Tourette Patients Benefit From Behavioral Therapy: Study

MONDAY Aug. 6, 2012 -- Tourette Syndrome patients fare better when offered tic management therapy as opposed to support sessions solely focused on providing information about the neurological disorder, new research suggests.

The finding is based on a study of 122 patients between the ages of 16 and 55, all of whom struggle with the sudden and unwanted repetitive physical and verbal tics that characterize Tourette Syndrome.

"Typically, medication has been used to treat tics," explained study author Sabine Wilhelm, director of the OCD (obsessive-compulsive disorder) and Related Disorders Program at Massachusetts General Hospital/Harvard Medical School in Boston. "But many patients refuse or discontinue medications due to unwanted side effects."

"Behavior therapy," Wilhelm said, "takes a different approach from medication. Patients often report a premonitory urge -- that's an unpleasant sensation -- prior to engaging in the tic, and they engage in tics in order to relieve the urge. Behavior therapy helps patients to disrupt this pattern. In behavior therapy, patients learn to detect signs that a tic will likely occur and they are taught to engage in competing responses, which are behaviors that are physically incompatible with the impending tic. Thus, patients learn new ways to manage their tics."

"We tested a newer behavioral treatment for tics called Comprehensive Behavioral Intervention for Tics (CBIT)," she said. It "teaches patients to consider the impact of their environment on tics and incorporates procedures to reduce environmental influences that increase tics. The result of our study is exciting news for patients with tic disorders as they now have solid support for behavior therapy for tics."

Wilhelm and her colleagues from several other institutions (including Yale University and the University of Texas Health Science Center at San Antonio) report their findings in the August issue of the Archives of General Psychiatry. The research was supported by the U.S. National Institute of Mental Health.

Tourette syndrome is typified by a wide range of physical and verbal symptoms, which can include uncontrolled eye blinking, head-jerking, reaching out, touching, throat clearing, coughing, and at times the utterance or display of words, phrases, or movements that may involve cursing or the demonstration of socially inappropriate gestures.

However, Wilhelm stressed that to a large degree the public's popular notion of what constitutes Tourette syndrome is off-base, given that four-letter word declarations occur in only about 10 to 15 percent of Tourette patients.

That said, while Tourette syndrome often starts in early childhood and peaks by adolescence, the disorder continues to impair the quality of life of an estimated one in every 2,000 adults, for whom medication may prove problematic.

Between 2005 and 2009, Wilhelm's team focused on Tourette syndrome -- as well as chronic tic disorder -- in patients being treated at one of three outpatient research clinics.

For a 10-week period, roughly half the patients were offered eight sessions of standard patient support and education, which provided information concerning both the neurological underpinnings of the disorder and the range of effects and possible treatments.

The other half was given eight sessions of the comprehensive behavioral intervention, which focused on tic awareness to help patients detect early warning signs of an imminent tic; relaxation training; and so-called "competing-response training." This training teaches patients how to voluntarily engage in behaviors that might impede the onset of tics -- such as breathing rhythmically to block word bursts, or pressing the elbow into the torso to prevent arm thrusts. They also talked about management of situations that might raise the risk for experiencing a tic.

Patients in either group who were already on medications before the study launch continued to take them throughout.

Mental health evaluations revealed that more than 38 percent of those in the intervention group showed "significant" improvement, a figure that dropped to just about 7 percent among the support/education group.

Specifically, tic severity dropped by 26 percent among the behavioral intervention patients, but only by about 12 percent among the other group.

Follow-up testing further showed that behavioral-intervention patients who did derive benefit maintained their symptom improvement six months down the road.

"The obvious next step," Wilhelm said, "is to teach clinicians how to administer CBIT."

More information

For more on Tourette syndrome and therapy, visit the National Tourette Syndrome Association.

Posted: August 2012


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