The efficacy of habit reversal therapy for tics, habit disorders, and stuttering: A meta-analytic review
Highlights
► Habit reversal therapy has a large effect size in the treatment of tic disorders, habit disorders, and stuttering. ► Habit reversal therapy tends to be efficacious for both adults and children. ► The positive effects of habit reversal therapy tend to endure over time.
Section snippets
Primary ingredients of HRT
The complex nature of the original conceptualization of HRT has led to attempts by a number of researchers to identify the active primary components of the procedure and to elucidate which elements were necessary for the effectiveness of the package. Many authors considered HRT to be a lengthy and overly comprehensive procedure (O'Connor, 2005). Subsequently, researchers have evaluated a number of variations of HRT for the treatment of habit disorders (O'Connor, 2005). The majority of component
Efficacy of HRT
Many studies have examined the efficacy of HRT for habit disorders. Clinical case studies involving tics have consistently reported target behavior reductions of 75% to 100% with HRT (O'Connor & Leclerc, 2008). Randomized controlled trials have also provided support for the efficacy of HRT with tics, starting with Azrin, Nunn, and Frantz (1980a). Carr and Chong, 2005, Cook and Blacher, 2007 reviewed the empirical evidence on use of HRT to ameliorate tics and found substantial evidence of
Literature search
A systematic literature search included PsycINFO, Cambridge Scientific Abstracts, ProQuest, Google Scholar, and PubMed online databases for studies published prior to or during July 2009. We extracted studies containing “habit reversal” as a keyword and at least one of the following search terms: (a) cognitive-behavioral or behavioral, (b) intervention or treatment or therapy, (c) control group or placebo or comparison, (d) habit disorder, repetitive behavior disorder, Tourette's syndrome, or
Results
Eighteen studies produced effect sizes, with a total of 19 between-groups comparisons and a total of 575 participants. Table 1 summarizes key characteristics of the studies included in the meta-analysis, including sample characteristics and effect size. The overall effect of HRT was large (Cohen, 1988), d = 0.80 [95% CI: 0.53, 1.07], with 57 as the fail-safe N (Borenstein, Hedges, Higgins, & Rothstein, 2009), specifically the number of zero-effect-size studies needed to reduce d to 0.20, an
Discussion
The present study found that the overall effect of HRT from pre-assessment to final post-treatment assessment was large in comparison with control conditions. The overall finding suggests that HRT is an efficacious behavioral intervention for the symptoms of disorders for which it is commonly used: tics; stuttering; and habit disorders such as nail biting, thumb sucking, and lip biting. The large effect size, d = 0.80, roughly equivalent across disorders, is noteworthy. Furthermore, the moderator
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Cited by (0)
- 1
Contributed equally to this publication.
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References marked with an asterisk indicate studies included in the meta-analysis.