Abstract
INTRODUCTION: Tourette syndrome and chronic tic disorders are neurodevelopmental disorders characterized by involuntary motor and vocal tics, often beginning in childhood and causing significant distress. While medication and behavioral therapies are established treatments, chronic use of medication can cause side effects, and behavioral therapy faces limited provider availability and geographic barriers. Internet-based behavioral interventions are emerging as alternatives to improve treatment accessibility. METHODS: We performed a meta-analysis of five randomized controlled trials examining online delivery of comprehensive behavioral interventions for tics/habit reversal training or exposure and response prevention for tic disorders. Primary outcomes included Yale Global Tic Severity Scale scores and treatment response rate. A fixed-effect model was used, with heterogeneity and subgroup analyses to assess consistency. RESULTS: The overall Hedges' g was -0.26 (95% CI: -0.42 to -0.10, p = 0.0019), indicating a small but significant effect of online interventions. Treatment response odds ratio was 2.34 (95% CI: 1.55-3.52, p < 0.001), with no significant subgroup differences by control condtion, age, intervention, or delivery method. CONCLUSION: In this meta-analysis, internet-based behavior therapy demonstrated modest yet statistically significant reductions in tic symptoms, marginally lower than those achieved with in-person. Nevertheless, their cost-effectiveness and potential to broaden treatment accessibility underscore the necessity for large-scale, methodologically rigorous trials that explore long-term outcomes, developmental considerations, and comorbidities. Our findings support the clinical utility and feasibility of internet-based behavior therapy for tic disorders. This approach may broaden treatment access for underserved communities and potentially improve patients' quality of life in the digital healthcare era.