Behavioural treatment as effective as drugs for Tourette syndrome
Tourettes action
New research published in the JAMA/Journal of the American Association on the 19 May 2010 showed that Comprehensive Behavioural Intervention (CBIT) gave a significantly greater decrease in tic severity and also improved the psychological, social and school functioning for children and adolescents compared to a control group. The control group received only supportive therapy and education, without CBIT. In addition, the tic reduction after this treatment was about the same as recent studies examining the effectiveness of medication, and without side effects.
Comprehensive behavioural intervention (CBIT) is a combination of tic-awareness and competing-response training. Tic awareness involves identifying what situations triggers or increases a person’s tics; and then help to find ways to avoid or cope with them. For example if anxiety worsens a child’s Tourettes, he or she can be taught relaxation techniques.
Competing response (or Habit Reversal Therapy - HRT) is helping a person recognise when they are feeling the urge to tic, and training them to perform an intentional movement instead. For example, a child with vocal tics who utters words or sounds involuntarily may be taught slow rhythmic breathing techniques to manage the urge to vocalise. HRT doesn't suppress the urge to tic, but it channels the urge into another, less noticeable and/or less painful movement.
The authors reported that almost 53 percent of the children who received CIBT were judged significantly improved compared with 19 percent of those who did not receive CIBT. This effect was still maintained after a 6 month follow up for 87 percent of the children who initially had been responsive to the treatment.
The study was conducted in the USA and included 126 children with moderate to severe Tourette syndrome. The children were randomly assigned to undergo either CIBT, or to be part of the control group who received supportive therapy and education sessions. The CBIT treatment and the control treatment were delivered in 8 sessions across 10 weeks. All of the children participating were between 9 - 17 years old.
One of the authors, John Piacentini, Professor of Psychiatry and Biobehavioral Sciences at UCLA, commented that ‘’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.’’
Habit reversal therapy was the topic of Tourettes Action’s latest conference and one of the speakers - Liz Murray - talked about how she has benefited from Habit Reversal Therapy. "It's now one year since the end of my treatment and habit reversal therapy has made a big difference to my quality of life bringing a very welcome reduction of tic symptoms'', she says. ''I am actively supporting the quest that everyone in the UK who has Tourette syndrome or a tic disorder eventually has the opportunity to access CBIT's / habit reversal therapy.''
Unfortunately it can be difficult for people to access these types of treatments in the UK. Typically, CBIT/HRT would be practiced by a Clinical Psychologist, but it may also be possible for different types of health professionals to be trained in delivering the technique. However it is likely to be an advantage if the practitioner is previously qualified in Cognitive Behavioural Therapy, as HRT builds upon that.
Nevertheless, this is very exciting news that gives us strong evidence to support the need for increased access to behavioural treatments for Tourette’s in the UK.
Dr Tara Murphy, Clinical Psychologist at the Great Ormond Street Hospital in London made this comment: "The results of the CBIT study clearly demonstrates the benefits of Habit Reversal Training for people with Tourette syndrome. These long awaited results should be a strong motivator for therapists working with children and adults with Tourette syndrome. A network of psychologists and other therapists who work with people with Tourette syndrome in the United Kingdom is becoming established. We hope to establish a specialist training workshop led by experts in behavioural treatments for tics during 2011. If you are interested in joining the network or attending the training please contact Dr Andrew Clempson, Research Manager at andrew.clempson@tourettes-action.org.uk or Liz Murray, Psychologist at lizgmurray@yahoo.co.uk"