Efficacy of therapist-supported online remote behavioral therapy for tic disorders: a systematic review and meta-analysis

Xiaolei Xu; Kangsheng Zhu; Weiyi Wang; Tianyu Zhao; Congrui Fu

doi:10.3389/fpsyt.2025.1521947

Efficacy of therapist-supported online remote behavioral therapy for tic disorders: a systematic review and meta-analysis

Front Psychiatry. 2025 Jun 13:16:1521947. doi: 10.3389/fpsyt.2025.1521947. eCollection 2025.

Authors

Xiaolei Xu¹, Kangsheng Zhu², Weiyi Wang³, Tianyu Zhao¹, Congrui Fu¹

Affiliations

¹ School of Nursing, Hebei Medical University, Hebei, Shijiazhuang, China.
² Department of Anesthesiology, The Forth Hospital of Hebei Medical University, Shijiazhuang, China.
³ Department of Immunology and Pathobiology, Hebei University of Chinese Medicine, Shijiazhuang, China.

Abstract

Introduction: Recently, several studies about therapist-supported online remote behavioral therapy (TSORBT) have been showed effective for tic disorders (TD). With the increasing adoption of telemedicine, a systematic review of existing evidence is crucial to confirm the efficacy of TSORBT in treating TD.

Aim: We aim to assess the efficacy of TSORBT on the treatment of TD.

Method: This review followed PRISMA guidelines. We searched PubMed, Web of Science, Cochrane, and Embase up to September 2024 for clinical trials on TSORBT's efficacy in TD. Two researchers independently screened studies, focusing on the Total Tic Severity Score of the Yale Global Tic Severity Scale (YGTSS-TTSS) and other subscores of the YGTSS-motor tic score (YGTSS-MTS), YGTSS-vocal tic score (YGTSS -VTS), YGTSS-impairment score and Parent Tic Questionnaire (PTQ). Risk of bias was assessed using Cochrane RoB 2. Data were analyzed in RevMan 5.4, with outcomes expressed as mean difference (MD) and 95% CI.

Results: In total, 2764 articles were identified for screening. Nine studies involving 1049 participants, with 527 assigned to the TSORBT and 522 to the control were included. TSORBT exhibited potential in addressing YGTSS-TTSS (MD = -2.22, 95% CI: [-3.16, -1.29], P<0.00001), YGTSS-MTS (MD = -2.17, 95% CI: [-3.39, -0.96], P=0.0004), YGTSS-impairment score (MD= -1.69, 95% CI: [-3.26, -0.12], P=0.03) and PTQ score (MD= -6.05, 95% CI: [-8.65, -3.44], P<0.00001);. Subgroup analyses revealed that TSORBT demonstrated nearly the same efficacy as face-to-face BT in addressing YGTSS-TTSS (MD = -0.38, 95% CI: [-3.20, 2.43], P=0.79), but more effective than online psychoeducation (MD = -2.37, 95% CI: [-3.64, -1.10], P = 0.0002).

Conclusion: The current study demonstrates the promising therapeutic efficacy of TSORBT in TD. Further rigorously designed studies, particularly those assessing long-term treatment durability, are warranted to consolidate the evidence base.

Keywords: behavior therapy; internet-delivered; online; tic disorders; tics.

Publication types

Review