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• W4206924093 abstract "We read with great interest an Article by Chris Hollis and colleagues,1Hollis C Hall CL Jones R et al.Therapist-supported online remote behavioural intervention for tics in children and adolescents in England (ORBIT): a multicentre, parallel group, single-blind, randomised controlled trial.Lancet Psychiatry. 2021; 8: 871-882Summary Full Text Full Text PDF PubMed Scopus (25) Google Scholar and thank the authors for their excellent work on online Exposure and Response Prevention (ERP) for paediatric tics. The comprehensiveness of the analyses, including the efficacy, safety, and cost of the programme, was particularly impressive, and we believe the study could be a landmark in this field. We would also like to congratulate all the staff who contributed to developing this online programme for their excellent work. However, we were somewhat concerned about patients’ adherence to the programme. Online ERP might be less effective in clinical practice because of lower treatment adherence. In this trial, 99 (88%) of 112 participants in the ERP group and 105 (94%) of 112 in the psychoeducation group completed at least four of ten chapters and were termed treatment completers. The lower completion rate in the ERP group is understandable, as ERP for obsessive-compulsive disorder is known to be demanding to both the therapist and the patient.2Law C Boisseau CL Exposure and response prevention in the treatment of obsessive-compulsive disorder: current perspectives.Psychol Res Behav Manag. 2019; 12: 1167-1174Crossref PubMed Scopus (19) Google Scholar Furthermore, real-world treatment adherence is usually lower than in trials because trial participants are more willing to receive an intervention. For this reason, we predict that even fewer patients in the real-world setting will complete online ERP. The authors might be able to enhance understanding of online ERP by providing more information about the treatment completers. The number of treatment completers among patients followed up at 3 months in each group is of particular interest. The primary outcome, the Total Tic Severity Score on the Yale Global Tic Severity Scale at 3 months after randomisation, can be compared between treatment completers as a per-protocol analysis. Clinicians might also be interested in the comorbidities of the patients who did not complete online ERP, such as anxiety disorder, ADHD, and obsessive-compulsive disorder. Nonetheless, we agree with the authors that online ERP has huge potential to address the shortage of highly trained therapists, the scarcity of opportunities for face-to-face behavioural therapy, and the difficulties imposed by the COVID-19 pandemic. We look forward to the results of the 18-month follow-up of the ORBIT study and future research, including validation of online ERP in other regions and cost-effectiveness analyses of combined online and face-to-face ERP approaches. We declare no competing interests. Treatment adherence might be the key to online Exposure and Response Prevention for paediatric tics – Authors' replyWe thank Qianzhi Wang and colleagues for their endorsement of the ORBIT trial1,2 and for acknowledging the importance of the findings. We are grateful for the opportunity to clarify the issue of adherence within the trial, which we believe to be a strength of this study. Full-Text PDF Therapist-supported online remote behavioural intervention for tics in children and adolescents in England (ORBIT): a multicentre, parallel group, single-blind, randomised controlled trialERP is an effective behavioural therapy for tics. Remotely delivered, online ERP with minimal therapist contact time represents an efficient public mental health approach to improve access to behavioural therapy for tics in children and adolescents. Full-Text PDF Open Access" @default.
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• W4206924093 date "2022-02-01" @default.
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• W4206924093 title "Treatment adherence might be the key to online Exposure and Response Prevention for paediatric tics" @default.
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• W4206924093 doi "https://doi.org/10.1016/s2215-0366(21)00433-8" @default.
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