Habit Reversal Therapy
Treatment for Tourette Syndrome can involve both pharmacologic (drugs) and non-pharmacologic approaches. Recently, interest has grown in non-pharmacologic treatments as drugs often have unpleasant side-effects. Non-pharmacologic treatments are based on psychosocial interventions. They vary widely but here are a few examples –
- Habit reversal therapy (HRT)
- Cognitive behaviour therapy (CBT)
- Exposure and prevention response (ERP)
- Self monitoring
What is HRT?
HRT is a behavioural therapy introduced in the 1970’s that aims to prevent tics by acting on the ‘premonitory urge’ associated with them. Many people experience this urge immediately before a tic occurs and it is often described as an unpleasant build up of pressure or an itch that can only be relieved by doing the tic. HRT works by replacing the tic with a less obvious movement called a ‘competing response’. This helps to break the connection between the premonitory urge and the tic, allowing some people to eventually overcome them.
Despite this, some tics are deeply-rooted in early learning theory and strong internal and external factors may be present that reinforce tic expression and maintenance. Furthermore, expressing the tic usually relieves the discomfort associated with the premonitory urge, thereby strengthening the urge-tic cycle. Only with long-term practice and perseverance can HRT help to break this cycle, meaning that sometimes, this treatment is difficult to achieve and may be long-running.
Other types of behavioural therapy work well in conjunction with HRT. These include behaviour modification therapies and psychotherapy (“talk therapy”) which are thought to help deal with other conditions such as depression, OCD and rage attacks.
If you are interested in trying HRT, we suggest that you contact a TS specialist to talk over the therapy in more detail. We are currently creating a HRT specialists list - please stay tuned for further updates. Another common behaviour therapy is Exposure and Response Prevention. This involves increasing exposure to the premonitory urges (i.e. suppressing for longer each time), with the theory that one becomes accustomed to the feeling of needing to tic until the urge (and any related anxiety) decreases in strength. Again - if you are intersted in trying this therapy, please consult your specilaist first.
More information on HRT can be found below -
Tourettes Action Information on HRT
- Read our leaflet: Psychological interventions for the treatment and management of Tourette Syndrome.
- Visit our Research News page for more information
- Tourettes Action helpline and helpdesk - 0845 458 1252 and
- Tourette Action conferences on HRT. Click here and here. The Tourette Syndrome Association also held a similar conference – slides can be found here.
Other sources of information
Click here to find out about the book ‘Managing Tourette Syndrome: A Behavioral Intervention for Children and Adults Therapist Guide (Treatments That Work)’ by Douglas W. Woods, John Piacentini, Susanna Chang, Thilo Deckersbach, Golda Ginsburg, Alan Peterson, Lawrence D Scahill, John T Walkup and Sabine Wilhelm.
Click here for information on the book 'Tics - Therapist Manual & Workbook for Children' by Cara Verdellen, Jolande van de Griendt, Sanne Kriens and Ilse van Oostrum
The information on this page was adapted from the following papers which also discuss HRT in more detail-
- Reese et al., (2010). Please click here.
- Piacentini et al., (2010). Please click here.