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Tic Tack

Behavioral therapy proves effective for Tourette’s tics in adults

Adults with tourette syndrome may be able to use behavioral therapy to control the sometimes debilitating physical and verbal tics that characterize the condition. A team of investigators at Massachusetts General Hospital reports that a combination of tic awareness and competing-response training, what the team calls comprehensive behavioral intervention for tics, allowed patients to gain greater control over their tic expression when compared with an approach that uses traditional psychoeducation and supportive therapy.

The research team, headed by Sabine Wilhelm, director of the OCD and Related Disorders Program at Mass General, conducted a multisite, randomized, case-controlled trial of 122 adult participants in which participants were taught to recognize early signs of a tic urge, and to respond to the urge with a voluntary movement instead. The data, gathered at Mass General, Yale University, and the University of Texas Health Science Center at San Antonio, were published in August in Archives of General Psychiatry.

“The program we tested was associated with a greater decrease in tic severity than the control treatment,” says Wilhelm.

At the end of the 10-week study period, 38 percent of the patients who learned comprehensive behavioral intervention for tics showed significant improvement when compared with those who received psychoeducation and supportive therapy. At a six-month follow-up, study participants reported that the beneficial effects of the behavioral therapy approach persisted.

Tourette syndrome affects an estimated 6 in 1,000 children in the United States. While children’s symptoms frequently decrease as they grow older, the verbal and physical tics can persist into adulthood. Clinicians have long relied on powerful antipsychotic medications as treatment. However, the unpleasant side effects of these medications cause patients to discontinue them, resulting in a return of symptoms.

“This study,” says Wilhelm, “shows that cognitive–behavioral approaches can be an important part of the treatment of Tourette syndrome.”


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