Effectiveness of Behavior Therapy and Psychosocial Therapy for the Treatment of Tourette Syndrome and Chronic Tic Disorder

• Tic-related impairment [ Time Frame: Measured at Week 10 ] [ Designated as safety issue: No ]
• Depressive symptoms [ Time Frame: Measured at Week 10 ] [ Designated as safety issue: Yes ]
• Anxiety symptoms [ Time Frame: Measured at Week 10 ] [ Designated as safety issue: No ]
• Obsessive-compulsive symptoms [ Time Frame: Measured at Week 10 ] [ Designated as safety issue: No ]

• Tic-related impairment; measured at Week 10
• Depressive symptoms; measured at Week 10
• Anxiety symptoms; measured at Week 10
• Obsessive-compulsive symptoms; measured at Week 10

This study will compare the efficacy of supportive therapy versus habit-reversal therapy for the treatment of Tourette syndrome and chronic tic disorder.

Tourette syndrome and chronic tic disorder are neurological disorders characterized by tics. Tics are involuntary, rapid motor movements or vocalizations that occur suddenly and repeatedly. In adults, the symptoms of Tourette syndrome or chronic tic disorder can be severe. These symptoms often cause difficulties in interpersonal relationships and high unemployment rates. Medication treatments are available for both Tourette syndrome and chronic tic disorder, but most are not completely effective and cause considerable negative side effects. Therefore, non-medication treatments are needed. This study will compare the efficacy of supportive therapy versus habit-reversal therapy for the treatment of Tourette syndrome and chronic tic disorder.

Participants in this open-label study will be randomly assigned to receive either supportive therapy or habit-reversal therapy. Over the course of 10 weeks, all participants will receive 8 treatment sessions of their assigned therapy. The supportive therapy will focus on educating participants on what tics are, how tics present themselves, the causes of tics, the common conditions that may occur along with tics, and environmental factors that may affect their tics (e.g. family, social, school, stress). Habit-reversal therapy will consist of awareness training, relaxation training, self-monitoring, and competing response training. Tic severity, tic-related impairment, depressive symptoms, anxiety symptoms, and obsessive-compulsive symptoms will be assessed at each study session, using diagnostic interviews and self-report scales.

• Tourette Syndrome
• Tic Disorders

• Behavioral: Habit reversal therapy
  Habit reversal therapy consists of awareness training, relaxation training, self-monitoring, and competing response training.
• Behavioral: Supportive therapy
  Supportive therapy focuses on educating participants about tics: how tics present themselves, the causes of tics, the common conditions that may occur along with tics, and environmental factors that may affect their tics (e.g. family, social, school, stress).

• Placebo Comparator: 1
  Participants will receive supportive psychotherapy.
  Intervention: Behavioral: Supportive therapy
• Active Comparator: 2
  Participants will receive habit reversal therapy.
  Intervention: Behavioral: Habit reversal therapy

• Lin H, Yeh CB, Peterson BS, Scahill L, Grantz H, Findley DB, Katsovich L, Otka J, Lombroso PJ, King RA, Leckman JF. Assessment of symptom exacerbations in a longitudinal study of children with Tourette's syndrome or obsessive-compulsive disorder. J Am Acad Child Adolesc Psychiatry. 2002 Sep;41(9):1070-7.
• Bruun RD. Subtle and underrecognized side effects of neuroleptic treatment in children with Tourette's disorder. Am J Psychiatry. 1988 May;145(5):621-4.
• Scahill L, Chappell PB, King RA, Leckman JF. Pharmacologic treatment of tic disorders. Child Adolesc Psychiatr Clin N Am. 2000 Jan;9(1):99-117. Review.
• Wilhelm S, Peterson AL, Piacentini J, Woods DW, Deckersbach T, Sukhodolsky DG, Chang S, Liu H, Dziura J, Walkup JT, Scahill L. Randomized trial of behavior therapy for adults with Tourette syndrome. Arch Gen Psychiatry. 2012 Aug;69(8):795-803.

Inclusion Criteria:

• Meets DSM-IV diagnostic criteria for Tourette syndrome or chronic tic disorder
• The primary reason for seeking treatment is Tourette syndrome and/or chronic tic disorder
• Either Tourette syndrome or chronic tic disorder is of more concern than any other simultaneous disease or disorder
• Score greater than 3 on the Clinical Global Impressions Severity Scale
• Score greater than 14 on the Yale Global Tic Severity Scale
• Unmedicated or on stable medication treatment for tics, obsessive compulsive disorder, attention deficit hyperactivity disorder, and/or depressive disorder for at least 6 weeks, and not planning to change medication for the duration of study participation

Exclusion Criteria:

• Total tic score greater than 33
• Score less than 80 on the Wechsler Test of Adult Reading
• DSM-IV diagnosis of alcohol or substance dependence within the 3 months prior to study enrollment
• Currently taking psychotropic medications for any psychiatric disorder (except for tics, obsessive compulsive disorder, attention deficit hyperactivity disorder, and/or depressive disorder)
• Any serious psychiatric disorder (e.g., bipolar disorder, psychosis) that requires immediate alternative treatment
• Previously treated with four or more sessions of habit-reversal therapy for tics