deletions | additions       diff --git a/Treatment.md b/Treatment.md  index a43a0b0..6a33043 100644  --- a/Treatment.md  +++ b/Treatment.md 
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## Treatment  A meta-analysis of tic treatment from 2016 discusses patient satisfaction in addition to efficacy and side effects effects, and concludes that there is good evidence supporting a favorable benefits:harms ratio for the most commonly used medications, but that "larger and better-conducted trials addressing important clinical uncertainties are required"  \cite{26786936}. ### Psychological interventions 
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Another approach to the implementation concerns noted above is online therapy. Kirsten Müller-Vahl and colleagues are beginning a large RCT that will test the efficacy of CBIT delivered by internet \cite{27445874}. A commercial CBIT delivery system has been described, but (as of mid-2017) [is not yet active](http://www.tichelper.com/).  Research continues on other psychotherapy approaches. Suppressing tics is generally uncomfortable—leading uncomfortable—leading  to the theory of negative reinforcement that motivates CBIT and exposure and response prevention approaches to tic treatment—and treatment—and  in recent years Acceptance and Commitment Therapy has become more popular, and pilot studies have appeared applying this approach to tics \cite{Franklin_2011,Reese_2015}. In this setting, \cite{Gev201678} report their study of 45 children and adolescents with TS who rated severity of tic urges and were observed during each of three 2-minute conditions: baseline (ticcing freely), tic suppression, and urge acceptance. Urges and discomfort decreased significantly during the acceptance condition, and more importantly, so did tic frequency. By contrast, tic urge intensity and self-rated discomfort increased during the tic suppression condition. These findings suggest that acceptance therapy may be better—accepted—by better—accepted—by  patients. It is now ripe for tests of long-term efficacy. For some years, O'Connor, Leclerc and colleagues have developed and utilized a cognitive-behavioral-psychophysical treatment model for tic disorders. The treatment aims to address sensorimotor function more broadly, including proprioception, response inhibition and perfectionism, rather than focusing on tics directly. In 2016, several important publications from this group addressed this approach, including an open study of 102 adults with a chronic tic disorder (TS/CTD) \cite{26250742}, in which tic severity improved for both simple and complex tics, and continued improved at 6 months. Measures of self-esteem and perfectionism also improved. A pilot study in children ages 8-16 was also reported \cite{Leclerc2016}, and the authors then described initial results with a manualized version of this therapy in children ages 8-12 \cite{27563292}. This "cognitive-psychophysiological treatment" model provides another potential approach to treatment that may prove to have more generalizable benefits.