The latest edition of  the official monthly publication of The British Psychological Society features a letter about therapies for Tourette Syndrome by psychologists Liz Murray and Tara Murphy. 

We are very grateful to both the authors and the British Psychological Society for giving us permission to reproduce the text of the letter here:

Psychological interventions in Tourette’s syndrome

Tourette’s syndrome (TS) is a well-known neurological condition that features involuntary sounds and movements (tics). TS is often linked to other behaviours, such as obsessive-compulsive disorder and attention deficit disorders. We would like to highlight recent developments in behavioural treatments and psychoeducation in TS with a view to establishing a network of interested psychologists.

Since Mary Robertson’s 2004 article in The Psychologist psychological interventions for tics have been developed further in Europe and North America. These include a manualised package based on habit reversal therapy/training, cognitive behavioural therapy (CBT), exposure and response prevention (ERP) and psychoeducation.

Douglas Woods and the American TS Behavioural Science Consortium have developed a comprehensive behavioural intervention for tics with a therapist manual for the treatment of tic disorders entitled Managing Tourette Syndrome (2008). There are three additional workbooks to accompany the manual: for children, parents and adults. Kieron O’Connor takes a different approach and has applied CBT to the treatment of tics in adults. His book Cognitive-Behavioural Management of Tic Disorders (2005) is very accessible and also offers a client manual and a therapist manual with questionnaires and worksheets. A third approach draws on ERP strategies for treating tics. Cara Verdellen (2004) has developed a protocol that encourages the person with tics to endure the premonitory sensation for a period of time (exposure) and resist the tic (response prevention), therefore causing a reduction of tics through habituation.

Resources promoting psychoeducation for the individual, their family and school/workplace (Buffolano, 2008; Robertson & Cavanna, 2008) and group work (Murphy & Heyman, 2007) can be used as an important addition to behavioural treatments. For many people with mild TS, this approach may be intervention enough to enhance quality
of life.

Currently there is a significant level of unmet need for treatments for people with tics in the UK. We would like to help develop these treatments within UK-based services. Although specialist clinics exist, most psychologists working in applied settings will have contact with people with TS at some point. However, a recent survey by the charity Tourettes Action showed that few clinical services in the UK have specialist training in treating tic disorders. There is little contact amongst psychologists with an interest in this area within the UK, unlike other countries where psychologists have developed specialist networks. If you already work in this area or have an interest in learning about using psychological treatments for TS please contact one of us (lizgmurray@yahoo.co.uk or t.murphy@ich.ucl.ac.uk) to discuss the possibility of forming a network.

Liz Murray
Dumfries
Tara Murphy
Great Ormond St Hospital for Children

References

Buffolano, S. (2008). Coping with Tourette syndrome. Oakland, CA: Instant Help Books. Murphy, T. & Heyman, I. (2007). Group work in young people with Tourette syndrome. Child and Adolescent Mental Health, 12, 46–48.
O'Connor, K. (2005). Cognitive-behavioural management of tic disorders. Chichester: Wiley.
Robertson, M. & Cavanna, A. (2008). Tourette syndrome (The facts). Oxford: Oxford University Press.
Verdellen, C.W.J., Hoogduin, C.A.L. & Keijsers, G.P.J. (2004). Exposure with response prevention versus habit reversal in Tourette's syndrome: A controlled study. Behaviour Research and Therapy, 42, 501–511. Woods, D.W., Piacentini, J., Chang, S. et al. (2008). Managing Tourette syndrome. New York: Oxford University Press.

Letter originally published in 'The Psychologist', February 2010.