13 August 2012

Behaviour therapy dampens Tourette tics

Behaviour therapy can help some people with Tourette syndrome stifle their embarrassing and sometimes inappropriate tics.


Behaviour therapy can help some people with Tourette syndrome stifle their embarrassing and sometimes inappropriate tics, according to a new study of adults with the neurologic condition.

"It really gives patients a wonderful alternative to medications," said Dr Sabine Wilhelm, who directs the OCD and Related Disorders Program at Massachusetts General Hospital in Boston and led the study."It is something that has created a lot of excitement in the field," she added, "because now we can finally treat neurological disorders with psychological interventions."

"Sometimes patients have tics where they actually hurt themselves," said Dr Wilhelm, whose findings appear this month in the Archives of General Psychiatry. There is no cure for Tourette. Antipsychotics are sometimes used to ease the symptoms, but they often come with serious side effects such as sedation, movement problems or weight gain.

How the study was done

Dr Wilhelm's study tested a new kind of therapy called Comprehensive Behavioural Intervention for Tics, or CBIT, which grew out of an earlier behavioural technique.

She explained that it focuses on creating awareness of oncoming tics and their triggers, so that people have a shot at controlling them before its too late. CBIT also teaches people to counteract the tic in subtle ways, for instance by balling up their fists if they feel compelled "to give someone the finger," according to Dr Wilhelm.

122 people over 16 were assigned

The researchers assigned 122 people over age 16 - most with Tourette and some with a problem called chronic tic disorder - to one of two groups. One group got eight sessions of CBIT training, while the others received only supportive treatment and education. At the end of the training, 38% of people in the CBIT group were much or very much improved, compared to just 6% of the control group.

The CBIT group also had a 26% decrease in the severity and frequency of their tics - more than double the improvement in the other group. "Patients were so grateful, they would say things like, 'This gives me a way to manage my tics, I now feel like I have control over my body,'" Dr Wilhelm said. "We also had three- and six-month follow-ups and the treatment gains were maintained over time."

She couldn't say what CBIT costs, but she said some insurers cover it. And while it's not widely available yet, her group has been working with the US Centers for Disease Control and Prevention to train health professionals in the technique. So far, they have reached more than 2 000 providers, Dr Wilhelm said. She refers patients to the website of the national Tourette Syndrome Association. The new study expands on earlier work in children by Dr Wilhelm's group, which found similarly encouraging results.

"These two studies on behaviour therapy... are by far the largest studies that have ever been done in terms of treatment of Tourette disorder," she told Reuters Health, adding that she hopes to compare the behaviour therapy with drugs in the future. "This is hopefully just the first step," Dr Wilhelm said.

(Reuters Health, Frederik Joelving, August 2012)

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