Randomized Trial of Behavior Therapy for Adults With Tourette Syndrome

Abstract

Context Tics in Tourette syndrome begin in childhood, peak in early adolescence, and often decline by early adulthood. However, some adult patients continue to have impairing tics. Medications for tics are often effective but can cause adverse effects. Behavior therapy may offer an alternative but has not been examined in a large-scale controlled trial in adults. Objective To test the efficacy of a comprehensive behavioral intervention for tics in adults with Tourette syndrome of at least moderate severity. Design A randomized, controlled trial with posttreatment evaluations at 3 and 6 months for positive responders. Setting Three outpatient research clinics. Subjects Subjects (N = 122; 78 males, age 16 to 69 years) with Tourette syndrome or chronic tic disorder. Interventions Eight sessions of Comprehensive Behavioral Intervention for Tics or 8 sessions of supportive treatment delivered over 10 weeks. Subjects showing a positive response were given 3 monthly booster sessions. Main Outcome Measures Total Tic score of the Yale Global Tic Severity Scale and the Improvement scale of the Clinical Global Impression rated by a clinician blind to treatment assignment. Results Behavior therapy was associated with a significantly greater decrease on the Yale Global Tic Severity Scale (24.0 ± 6.47 to 17.8 ± 7.32) from baseline to endpoint compared to the control treatment (21.8 ± 6.59 to 19.3 ± 7.40) (P < .001; effect size = 0.57). Twenty-four of 63 subjects (38.1%) in CBIT were rated as Much Improved or Very Much Improved on the Clinical Global Impression-Improvement scale compared to 6.8% (4 of 63) in the control group (P < .0001). Attrition was 13.9% with no difference across groups. Subjects in behavior therapy available for assessment at 6 months posttreatment showed continued benefit. Conclusions Comprehensive behavior therapy is a safe and effective intervention for adults with Tourette syndrome.

Gilles de la Tourette syndrome

“…Wilhelm and colleagues studied adults with GTS and found that those receiving CBIT demonstrated significant reductions and tics and tic-related impairment at the end of acute-phase treatment relative to supportive therapy. Gains were maintained for post-treatment responders at the 6-month follow-up 152 . In both studies, adverse events were tracked, and none were associated with CBIT.…”

“…Implemented in 8, structured 60-90 minute sessions over 10 weeks, this comprehensive behavioural intervention for tics (CBIT) 151 was tested through two large randomised controlled trials 89,152 . Both studies compared CBIT to a psychoeducation and supportive therapy control condition.…”

Pilot Open Case Series of Voice over Internet Protocol-Delivered Assessment and Behavior Therapy for Chronic Tic Disorders

“…The purpose of the evaluation was to (a) confirm eligibility, (b) determine initial tic severity, (c) establish the presence of comorbid conditions, and (d) document the type of VC and computer equipment being used by participants for the study. After eligibility was confirmed, a CBIT parent workbook (Woods et al, 2008) was mailed to families.…”

On Protocols and Principles in the Case of Hiro

“…CBIT is a contemporary treatment program that incorporates early behavioral approaches (e.g., HRT) with other behavior therapy techniques. Recent multisite randomized controlled trials have demonstrated that CBIT is efficacious in both youth (Piacentini et al, 2010) and adults (Wilhelm et al, 2012), with treatment effects comparable to psychotropic medications, but without significant side effects (Scahill et al, 2013). In light of this strong efficacy data, CBIT has been disseminated through various avenues.…”