Shorter communication A randomized pilot trial comparing videoconference versus face-to-face delivery of behavior therapy for childhood tic disorders Michael B. Himle a, * , Malinda Freitag a , Michael Walther b , Shana A. Franklin b , Laura Ely b , Douglas W. Woods b a University of Utah, USA b University of Wisconsin-Milwaukee, USA article info Article history: Received 28 December 2011 Received in revised form 16 May 2012 Accepted 25 May 2012 Keywords: Tourette Tic Behavior therapy Telehealth abstract 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 chil- dren were randomly assigned to receive CBIT over videoconference or via traditional face-to-face delivery. Results show that both treatment delivery modalities resulted 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. Ó 2012 Elsevier Ltd. All rights reserved. Chronic tic disorders (CTDs), including Tourette Disorder (TD), are characterized by involuntary motor and vocal tics (APA, 2000). The most common treatment for CTD is psychotropic medication (see Scahill et al., 2006), however behavioral techniques have also been shown to be effective for reducing tics (see Himle, Woods, Piacentini, & Walkup, 2006). A collection of behavioral techniques referred to as Comprehensive Behavioral Intervention for Tics (CBIT; Woods et al., 2008a) uses psychoeducation, self-monitoring, function-based interventions, relaxation training, and habit reversal training (HRT; Azrin & Nunn, 1973) to teach children and families a specific set of skills to manage and reduce tics. Research over the past decade has established CBIT as an empiri- cally well-established treatment (Cook & Blacher, 2007). Perhaps the most convincing evidence for the efficacy of CBIT comes from a recent multi-site randomized controlled trial comparing CBIT to a psycho- education and supportive therapy (PST) control (Piacentini et al., 2010). In this trial, 126 children with CTD (approximately 60e65% of which were unmedicated) were randomly assigned to receive eight sessions of either CBIT or PST. Results showed that 53% of children receiving CBIT demonstrated a clinically significant improvement in symptoms compared to 19% of those assigned to PST, and gains were generally maintained at 6 months post-treatment. Unfortunately, CBIT is not widely available. A recent survey of 740 parents of children with CTD found that only 6% of treatment- seeking children/families and 4% of treatment seeking adults had received HRT/CBIT (Woods, Conelea, & Himle, 2010). One of the most commonly endorsed treatment barriers was a lack of trained providers, highlighting the need for novel strategies to increase the availability of CBIT. One dissemination strategy that holds particular promise is telehealth, which utilizes communication technology, such as videoconference (VC), to deliver therapeutic or consultation services. Several studies concerning a variety of psychiatric and behavioral problems have shown promising results for delivering behavior therapy via telehealth (e.g., Himle, Fischer, et al., 2006; Himle, Woods, et al., 2006). The nature of CBIT, however, poses unique challenges to remote delivery. For example, when con- ducting HRT (a primary component of CBIT) the clinician must be able to observe, detect, and discriminate discreet episodes of tics, which are often very subtle, rapid, and can occur in paroxysms. Similarly, the client needs to be able to observe the therapist modeling treatment techniques and the therapist needs to be able to observe whether the client is performing subtle skills so that he/ she can provide corrective feedback and reinforcement. Any disruption or delay in the video exchange due to technological limitations or other remote-delivery factors might well undermine treatment relative to traditional face-to-face delivery. Preliminary evidence suggests that VC-delivered CBIT is feasible. Himle, Olufs, Himle, Tucker, and Woods (2010) used a multiple * Corresponding author. Department of Psychology, University of Utah, 380 S 1530 E, Behavioral Sciences Building Room 502, Salt Lake City, UT 84112, USA. Tel.: þ1 801 581 7529; fax: þ1 801 581 5841. E-mail address: michael.himle@utah.edu (M.B. Himle). Contents lists available at SciVerse ScienceDirect Behaviour Research and Therapy journal homepage: www.elsevier.com/locate/brat 0005-7967/$ e see front matter Ó 2012 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.brat.2012.05.009 Behaviour Research and Therapy 50 (2012) 565e570