Software for web-based tic suppression training.

Jonathan K Black,Kevin J Black

doi:10.12688/f1000research.13460.1

Abstract

Exposure and response prevention (ERP) is a first-line behavior therapy for obsessive-compulsive disorder, and has also been tested in Tourette syndrome (TS). However, ERP for tic disorders requires intentional tic suppression, which for some patients is difficult even for brief periods. Additionally, practical access to behavior therapy is difficult for many patients, especially those in rural areas. The authors present a simple, working web platform (TicTrainer) that implements a strategy called reward-enhanced exposure and response prevention (RE-ERP). This strategy sacrifices most expert therapist components of ERP, focusing only on increasing the duration of time for which the user can suppress tics through automated differential reinforcement of tic-free periods (DRO). RE-ERP requires an external tic monitor, such as a parent, during training sessions. The user sees increasing digital rewards for longer and longer periods of successful tic suppression, similar to a video game score. TicTrainer is designed with security in mind, storing no personally identifiable health information, and has features to facilitate research, including optional masked comparison of tics during DRO vs. noncontingent reward conditions. A working instance of TicTrainer is available from https://tictrainer.com/.

Highlights

Recent years have seen increasing evidence for and acceptance of behavior therapies for tic disorders such as Tourette syndrome (Capriotti et al, 2014)
Tic suppression plays a key role in these therapies (Specht et al, 2014)
We showed that even children with recent-onset tic disorders could suppress tics when brief tic-free periods were rewarded immediately by small tokens (Greene et al, 2015)

Summary

Introduction

“ERP showed similar tic reduction..” clarify if the other treatment being referred to is Habit Reversal Therapy/Comprehensive Behavioral Intervention for Tics. I assuming the program is intended to shape longer tic suppression durations but am not clear if the program aims to do this with an increasing or decreasing reward density It sounds like the reward schedule can be manipulated in a research context, so clarification of what the default settings vs customizable settings would be useful. As for the question about research use, the current version of the software allows administrators to change a participant from the contingent reward schedule above to a noncontingent reward strategy in which rewards are given regardless of tics at a fixed initial rate that increases with each subsequent level. USA Oops, that sentence should have read: "Higher levels give higher reward magnitude, but reward frequency is slower." Competing Interests: No competing interests were disclosed

Methods

Conclusions