Integrating Exposure and Response Prevention and Habit Reversal Techniques to Treat a Tourettic Subtype of Obsessive-Compulsive Disorder (Tourettic OCD)

NCT07725926 | Recruiting

• 1 other identifier: ERP/HR TOCD RTC - 177187
• Study Type: interventional
• Target: 40
• Locations: 1 country
• Sites: 2

Brief Summary

Obsessive-Compulsive Disorder and Tic Disorders frequently co-occur, and a subgroup of patients - those with a Tourettic Subtype of OCD (TOCD) - present with concurrent obsessive-compulsive and tic symptoms. Existing psychological interventions typically target one condition or the other, but rarely both together. This study aims to test whether a combined psychological therapy integrating Exposure and Response Prevention (ERP) and Habit Reversal (HbRT) is more effective at reducing symptoms than either therapy delivered alone, in adults with TOCD.

Conditions

Obsessive - Compulsive Disorder; Tic Disorder, Chronic Motor or Vocal; Tic Disorders; Tic Disorder, Combined Vocal and Multiple Motor; Tourette Disease; Tourette Disorder; Tourettes Syndrome; Gilles de la Tourette Syndrome

Keywords

Obsessive-Compulsive Disorder; Tic Disorders; Tourette Syndrome; Tourettic Obsessive-Compulsive Disorder; Exposure and Response Prevention; Habit Reversal Training

Outcome Measures

Primary Outcomes (2)

• Change From Baseline in Yale-Brown Obsessive Compulsive Scale Total Score

  Obsessive-compulsive symptom severity will be assessed using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Total scores range from 0 to 40, with higher scores indicating greater obsessive-compulsive symptom severity. Change from baseline will be assessed at Week 12 and Week 24.

  Baseline, Week 12 and Week 24

• Change From Baseline in Yale Global Tic Severity Scale Total Tic Severity Score

  Tic symptom severity will be assessed using the Yale Global Tic Severity Scale (YGTSS) Total Tic Severity Score. Scores range from 0 to 50, with higher scores indicating greater tic symptom severity. Change from baseline will be assessed at Week 12 and Week 24.

  Baseline, Week 12 and Week 24

Secondary Outcomes (1)

• Change From Baseline in Yale Global Tic Severity Scale Global Severity Score

  Baseline, Week 12 and Week 24

Study Arms (4)

Combined Exposure and Response Prevention and Habit Reversal

EXPERIMENTAL

Participants allocated to this arm will receive a 12-week individual psychological intervention integrating Exposure and Response Prevention (ERP) and Habit Reversal Training (HRT). ERP will involve planned exposure to obsessional fears, distress, sensory discomfort, premonitory urges, and "not-just-right" experiences while reducing compulsions, avoidance, reassurance seeking, and other safety behaviours. HRT will include awareness training, identification of premonitory urges and tic-related cues, development and practice of competing responses, and strategies to support generalisation. Sessions will last approximately 50 minutes and will be delivered face-to-face or remotely.

Behavioral: Exposure and Response Prevention (ERP); Behavioral: Habit Reversal Training (HbRT

Standardised Exposure and Response Prevention

ACTIVE COMPARATOR

Participants allocated to this arm will receive a 12-week individual psychological intervention based on Exposure and Response Prevention (ERP). Treatment will involve gradual and systematic exposure to obsessional fears, distress, sensory discomfort, premonitory urges, and "not-just-right" experiences while refraining from compulsions, avoidance, reassurance seeking, and other safety behaviours. The intervention aims to reduce obsessive-compulsive symptoms by promoting inhibitory learning and increasing tolerance of uncertainty and internal experiences. Sessions will last approximately 50 minutes and will be delivered face-to-face or remotely.

Behavioral: Exposure and Response Prevention (ERP)

Standardised Habit Reversal

ACTIVE COMPARATOR

Participants allocated to this arm will receive a 12-week individual psychological intervention based on Habit Reversal Training (HbRT). Treatment will include awareness training to improve recognition of tics and premonitory urges, identification of antecedents and contextual triggers, development and practice of competing responses, and strategies to promote generalisation of skills to everyday settings. The intervention aims to reduce tic severity and improve voluntary tic management. Sessions will last approximately 50 minutes and will be delivered face-to-face or remotely.

Behavioral: Habit Reversal Training (HbRT

Psychoeducation / Supportive Intervention

ACTIVE COMPARATOR

Participants allocated to this arm will receive a 12-week individual psychological intervention consisting of psychoeducation and supportive therapy. Sessions will provide information about obsessive-compulsive disorder, tic disorders, Tourettic obsessive-compulsive disorder, stress, and wellbeing, together with supportive discussion and general problem-solving. This intervention will not include structured Exposure and Response Prevention, Habit Reversal Training, or other targeted behavioural techniques. Sessions will last approximately 50 minutes and will be delivered face-to-face or remotely.

