Efficacy of cognitive-behavioral therapy combined with habit reversal training on anxiety disorders in children with Tourette’s syndrome

Table 1 Baseline characteristics of participants

Characteristic	Control (n = 65)	CBT combined with HRT (n = 71)	t/χ2	P value
Age (years)	11.54 ± 2.31	11.72 ± 2.13	0.465	0.643
Gender [male/female, n (%)]	40 (61.54)/25 (38.46)	45 (63.38)/26 (36.62)	0.002	0.965
BMI	16.73 ± 2.14	17.24 ± 2.35	1.326	0.187
Age of onset (years)	8.74 ± 2.46	8.61 ± 2.38	0.302	0.763
Duration of Tourette’s syndrome (months)	16.28 ± 4.67	15.92 ± 5.01	0.434	0.665
Comorbid ADHD, n (%)	17 (26.15)	20 (28.17)	0.005	0.943
Comorbid OCD, n (%)	11 (16.92)	10 (14.08)	0.048	0.826
Previous treatment, n (%)	27 (41.54)	27 (38.03)	0.059	0.808
Parental education			None	0.779
High school or less	23 (35.38)	20 (28.17)
Some college	16 (24.62)	21 (29.58)
Bachelor’s degree	13 (20.00)	18 (25.35)
Master’s degree	10 (15.38)	8 (11.27)
Doctoral degree	3 (4.62)	4 (5.63)
Parental marital status, n (%)			None	0.919
Married	45 (69.23)	52 (73.24)
Divorced/separated	10 (15.38)	9 (12.68)
Single parent	7 (10.77)	6 (8.45)
Other	3 (4.62)	4 (5.63)
Family history of ADHD, n (%)	7 (10.77)	9 (12.68)	0.006	0.938
Family history of OCD, n (%)	7 (10.77)	9 (12.68)	0.006	0.938
Family history of Tourette’s syndrome, n (%)	16 (24.62)	21 (29.58)	0.209	0.648

BMI: Body mass index; CBT: Cognitive-behavioral therapy; HRT: Habit reversal training.

Table 2 Pre-intervention anxiety and tic severity scores

Measure	Control (n = 65)	CBT combined with HRT (n = 71)	t value	P value
Anxiety score	63.52 ± 1.81	64.03 ± 1.67	1.703	0.091
YGTSS total score	22.14 ± 5.67	21.89 ± 5.12	0.274	0.785
CY-BOCS total Score	18.25 ± 4.92	18.51 ± 4.57	0.324	0.747
CGI-S score	3.48 ± 0.82	3.56 ± 0.75	0.632	0.528
FACES IV score	15.89 ± 5.12	14.72 ± 4.78	1.374	0.172

CBT: Cognitive-behavioral therapy; HRT: Habit reversal training; YGTSS: Yale Global Tic Severity Scale; CY-BOCS: Children's Yale-Brown Obsessive Compulsive Scale; CGI-S: Clinical Global Impression-Severity.

Table 3 Post-intervention anxiety and tic severity scores

Measure	Control (n = 65)	CBT combined with HRT (n = 71)	t value	P value
Anxiety score	40.53 ± 1.64	39.97 ± 1.58	2.022	0.045
YGTSS total score	16.28 ± 4.91	14.49 ± 4.12	2.288	0.024
CY-BOCS total Score	13.36 ± 3.82	11.75 ± 3.49	2.555	0.012
CGI-S score	2.31 ± 0.68	2.08 ± 0.59	2.146	0.034
FACES IV score	24.77 ± 6.28	27.48 ± 5.93	2.586	0.011

CBT: Cognitive-behavioral therapy; HRT: Habit reversal training; YGTSS: Yale Global Tic Severity Scale; CY-BOCS: Children's Yale-Brown Obsessive Compulsive Scale; CGI-S: Clinical Global Impression-Severity.

Table 4 Parental satisfaction survey results

Measure	Control (n = 65)	CBT combined with HRT (n = 71)	t/χ2	P value
Satisfaction score (1-10)	7.87 ± 1.92	8.69 ± 1.77	2.592	0.011
Would recommend, n (%)	51 (78.46)	66 (92.96)	4.788	0.029

CBT: Cognitive-behavioral therapy; HRT: Habit reversal training.

Table 5 Correlation analysis between cognitive-behavioral therapy combined with habit reversal training treatment and post-intervention anxiety and tic severity scores

Measure	r	R2	P value
Anxiety score (1-10)	−0.172	0.03	0.045
YGTSS total score	−0.195	0.038	0.023
CY-BOCS total Score	−0.216	0.047	0.011
CGI-S score	−0.183	0.034	0.033
FACES IV score	0.219	0.048	0.011

YGTSS: Yale Global Tic Severity Scale; CY-BOCS: Children's Yale-Brown Obsessive Compulsive Scale; CGI-S: Clinical Global Impression-Severity.