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Effect of behavior therapy for Tourette's disorder on psychiatric symptoms and functioning in adults

Published online by Cambridge University Press:  27 August 2019

Joseph F. McGuire*
Affiliation:
Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Emily J. Ricketts
Affiliation:
Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California, USA
Lawrence Scahill
Affiliation:
Marcus Autism Center, Emory University School of Medicine, Atlanta, Georgia, USA
Sabine Wilhelm
Affiliation:
Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
Douglas W. Woods
Affiliation:
Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA
John Piacentini
Affiliation:
Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, California, USA
John T. Walkup
Affiliation:
Lurie Children's Hospital, Chicago, Illinois, USA
Alan L. Peterson
Affiliation:
Department of Psychiatry, University of Texas Health Science at Center, San Antonio, Texas, USA Department of Psychology, University of Texas at San Antonio, San Antonio, Texas, USA South Texas Veterans Health Care System, San Antonio, Texas, USA
*
Author for correspondence: Joseph F. McGuire, E-mail: jfmcguire@jhmi.edu

Abstract

Background

Although behavior therapy reduces tic severity, it is unknown whether it improves co-occurring psychiatric symptoms and functional outcomes for adults with Tourette's disorder (TD). This information is essential for effective treatment planning. This study examined the effects of behavior therapy on psychiatric symptoms and functional outcomes in older adolescents and adults with TD.

Method

A total of 122 individuals with TD or a chronic tic disorder participated in a clinical trial comparing behavior therapy to psychoeducation and supportive therapy. At baseline, posttreatment, and follow-up visits, participants completed assessments of tic severity, co-occurring symptoms (inattention, impulsiveness, hyperactivity, anger, anxiety, depression, obsessions, and compulsions), and psychosocial functioning. We compared changes in tic severity, psychiatric symptoms, and functional outcomes using repeated measure and one-way analysis of variance.

Results

At posttreatment, participants receiving behavior therapy reported greater reductions in obsessions compared to participants in supportive therapy ($\eta _p^2 $ = 0.04, p = 0.04). Across treatments, a positive treatment response on the Clinical Global Impression of Improvement scale was associated with a reduced disruption in family life ($\eta _p^2 $ = 0.05, p = 0.02) and improved functioning in a parental role ($\eta _p^2 $ = 0.37, p = 0.02). Participants who responded positively to eight sessions of behavior therapy had an improvement in tic severity ($\eta _p^2 $ = 0.75, p < 0.001), inattention ($\eta _p^2 $ = 0.48, p < 0.02), and functioning ($\eta _p^2 $ = 0.39–0.42, p < 0.03–0.04) at the 6-month follow-up.

Conclusion

Behavior therapy has a therapeutic benefit for co-occurring obsessive symptoms in the short-term, and reduces tic severity and disability in adults with TD over time. Additional treatments may be necessary to address co-occurring symptoms and improve functional outcomes.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2019

