Tourette Syndrome Patients May Benefit from Behavioral Therapy
An intensive course of a specialized behavior training therapy, called comprehensive behavioral intervention for tics or CBIT, may help lessen tics in children and teens about as effectively as medication. The study, conducted at the University of California, Los Angeles, was released this week in the Journal of the American Medical Association.
Tourette syndrome is a neurological disorder characterized by short, rapid involuntary physical or vocal “tics” such as blinking, jerking motions, and blurting out words. It affects an estimated 148,000 U.S. children, many of whom have other disabilities such as attention deficit hyperactivity disorder, according to a survey by the Centers for Disease Control and Prevention.
The condition can be devastating for children due to the social stigmatization, and the drugs that are used to treat the condition, including antidepressants, anti-anxiety meds, and antipsychotics, can have significant side effects.
In the study, 126 Tourette children ages 9 to 17 were randomly assigned to 10 weeks of CBIT or to a control group that received support therapy and education. Some of the children in the therapy group received additional treatments at three and six months after the original 10-week session as well. About a third of the children remained on anti-tic medication.
At the end of the study, about 53% of the children who received CBIT therapy were judged significantly improved, using the Yale Global Tic Severity Scale, compared with 19% of children in the control group. In addition, the children who received the therapy also saw greater improvements in psychological, social and school functioning.
At the six month follow-up after the therapy sessions, 87% of the children still showed benefits.
This finding was "pretty exciting to us," said study author Dr. John Piacentini, professor of psychiatry at the University of California at Los Angeles. "One of the benefits of the behavior treatment is it was also associated with no side effects," he explained.
CBIT involves habit reversal training which helps patients become more aware of the urge to tic. It then teaches them to engage in a voluntary behavior, such as rhythmic breathing, that competes with the urge and makes the tic less noticeable. Habit reversal training is also useful in other types of disorders, including trichotillomania (compulsive hair pulling or twisting) and compulsive nail biting.
A second part of the therapy involves identifying situations that can trigger tics or make them worse. This can help children and their parents find ways to avoid them or cope with them.
According to Piacentini, CIBT doesn't "cure" Tourette's, but gives people a tool to manage their symptoms that they can turn back to any time when their tics worsen or reappear.