Behavioral: Psychoeducation and Supportive Intervention

Interventions

Exposure and Response Prevention (ERP) BEHAVIORAL

Exposure and Response Prevention (ERP) is a behavioural intervention that involves gradual and systematic exposure to obsessional fears, distress, sensory discomfort, premonitory urges, and "not-just-right" experiences while refraining from compulsions, avoidance, reassurance seeking, and other safety behaviours. Treatment is delivered individually over 12 weekly 50-minute sessions, either face-to-face or remotely.

Combined Exposure and Response Prevention and Habit Reversal; Standardised Exposure and Response Prevention

Habit Reversal Training (HbRT BEHAVIORAL

Habit Reversal Training (HbRT) is a behavioural intervention that includes awareness training, identification of premonitory urges and antecedents to tic expression, development and practice of competing responses, and strategies to generalise skills across settings. Treatment is delivered individually over 12 weekly 50-minute sessions, either face-to-face or remotely.

Combined Exposure and Response Prevention and Habit Reversal; Standardised Habit Reversal

Psychoeducation and Supportive Intervention BEHAVIORAL

Psychoeducation and Supportive Therapy consists of structured education about obsessive-compulsive disorder, tic disorders, Tourettic obsessive-compulsive disorder, stress, and wellbeing, together with supportive discussion and general problem-solving. The intervention does not include Exposure and Response Prevention, Habit Reversal Training, or other targeted behavioural techniques. Treatment is delivered individually over 12 weekly 50-minute sessions, either face-to-face or remotely.

Psychoeducation / Supportive Intervention

Eligibility Criteria

• Age: 18 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age 18 years or older
• All genders
• Confirmation of a primary diagnosis of either:
• a. Tourettes Disorder / Tourette Syndrome b. Persistent Motor or Vocal Tic Disorder / Chronic Motor or Vocal Tic Disorder c. Provisional Tic Disorder / Transient Motor Tics d. Other Specified Tic Disorder e. Unspecified Tic Disorder f. Obsessive-Compulsive Disorder \[d\] Participants taking psychotropic medication are eligible provided medication type and dose remain stable throughout the intervention period \[e\] Ability to provide sustained informed consent \[f\] A minimum score of 16 on YBOCS \[g\] A minimum score of 5 on the Premonitory Urge for Tics Scale (PUTS)

You may not qualify if:

• Substance misuse
• Current diagnosis of a personality disorder
• Schizophrenia
• Bipolar disorder
• Contraindications to participation in a trial (i.e., active suicidal ideations and/or requirement of an interpreter)
• Any psychiatric or neurological condition that, in the opinion of the investigators, would interfere with participation or interpretation of study outcomes.

Sponsors & Collaborators

• University College, London: collaborator
• University College London Hospitals: lead

Study Sites (2)

University College London Hospitals NHS Foundation Trust

London, London, WC1N 3BG, United Kingdom

RECRUITING

University College London Queen Square Institute of Neurology

London, London, WC1N 3BG, United Kingdom

RECRUITING

MeSH Terms

Conditions

Compulsive Personality Disorder; Tic Disorders; Tourette Syndrome; Obsessive-Compulsive Disorder

Condition Hierarchy (Ancestors)

Personality Disorders; Mental Disorders; Movement Disorders; Central Nervous System Diseases; Nervous System Diseases; Neurodevelopmental Disorders; Basal Ganglia Diseases; Brain Diseases; Heredodegenerative Disorders, Nervous System; Neurodegenerative Diseases; Genetic Diseases, Inborn; Congenital, Hereditary, and Neonatal Diseases and Abnormalities; Anxiety Disorders

Central Study Contacts

Dipesh Patel, MPhil / PhD

CONTACT

+44 (0)20 3456 7890; dipesh.patel.23@ucl.ac.uk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Dr

Model Details: Participants are randomly allocated to one of four groups: (1) combined ERP and HbRT, (2) ERP alone, (3) HbRT alone, or (4) a supportive psychoeducation control.

Study Record Dates

• First Submitted: July 21, 2026
• First Posted: July 24, 2026
• Study Start: July 8, 2026
• Primary Completion (Estimated): August 1, 2027
• Study Completion (Estimated): February 1, 2030
• Last Updated: July 27, 2026

Record last verified: 2026-07

Locations

GB (2)