Kosin Medical Journal

Review articles

Behavioral treatments for tic disorders: a structured review of HRT, ERP, and CBIT: Bum-Sung Choi; Kosin Med J. 2025;40(3):160-166. Published online September 10, 2025; DOI: https://doi.org/10.7180/kmj.25.115

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Abstract PDF PubReader ePub: Tic disorders, such as Tourette syndrome, are neurodevelopmental conditions marked by involuntary motor or vocal tics. Although these disorders have strong genetic and neurobiological bases, their expression and persistence are influenced by internal experiences and external environmental factors. Behavioral interventions have demonstrated significant efficacy in managing tic symptoms. This review examines three principal evidence-based behavioral treatments for tic disorders: habit reversal training (HRT), exposure with response prevention (ERP), and comprehensive behavioral intervention for tics (CBIT). Each intervention is analyzed based on its theoretical foundation, therapeutic components, and clinical implementation. The shared objective of these treatments is to disrupt the reinforcement mechanisms that maintain tic expression, thereby reducing symptom severity. This review synthesizes empirical evidence supporting the efficacy of HRT, ERP, and CBIT as frontline treatments for tic disorders. Drawing upon randomized controlled trials, long-term follow-up studies, and open-label trials, we examine therapeutic outcomes, methodological strengths and limitations, and the clinical generalizability of each intervention. The findings indicate robust short- and long-term efficacy for HRT and CBIT, whereas ERP shows promising short-term outcomes but a relative paucity of long-term data. Methodological variability, including session format and evaluator blinding, is addressed to inform clinical applications and guide future research.

Non-pharmacological treatments for insomnia: a focus on components of cognitive behavioral therapy for insomnia: Soyoung Park, Eun Ji Lim, Dongyun Lee, Young-Ji Lee; Kosin Med J. 2024;39(4):238-245. Published online December 19, 2024; DOI: https://doi.org/10.7180/kmj.24.153

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Abstract PDF PubReader ePub: Insomnia is a prevalent disorder that affects 4% to 22% of the population in the United States. While cognitive behavioral therapy for insomnia (CBT-I) remains the gold standard for non-pharmacological treatment, accessibility barriers exist owing to a shortage of trained professionals and high costs. This review examines the efficacy of the individual components of CBT-I as stand-alone interventions to improve treatment accessibility, digital CBT-I, and other non-pharmacological interventions. Guidelines from organizations such as the American Academy of Sleep Medicine and, European Sleep Research Society, along with recent meta-analyses, support the effectiveness of these components as stand-alone treatments. Sleep restriction therapy and stimulus control therapy show promise as effective interventions. Although recommended by certain guidelines, relaxation therapy has yielded mixed results. Sleep hygiene education, a common component of CBT-I, has not demonstrated significant efficacy as a stand-alone treatment. Cognitive strategies have shown promise in recent studies. Sufficient clinical evidence supports the efficacy of digital CBT-I in treating insomnia. Internationally, various platforms for digital CBT-I have already been developed and are in use, and in South Korea, some digital CBT-I software programs have received digital therapeutic device approval in 2023. This review highlights the potential of individual components of CBT-I as effective stand-alone interventions for insomnia, as well as digital CBT-I, emphasizing their importance for improving the accessibility of non-pharmacological insomnia treatments in clinical settings where full CBT-I may not be available.

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