Tell us about Behavioural Therapy

Posted on 4 January 2017

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A second year undergraduate psychology student from Liverpool Hope University got in touch with Tourettes Action to ask some questions about behavioural therapy. Below are responses from Health Psychologist & Cognitive Behaviour Therapist, Jolande van de Griendt; and Consultant Clinical Psychologist Dr Tara Murphy. Jolande and Tara are both involved in the TA Behavioural Therapy Training Programme.

                               Jolande Van de Griendt                                                        Dr Tara Murphy

How do you feel Comprehensive Behavioural Intervention for Tics (CBIT) and habit reversal training (HRT) has improved the quality of life for the patients with Tourette Syndrome you have treated? 

Behaviour therapies such as (habit reversal training (HRT) and exposure and response prevention (ERP) aim to facilitate an individual with tics to gain control over their tics (both movements and sounds). Therefore learning the strategy offers individuals, a strategy to achieve significant tic reduction and an improved feeling of control over the involuntary tics. Instead of being powerless to control their tics, the individual with tics, through behavioural therapy learns to choose whether they perform a tic or resist it. Of course patients cannot learn to control their tics 24 hours per day, yet the feeling of control can help them in situations where they normally have many tics. The strategies help to strengthen the self-confidence of the individual with tics.

Another important element of behavioural therapy is the educational component. As part of the treatment, the individual with tics and important others in their environment (i.e. parents, teachers, family members, employers etc) learn about tics. Important information which is gained about tics is that they wax and wane and change with time. It is also important for people to understand that tics can be suggestible and although they may appear to include personal information about other people, this is not the intention of the person with tics.

Studies which have looked at individual’s mood, friendships and social activities after a course of comprehensive behavioural intervention for tics suggest that within 3 months children who have had this intervention show improves, but interestingly, these changes are not seen immediately (Woods et al, 2011; J of Child Neurology).

Does CBIT or HRT appear to hold ecological validity? (this term refers to the extent to which the findings of a research study are able to be generalized to real-life settings).

Behaviour therapy for Tourettes Syndrome and tic disorders is a very hands-on, structured way of treating patients. There are manuals published on which therapists can rely, and these manuals make research more transparent as similar treatment can be delivered by any therapist with an understanding about the models of treatment involved. It is clear for both patients and therapists what information should be understood and techniques learnt each session. Individuals undergoing treatment need to understand the rational for the treatment, how and why the therapist believes that it works. The treatment is very collaborative and many of the decisions in treatment are made between the patient and clinician. So yes, there is sufficient ecological validity. Of course manuals might be followed more strictly while in a research setting than in daily life, which might have a better effect, yet the effects of this are expected to be quite similar.

In terms of biological, psychological and social factors detriment to Tourette Syndrome, how would you say CBIT and HRT have been able to provide successful treatment intervention? 

Medication has previously been the first choice in treating people with tic disorders. Anti-psychotic medication has shown good results in tic reduction. However it can lead to side effects that were sometimes felt to be uncomfortable and unpleasant. Due to the growing body of research, behaviour therapy can be considered as an equally effective treatment for Tourette and tic disorders as medication. The European Clinical Guidelines for the treatment of Tourette Syndrome, which were published in 2011, advise to start with educational about tic disorders and Tourette syndrome for all individuals with tic disorders.  Behaviour therapy, where it is available is also considered a ‘first line’ intervention because of the expected positive long term effects, beyond the duration of the therapy, as well as the assumed less frequent and less severe adverse effects.

Results from a study investigating outcome following habit reversal training delivered within a group suggest that children’s attendance at school improves following a course of treatment.

Preliminary research investigating the effects of behaviour therapy on the brain in adults with Tourette syndrome showed changes on electrophysiological measures assessing cortical activation (Lavioe et al, 2011; International Journal of Cognitive Therapy).

Any other comments regarding your point of view on the efficiency of CBIT and HRT? 

Although behaviour therapy is recommended as a first-line intervention and is preferred above medication, the situation in reality is that there is a shortage of therapists who are trained to deliver the treatment. This results in many patients who are unable to access treatment because they cannot find a qualified therapist. Luckily Tourettes Action is promoting knowledge about behaviour therapy, both in patients as well as in professionals, to bring science and daily practice closer together and give every person with tics that bother them and impact their daily life the chance to access their preferred treatment.

Read more about behavioural therapy on the TA website

If you are interested in finding out about therapists who offer behavioural therapy please contact the TA helpdesk.

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