukee, USA.
authors.forename: Flint M
authors.initials: FM
authors.lastname: Espil
authors.affiliation: Department of Psychology, University of Wisconsin-Milwaukee, USA.
authors.forename: Ívar
authors.initials: Í
authors.lastname: Snorrason
authors.affiliation: Department of Psychology, University of Wisconsin-Milwaukee, USA.
authors.forename: Dagong
authors.initials: D
authors.lastname: Ran
authors.affiliation: Department of Psychology, Texas A&M University, USA dowoods@tamu.edu.
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Woods
mesh_terms: D000293:Adolescent; D001521:Behavior Therapy / Q000379:methods*; D002648:Child; D002908:Chronic Disease; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration; D010342:Patient Acceptance of Health Care; D010865:Pilot Projects; D012720:Severity of Illness Index; D017216:Telemedicine / Q000379:methods*; D013981:Tic Disorders / Q000628:therapy*; D049269:Videoconferencing; D014850:Waiting Lists
keywords: Tourette’s disorder; chronic tic disorders; voice over Internet protocol; web camera; web-based videoconferencing