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Woods DW, Himle MB, Stiede JT, Pitts BX. Behavioral Interventions for Children and Adults with Tic Disorder. Annu Rev Clin Psychol 2023; 19:233-260. [PMID: 37159286 DOI: 10.1146/annurev-clinpsy-080921-074307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Over the past decade, behavioral interventions have become increasingly recognized and recommended as effective first-line therapies for treating individuals with tic disorders. In this article, we describe a basic theoretical and conceptual framework through which the reader can understand the application of these interventions for treating tics. The three primary behavioral interventions for tics with the strongest empirical support (habit reversal, Comprehensive Behavioral Intervention for Tics, and exposure and response prevention) are described. Research on the efficacy and effectiveness of these treatments is summarized along with a discussion of the research evaluating the delivery of these treatments in different formats and modalities. The article closes with a review of the possible mechanisms of change underlying behavioral interventions for tics and areas for future research.
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Affiliation(s)
- Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA;
| | - Michael B Himle
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Jordan T Stiede
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Brandon X Pitts
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA;
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2
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Frey J, Malaty IA. Tourette Syndrome Treatment Updates: a Review and Discussion of the Current and Upcoming Literature. Curr Neurol Neurosci Rep 2022; 22:123-142. [PMID: 35107785 PMCID: PMC8809236 DOI: 10.1007/s11910-022-01177-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2021] [Indexed: 11/30/2022]
Abstract
Purpose of Review This study aims to examine the treatments currently available for Tourette syndrome (TS) and to discuss evolving therapies, spanning behavioral, pharmacologic, complementary and alternative medicine, and neuromodulation approaches. Recent Findings Behavioral therapies have undergone several modifications to improve accessibility, including transitioning to a virtual format which is particularly important in the current pandemic. There are several recent or ongoing pharmacologic studies that have shown promise including the selective D1 receptor antagonist ecopipam and various cannabinoid compounds. Adaptive DBS may enable the physiologic markers of tics to determine stimulation parameters and improve tic outcomes related to neuromodulation. Summary In recent years, there has been a wealth of research across multiple treatment domains in the TS field. This review highlights exciting and new potential options for the future treatment of patients with TS.
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Affiliation(s)
- Jessica Frey
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Irene A Malaty
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA.
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Andrén P, Jakubovski E, Murphy TL, Woitecki K, Tarnok Z, Zimmerman-Brenner S, van de Griendt J, Debes NM, Viefhaus P, Robinson S, Roessner V, Ganos C, Szejko N, Müller-Vahl KR, Cath D, Hartmann A, Verdellen C. European clinical guidelines for Tourette syndrome and other tic disorders-version 2.0. Part II: psychological interventions. Eur Child Adolesc Psychiatry 2022; 31:403-423. [PMID: 34313861 PMCID: PMC8314030 DOI: 10.1007/s00787-021-01845-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/07/2021] [Indexed: 12/20/2022]
Abstract
Part II of the European clinical guidelines for Tourette syndrome and other tic disorders (ECAP journal, 2011) provides updated information and recommendations for psychological interventions for individuals with tic disorders, created by a working group of the European Society for the Study of Tourette Syndrome (ESSTS). A systematic literature search was conducted to obtain original studies of psychological interventions for tic disorders, published since the initial European clinical guidelines were issued. Relevant studies were identified using computerized searches of the MEDLINE and PsycINFO databases for the years 2011-2019 and a manual search for the years 2019-2021. Based on clinical consensus, psychoeducation is recommended as an initial intervention regardless of symptom severity. According to a systematic literature search, most evidence was found for Habit Reversal Training (HRT), primarily the expanded package Comprehensive Behavioral Intervention for Tics (CBIT). Evidence was also found for Exposure and Response Prevention (ERP), but to a lesser degree of certainty than HRT/CBIT due to fewer studies. Currently, cognitive interventions and third-wave interventions are not recommended as stand-alone treatments for tic disorders. Several novel treatment delivery formats are currently being evaluated, of which videoconference delivery of HRT/CBIT has the most evidence to date. To summarize, when psychoeducation alone is insufficient, both HRT/CBIT and ERP are recommended as first-line interventions for tic disorders. As part of the development of the clinical guidelines, a survey is reported from ESSTS members and other tic disorder experts on preference, use and availability of psychological interventions for tic disorders.
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Affiliation(s)
- Per Andrén
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Gävlegatan 22, 113 30, Stockholm, Sweden.
