Habit Reversal Versus Supportive Psychotherapy for Tourette’s Disorder: A Randomized Controlled Trial

Harvard University, Cambridge, Massachusetts, United States
American Journal of Psychiatry (Impact Factor: 12.3). 07/2003; 160(6):1175-7. DOI: 10.1176/appi.ajp.160.6.1175
Source: PubMed


The authors investigated the efficacy of habit reversal for Tourette's disorder, which is characterized by multiple motor and vocal tics.
Thirty-two patients with Tourette's disorder were randomly assigned to 14 sessions of either habit reversal or supportive psychotherapy. Habit reversal consisted of awareness training, self-monitoring, relaxation training, competing response training, and contingency management. Changes in severity of Tourette's disorder and psychosocial impairment were investigated over the course of the 14-session treatment for the 29 patients who completed at least eight treatment sessions.
In contrast to the 13 patients in the supportive psychotherapy group, the 16 patients in the habit reversal group improved significantly. The habit reversal patients remained significantly improved over pretreatment at 10-month follow-up.
Habit reversal may be an effective behavioral treatment for Tourette's disorder.

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    • "Meanwhile, behavior interventions have also demonstrated success in reducing tic severity (Peterson, 2007). These behavior therapy interventions include habit reversal training (HRT; Azrin & Peterson, 1988, 1990; Peterson & Azrin, 1992; Wilhelm et al., 2003) and the comprehensive behavioral intervention for tics (CBIT; Piacentini et al., 2010; Wilhelm et al., 2012; Woods et al., 2008). Notably, HRT serves as the principle therapeutic ingredient in CBIT, which incorporates functional assessment and function-based intervention procedures to mitigate influences of daily life that worsen tics. "
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    ABSTRACT: Over the past six decades, behavior therapy has been a major contributor to the development of evidence-based psychotherapy treatments. However, a long-standing concern with behavior therapy among many nonbehavioral clinicians has been the potential risk for symptom substitution. Few studies have been conducted to evaluate symptom substitution in response to behavioral treatments, largely due to measurement and definitional challenges associated with treated psychiatric symptoms. Given the overt motor and vocal tics associated with Tourette's disorder, it presents an excellent opportunity to empirically evaluate the potential risk for symptom substitution associated with behavior therapy. The present study examined the possible presence of symptom substitution using four methods: (a) the onset of new tic symptoms, (b) the occurrence of adverse events, (c) change in tic medications, and (d) worsening of co-occurring psychiatric symptoms. Two hundred twenty-eight participants with Tourette's disorder or persistent motor or vocal tic disorders were randomly assigned to receive behavioral therapy or supportive therapy for tics. Both therapies consisted of eight sessions over 10 weeks. Results indicated that participants treated with behavior therapy were not more likely to have an onset of new tic symptoms, experience adverse events, increase tic medications, or have an exacerbation in co-occurring psychiatric symptoms relative to participants treated with supportive therapy. Further analysis suggested that the emergence of new tics was attributed with the normal waxing and waning nature of Tourette's disorder. Findings provide empirical support to counter the long-standing concern of symptom substitution in response to behavior therapy for individuals with Tourette's disorder.
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    • "They found continued benefit in 86% of available patients at 3 months follow up, and in 80% at 6 months follow up (Wilhelm et al., 2012). Other studies used the YGTSS, finding that stable results after 3 months (Piacentini et al., 2010; Verdellen et al., 2004a), 6 months (Deckersbach et al., 2006; Piacentini et al., 2010) and 10 months (Wilhelm et al., 2003). Woods et al. (2011) showed in the same children that Piacentini et al. (2010) researched that HR is effective in reducing long term secondary psychiatric symptoms as well, such as anxiety, disruptive behaviour, family strain and improved social functioning. "
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    ABSTRACT: Behaviour therapy has been shown to be an effective strategy in treating tics; both habit reversal (HR) and exposure and response prevention (ER) are recommended as first-line interventions. This review provides an overview of the history, theoretical concepts and evidence at present for HR and ER. In addition, treatment manuals for HR and ER are described. Despite the evidence and availability of treatment manuals, many patients do not receive a first-line psychological intervention for tics. Barriers to the acceptance and dissemination of behaviour therapy are discussed as are ways to overcome these barriers, such as the use of E-health and E-learning.
    Full-text · Article · Jul 2013 · Neuroscience & Biobehavioral Reviews
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    • "Table 1 displays the eight RCTs that met inclusion criteria, which produced a total sample of 438 participants. Two trials compared BT to a wait-list condition (Azrin and Peterson, 1990; O'Connor et al., 2001), and six trials compared a BT to an active comparison condition [e.g., awareness training (Piacentini et al., 2002), supportive therapy (Deckersbach et al., 2006; Wilhelm et al., 2003), psychoeducation and supportive therapy (Piacentini et al., 2010; Wilhelm et al., 2012), and ERP (Verdellen et al., 2004)]. "
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    ABSTRACT: Individual randomized controlled trials (RCTs) of habit reversal training and a Comprehensive Behavioral Intervention for Tics (collectively referred to as behavior therapy, BT) have demonstrated efficacy in reducing tic severity for individuals with Tourette Syndrome and Chronic Tic Disorders (collectively referred to as TS), with no examination of treatment moderators. The present meta-analysis synthesized the treatment effect sizes (ES) of BT relative to comparison conditions, and examined moderators of treatment. A comprehensive literature search identified eight RCTs that met inclusion criteria, and produced a total sample of 438 participants. A random effects meta-analysis found a medium to large ES for BT relative to comparison conditions. Participant mean age, average number of therapy sessions, and the percentage of participants with co-occurring attention deficit hyperactivity disorder (ADHD) were found to moderate treatment effects. Participants receiving BT were more likely to exhibit a treatment response compared to control interventions, and identified a number needed to treat (NNT) of three. Sensitivity analyses failed to identify publication bias. Overall, BT trials yield medium to large effects for TS that are comparable to treatment effects identified by meta-analyses of antipsychotic medication RCTs. Larger treatment effects may be observed among BT trials with older participants, more therapeutic contact, and less co-occurring ADHD.
    Full-text · Article · Jan 2013 · Journal of Psychiatric Research
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