Abstract
Tourette syndrome (TS) is a disorder characterised by multiple motor and vocal tics and is frequently associated with behavioural problems. Tics are known to be affected by internal factors such as inner tension and external factors such as the surrounding environment. A number of behavioural treatments have been suggested to treat the symptoms of TS, in addition to pharmacotherapy and surgery for the most severe cases. This review compiled all the studies investigating behavioural therapies for TS, briefly describing each technique and assessing the evidence in order to determine which of these appear to be effective. Different behavioural therapies that were used included habit reversal training (HRT), massed negative practice, supportive psychotherapy, exposure with response prevention, self-monitoring, cognitive-behavioural therapy, relaxation therapy, assertiveness training, contingency management, a tension-reduction technique and biofeedback training. Overall, HRT is the best-studied and most widely-used technique and there is sufficient experimental evidence to suggest that it is an effective treatment. Most of the other treatments, however, require further investigation to evaluate their efficacy. Specifically, evidence suggests that exposure with response prevention and self-monitoring are effective, and more research is needed to determine the therapeutic value of the other treatments. As most of the studies investigating behavioural treatments for TS are small-sample or single-case studies, larger randomised controlled trials are advocated.
Highlights
Tourette syndrome (TS) is a neurodevelopmental disorder characterised by the chronic presence of multiple motor and phonic tics, i.e. involuntary movements and utterances [1,2]
Carr and Chong [18] assessed 12 studies investigating the use of habit reversal training (HRT) to treat tics. 94% of the participants observed tic reductions, most of which maintained at long-term follow-up assessment, leading to the conclusion that HRT is an effective treatment for tics
The first study was conducted in the United States and included 126 children and adolescents with moderate to severe TS, who were randomly assigned to undergo a comprehensive behavioural intervention for tics (CBIT: a combination of tic awareness and HRT) or to be part of the control group who received supportive psychotherapy (SP) and education sessions
Summary
Tourette syndrome (TS) is a neurodevelopmental disorder characterised by the chronic presence of multiple motor and phonic tics, i.e. involuntary movements and utterances [1,2]. Co-morbid behavioural problems are reported by about 90% of patients with TS [5]. The most common psychiatric co-morbidities include obsessive compulsive disorder (OCD) [6], attention deficit hyperactivity disorder (ADHD) [7], affective disorders [8], impulse control disorders [9] and personality disorders [10]. Neuroimaging studies of subjects with TS have frequently implicated the basal ganglia and associated cortices with the disorder, demonstrating reduced activity within this area relative to control subjects [11]. Findings suggest that the basal ganglia portions of the striatum and its dopaminergic circuitry may be the key areas involved in the pathophysiology of TS, as this is the region regulating motor and behavioural expression [12]. As a result of this neurobiological model of TS, pharmacotherapy is currently
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