| | - Ewgeni Jakubovski
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Tara L Murphy
- Tic Disorder Clinic, Great Ormond Street Hospital NHS Foundation Trust, London, WC1 3JH, UK
| | - Katrin Woitecki
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), University Hospital, Cologne, Germany
| | - Zsanett Tarnok
- Vadaskert Child and Adolescent Psychiatry, Budapest, Hungary
| | - Sharon Zimmerman-Brenner
- Baruch Ivcher School of Psychology, The Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel
| | | | - Nanette Mol Debes
- Department of Pediatrics, Herlev University Hospital, Herlev, Denmark
| | - Paula Viefhaus
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), University Hospital, Cologne, Germany
| | - Sally Robinson
- Tic and Neurodevelopmental Movement Service (TANDeM), Children's Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, TU Dresden, Dresden, Germany
| | - Christos Ganos
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Natalia Szejko
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
- Department of Bioethics, Medical University of Warsaw, Warsaw, Poland
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, New Haven, USA
| | - Kirsten R Müller-Vahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Danielle Cath
- Department of Psychiatry, University Medical Center Groningen, Rijks Universiteit Groningen, GGZ Drenthe Mental Health Institution, Assen, The Netherlands
| | - Andreas Hartmann
- Department of Neurology, Hôpital de La Pitié-Salpêtrière, 75013, Paris, France
| | - Cara Verdellen
- PsyQ Nijmegen, Outpatient Treatment Center, Parnassia Group, Den Haag, The Netherlands
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Viefhaus P, Adam J, Goletz H, Woitecki K, Döpfner M. Implementation and Evaluation of Therapeutic Online Coaching Using Habit Reversal Training in Children With Tourette's Disorder - A Pilot Study. Front Psychol 2021; 12:780539. [PMID: 34887819 PMCID: PMC8649795 DOI: 10.3389/fpsyg.2021.780539] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Cognitive-behavioral interventions can be difficult to implement in daily routine, which is often essential for generalizing treatment effects to natural settings. Furthermore, there is a lack of adequate care options concerning habit reversal training for children with Tourette’s disorder. The objective of this study is to evaluate therapeutic online coaching via videoconferencing in the natural environment of children with Tourette’s disorder in addition to face-to-face therapy (blended therapy). Online coaching took place twice a week for a maximum of 12 weeks. In a single-case study (n = 5; patients aged 8–11 years), the first results were obtained for exploratory purposes, especially with regard to the feasibility and reduction of symptoms and impairment. Various outcome measures were assessed (severity of symptoms, impairment, practical implementation, and satisfaction). Despite some principal limitations, the findings provide first hints that blended therapy is feasible and improves symptoms in some children with tics. Clinical Trial Registration: [https://clinicaltrials.gov/], identifier [DRKS00017199].
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Affiliation(s)
- Paula Viefhaus
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Adam
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Hildegard Goletz
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Katrin Woitecki
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Manfred Döpfner
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Li Y, Woods DW, Gu Y, Yu L, Yan J, Wen F, Wang F, Liu J, Cui Y. Psychometric Properties of the Chinese Version of the Premonitory Urge for Tics Scale: A Preliminary Report. Front Psychol 2021; 12:573803. [PMID: 34646181 PMCID: PMC8503313 DOI: 10.3389/fpsyg.2021.573803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/26/2021] [Indexed: 12/27/2022] Open
Abstract
Premonitory urges (PUs) are sensory phenomena that immediately precede tics. The Premonitory Urge for Tics Scale (PUTS) is widely used to assess the severity of PUs, but the psychometric properties of PUTS and clinical features of PU in Chinese patients with tic disorders are still unclear. In this study, we examined the psychometric properties of the Chinese version of the PUTS in a large sample (including 367 Chinese pediatric patients with tic disorders). We found no difference in PU in different age groups. The exploratory factor analysis (EFA) of PUTS showed the emergence of four primary factors. The results of reliability and validity analyses indicated that the Chinese version showed good psychometric properties. It seemed that PU was associated with the severity of obsession symptoms in patients with tic disorders. Network analysis showed that Item 7 is a critical node for the PU, in addition to Items 1 and 4. Overall, the Chinese version of PUTS can be used in Chinese child and adolescent patients with tic disorders, particularly for patients with Tourette syndrome.
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Affiliation(s)
- Ying Li
- Department of Psychiatry, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, WI, United States
| | - Yi Gu
- Department of Psychiatry, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Liping Yu
- Department of Psychiatry, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Junjuan Yan
- Department of Psychiatry, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Fang Wen
- Department of Psychiatry, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Fang Wang
- Department of Psychiatry, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jingran Liu
- Department of Psychiatry, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yonghua Cui
- Department of Psychiatry, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
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Liu S, Li Y, Cui Y. Review of habit reversal training for tic disorders. Pediatr Investig 2020; 4:127-132. [PMID: 32851356 PMCID: PMC7331356 DOI: 10.1002/ped4.12190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 04/23/2020] [Indexed: 11/12/2022] Open
Abstract
Tic disorders (TD) is a neurodevelopmental disorder that is often first recognized in children and adolescents and is characterized mainly by motor and phonic tics. Drug treatment of TD has been criticized because of serious side effects, and TD treatment emphasizes behavioral psychotherapy. This study reviewed the most common behavioral psychotherapy for TD: habit reversal training (HRT). We examined the contents, variation, curative effects, and premonitory urge control of HRT and other behavioral psychotherapies. The findings suggest that current understanding of HRT is insufficient and further studies are needed. First, studies of online guidance training are needed to implement technology that can help more patients. Second, the future integration of HRT and other technologies is important. Third, imaging techniques could be used to further explore the brain mechanisms underlying HRT. Research on HRT for TD in China is insufficient. We call on more Chinese researchers to study, investigate, and develop technology to promote the development of behavioral psychotherapy for TD in China.
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Affiliation(s)
- Shijie Liu
- Xibeiwang Community Health Center in HaidianBeijingChina
| | - Ying Li
- Department of PsychiatryBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
| | - Yonghua Cui
- Department of PsychiatryBeijing Children’s HospitalCapital Medical UniversityNational Center for Children’s HealthBeijingChina
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