Date of Award

August 2014

Degree Type


Degree Name

Doctor of Philosophy



First Advisor

Bonita P. Klein-Tasman

Committee Members

Douglas W. Woods, Shawn P. Cahill, W. Hobart Davies, Robyn C. Ridley


Behavior Therapy, Tourette Syndrome, Videoconferencing, Voice Over Internet Protocol


Videoconferencing is efficacious, acceptable and equivalent to face to face for a range of psychotherapies, including a Comprehensive Behavioral Interventions for Tics (CBIT), but limited due to lack of portability, and restricted accessibility. An alternative is Voice over Internet Protocol (VoIP) transmission, allowing home delivery of treatment. The present study examined the preliminary efficacy, feasibility, and acceptability of CBIT-VoIP. Twenty youth (8-17) with CTDs participated in a randomized, waitlist-controlled trial of CBIT. Assessments were conducted via VoIP and internet surveys. Significantly greater reductions in total clinician-rated and parent-reported tic severity were found in the CBIT relative to the waitlist-control group, with 33.3% of those in CBIT considered treatment responders. Treatment satisfaction and the therapeutic alliance were high. Higher parent satisfaction with videoconferencing was associated with higher decreases in clinician-rated tic severity. Positive relationships were found between child computer usage at baseline and satisfaction with videoconferencing at post-assessment. VoIP was generally feasible, with some challenges due to audio and visual disruptions.