Abstract
Exposure and response prevention (ERP) is a first-line behavior therapy for obsessive-compulsive disorder and 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)
We showed that even children with recentonset tic disorders could suppress tics when brief tic-free periods were rewarded immediately by small tokens (Greene et al, 2015)
Contingently reinforced tic suppression produced decreases in tic frequency whether or not the participants were directed to attend to premonitory urges (Specht et al, 2013)
Summary
Any reports and responses or comments on the article can be found at the end of the article. The process of setting up an account and starting one’s first training session were quite opaque, and the web site shows improved “how to” instructions
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