{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T18:32:51Z","timestamp":1791484371904,"version":"4.3.4"},"reference-count":24,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,1,17]],"date-time":"2023-01-17T00:00:00Z","timestamp":1673913600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment Programme","doi-asserted-by":"publisher","award":["16\/19\/02"],"award-info":[{"award-number":["16\/19\/02"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acamh.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Child Psychology Psychiatry"],"published-print":{"date-parts":[[2023,6]]},"abstract":"\n Background<\/jats:title>\n Little is known about the long\u2010term effectiveness of behavioural therapy for tics. We aimed to assess the long\u2010term clinical and cost\u2010effectiveness of online therapist\u2010supported exposure and response prevention (ERP) therapy for tics 12 and 18 months after treatment initiation.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n ORBIT (online remote behavioural intervention for tics) was a two\u2010arm (1:1 ratio), superiority, single\u2010blind, multicentre randomised controlled trial comparing online ERP for tics with online psychoeducation. The trial was conducted across two Child and Adolescent Mental Health Services in England. Participants were recruited from these two sites, across other clinics in England, or by self\u2010referral. This study was a naturalistic follow\u2010up of participants at 12\u2010 and 18\u2010month postrandomisation. Participants were permitted to use alternative treatments recommended by their clinician. The key outcome was the Yale Global Tic Severity Scale Total Tic Severity Score (YGTSS\u2010TTSS). A full economic evaluation was conducted. Registrations are ISRCTN (ISRCTN70758207);\n ClinicalTrials.gov<\/jats:ext-link>\n (NCT03483493).\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Two hundred and twenty\u2010four participants were enrolled: 112 to ERP and 112 to psychoeducation. The sample was predominately male (177; 79%) and of white ethnicity (195; 87%). The ERP intervention reduced baseline YGTSS\u2010TTSS by 2.64 points (95% CI: \u22124.48 to \u22120.79) with an effect size of \u22120.36 (95% CI: \u22120.61 to \u22120.11) after 12\u2009months and by 2.01 points (95% CI: \u22123.86 to \u22120.15) with an effect size of \u22120.27 (95% CI \u20100.52 to \u22120.02) after 18\u2009months, compared with psychoeducation. Very few participants (<10%) started new tic treatment during follow\u2010up. The cost difference in ERP compared with psychoeducation was \u00a3304.94 (\u2212139.41 to 749.29). At 18\u2009months, the cost per QALY gained was \u00a316,708 for ERP compared with psychoeducation.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Remotely delivered online ERP is a clinical and cost\u2010effective intervention with durable benefits extending for up to 18\u2009months. This represents an efficient public mental health approach to increase access to behavioural therapy and improve outcomes for tics.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/jcpp.13756","type":"journal-article","created":{"date-parts":[[2023,1,17]],"date-time":"2023-01-17T18:21:30Z","timestamp":1673979690000},"page":"941-951","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Long\u2010term clinical and cost\u2010effectiveness of a therapist\u2010supported online remote behavioural intervention for tics in children and adolescents: extended 12\u2010 and 18\u2010month follow\u2010up of a single\u2010blind randomised controlled trial"],"prefix":"10.1111","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1083-6744","authenticated-orcid":false,"given":"Chris","family":"Hollis","sequence":"first","affiliation":[{"name":"NIHR MindTech MedTech Co\u2010operative, Institute of Mental Health, School of Medicine University of Nottingham Nottingham UK"},{"name":"NIHR Nottingham Biomedical Research Centre, Institute of Mental Health University of Nottingham Nottingham UK"},{"name":"Mental Health and Clinical Neurosciences, School of Medicine University of Nottingham, Queen's Medical Centre Nottingham UK"},{"name":"Department of Child and Adolescent Psychiatry Nottinghamshire Healthcare NHS Foundation Trust, South Block Level E, Queen's Medical Centre Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5412-6165","authenticated-orcid":false,"given":"Charlotte L.","family":"Hall","sequence":"additional","affiliation":[{"name":"NIHR MindTech MedTech Co\u2010operative, Institute of Mental Health, School of Medicine University of Nottingham Nottingham UK"},{"name":"NIHR Nottingham Biomedical Research Centre, Institute of Mental Health University of Nottingham Nottingham UK"},{"name":"Mental Health and Clinical Neurosciences, School of Medicine University of Nottingham, Queen's Medical Centre Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3836-2827","authenticated-orcid":false,"given":"Kareem","family":"Khan","sequence":"additional","affiliation":[{"name":"NIHR MindTech MedTech Co\u2010operative, Institute of Mental Health, School of Medicine University of Nottingham Nottingham UK"},{"name":"Mental Health and Clinical Neurosciences, School of Medicine University of Nottingham, Queen's Medical Centre Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Jones","sequence":"additional","affiliation":[{"name":"Division of Psychiatry and Priment CTU University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Marston","sequence":"additional","affiliation":[{"name":"Research Department of Primary Care and Population Health and Priment CTU University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Le Novere","sequence":"additional","affiliation":[{"name":"Research Department of Primary Care and Population Health and Priment CTU University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachael","family":"Hunter","sequence":"additional","affiliation":[{"name":"Research Department of Primary Care and Population Health and Priment CTU University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1358-0166","authenticated-orcid":false,"given":"Per","family":"Andr\u00e9n","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Centre for Psychiatry Research Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie D.","family":"Bennett","sequence":"additional","affiliation":[{"name":"UCL Great Ormond Street Institute of Child Health (ICH) London UK"},{"name":"Great Ormond Street Hospital for Children NHS Trust London UK"},{"name":"Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beverley J.","family":"Brown","sequence":"additional","affiliation":[{"name":"NIHR MindTech MedTech Co\u2010operative, Institute of Mental Health, School of Medicine University of Nottingham Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liam R.","family":"Chamberlain","sequence":"additional","affiliation":[{"name":"NIHR MindTech MedTech Co\u2010operative, Institute of Mental Health, School of Medicine University of Nottingham Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. Bethan","family":"Davies","sequence":"additional","affiliation":[{"name":"NIHR MindTech MedTech Co\u2010operative, Institute of Mental Health, School of Medicine University of Nottingham Nottingham UK"},{"name":"Mental Health and Clinical Neurosciences, School of Medicine University of Nottingham, Queen's Medical Centre Nottingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amber","family":"Evans","sequence":"additional","affiliation":[{"name":"UCL Great Ormond Street Institute of Child Health (ICH) London UK"},{"name":"Great Ormond Street Hospital for Children NHS Trust London UK"},{"name":"Psychological and Mental Health Services, Great Ormond Street Hospital for Children NHS Foundation Trust London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Kouzoupi","sequence":"additional","affiliation":[{"name":"UCL Great Ormond Street Institute of Child Health (ICH) London UK"},{"name":"Great Ormond Street Hospital for Children 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