***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: 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 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 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 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 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 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 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 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 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 
    Output:
    
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 .