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References

American Psychiatric Association (2013) Diagnostic and Statistic Manual of Mental Disorders. Arlington, VA: American Psychiatric Publishing.Google Scholar
Beck, AT, Epstein, N, Brown, G and Steer, RA (1988) An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology 56, 893897.CrossRefGoogle ScholarPubMed
Beck, AT, Steer, RA and Brown, GK (1996) Beck depression inventory-II. San Antonio 78, 490498.Google Scholar
Bloch, MH and Leckman, JF (2009) Clinical course of Tourette syndrome. Journal of Psychosomatic Research 67, 497501.CrossRefGoogle ScholarPubMed
Bloch, MH, Peterson, BS, Scahill, L, Otka, J, Katsovich, L, Zhang, H and Leckman, JF (2006) Adulthood outcome of tic and obsessive-compulsive symptom severity in children with Tourette syndrome. Archives of Pediatric and Adolescent Medicine 160, 6569.CrossRefGoogle ScholarPubMed
Cavanna, AE, David, K, Bandera, V, Termine, C, Balottin, U, Schrag, A and Selai, C (2013) Health-related quality of life in Gilles de la Tourette syndrome: a decade of research. Behavioural Neurology 27, 8393.CrossRefGoogle ScholarPubMed
Deckersbach, T, Rauch, S, Buhlmann, U and Wilhelm, S (2006) Habit reversal versus supportive psychotherapy in Tourette's disorder: a randomized controlled trial and predictors of treatment response. Behaviour Research and Therapy 44, 10791090.CrossRefGoogle ScholarPubMed
DuPaul, GJ, Power, TJ, McGoey, KE, Ikeda, MJ and Anastopoulos, AD (1998) Reliability and validity of parent and teacher ratings of attention-deficit/hyperactivity disorder symptoms. Journal of Psychoeducational Assessment 16, 5568.CrossRefGoogle Scholar
Eapen, V, Snedden, C, Črnčec, R, Pick, A and Sachdev, P (2016) Tourette syndrome, co-morbidities and quality of life. Australian & New Zealand Journal of Psychiatry 50, 8293.CrossRefGoogle ScholarPubMed
Elstner, K, Selai, CE, Trimble, MR and Robertson, MM (2001) Quality of life (QoL) of patients with Gilles de la Tourette's syndrome. Acta Psychiatrica Scandinavica 103, 5259.10.1111/j.1600-0447.2001.00147.xCrossRefGoogle ScholarPubMed
Evans, J, Seri, S and Cavanna, AE (2016) The effects of Gilles de la Tourette syndrome and other chronic tic disorders on quality of life across the lifespan: a systematic review. European Child & Adolescent Psychiatry 25, 939948.CrossRefGoogle ScholarPubMed
Goodman, W, Price, L, Rasmussen, S, Mazure, C, Fleischmann, R, Hill, C, Heninger, G and Charney, D (1989) The Yale-Brown Obsessive Compulsive Scale: development, use and reliability. Archives of General Psychiatry 46, 10061011.CrossRefGoogle ScholarPubMed
Groth, C, Debes, NM, Rask, CU, Lange, T and Skov, L (2017) Course of Tourette syndrome and comorbidities in a large prospective clinical study. Journal of the American Academy of Child & Adolescent Psychiatry 56, 304312.CrossRefGoogle Scholar
Guy, W (1976) ECDEU Assessment Manual for Psychopharmacology. Rockville, MD: National Institute for Mental Health.Google Scholar
Haddad, A, Umoh, G, Bhatia, V and Robertson, M (2009) Adults with tourette's syndrome with and without attention deficit hyperactivity disorder. Acta Psychiatrica Scandinavica 120, 299307.CrossRefGoogle ScholarPubMed
Hewitt, PL and Norton, GR (1993) The beck anxiety inventory: a psychometric analysis. Psychological Assessment 5, 408412.CrossRefGoogle Scholar
Hirschtritt, ME, Lee, PC, Pauls, DL, Dion, Y, Grados, MA, Illmann, C, King, RA, Sandor, P, McMahon, WM and Lyon, GJ (2015) Lifetime prevalence, age of risk, and genetic relationships of comorbid psychiatric disorders in Tourette syndrome. JAMA Psychiatry 72, 325333.CrossRefGoogle ScholarPubMed
Jalenques, I, Galland, F, Malet, L, Morand, D, Legrand, G, Auclair, C, Hartmann, A, Derost, P and Durif, F (2012) Quality of life in adults with Gilles de la Tourette Syndrome. BMC Psychiatry 12, 109.CrossRefGoogle ScholarPubMed
Jeon, S, Walkup, JT, Woods, DW, Peterson, A, Piacentini, J, Wilhelm, S, Katsovich, L, McGuire, JF, Dziura, J and Scahill, L (2013) Detecting a clinically meaningful change in tic severity in Tourette syndrome: a comparison of three methods. Contemporary Clinical Trials 36, 414420.CrossRefGoogle ScholarPubMed
Knight, T, Steeves, T, Day, L, Lowerison, M, Jette, N and Pringsheim, T (2012) Prevalence of tic disorders: a systematic review and meta-analysis. Pediatric Neurology 47, 7790.CrossRefGoogle ScholarPubMed
Leckman, JF, Riddle, MA, Hardin, MT and Ort, SI (1989) The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. Journal of the American Academy of Child & Adolescent Psychiatry 28, 566573.CrossRefGoogle ScholarPubMed
Leon, A, Shear, MK, Portera, L and Klerman, G (1992) Assessing impairment in patients with panic disorder: the Sheehan Disability Scale. Social Psychiatry and Psychiatric Epidemiology 27, 7882.CrossRefGoogle ScholarPubMed
Lievaart, M, Franken, IH and Hovens, JE (2016) Anger assessment in clinical and nonclinical populations: further validation of the State–Trait Anger Expression Inventory-2. Journal of Clinical Psychology 72, 263278.CrossRefGoogle ScholarPubMed
McGuire, JF, Nyirabahizi, E, Kircanski, K, Piacentini, J, Peterson, AL, Woods, DW, Wilhelm, S, Walkup, JT and Scahill, L (2013) A cluster analysis of tic symptoms in children and adults with Tourette syndrome: clinical correlates and treatment outcome. Psychiatry Research 210, 11981204.CrossRefGoogle ScholarPubMed
McGuire, JF, Arnold, E, Park, JM, Nadeau, JM, Lewin, AB, Murphy, TK and Storch, EA (2014) Living with tics: reduced impairment and improved quality of life for youth with chronic tic disorders. Psychiatry Research 225, 571579.CrossRefGoogle ScholarPubMed
McGuire, JF, Piacentini, J, Storch, EA, Murphy, TK, Ricketts, EJ, Woods, DW, Walkup, JW, Peterson, AL, Wilhelm, S, Lewin, AB, McCracken, JT, Leckman, JF and Scahill, L (2018) A multicenter examination and strategic revisions of the Yale Global Tic Severity Scale. Neurology 90, e1711e1719.CrossRefGoogle ScholarPubMed
Miguel, EC, Coffey, BJ, Baer, L, Savage, CR, Rauch, SL and Jenike, MA (1995) Phenomenology of intentional repetitive behaviors in obsessive-compulsive disorder and Tourette's disorder. The Journal of clinical psychiatry 56, 246255.Google ScholarPubMed
Müller‐Vahl, K, Dodel, I, Müller, N, Münchau, A, Reese, JP, Balzer‐Geldsetzer, M, Dodel, R and Oertel, WH (2010) Health‐related quality of life in patients with Gilles de la Tourette's syndrome. Movement Disorders 25, 309314.CrossRefGoogle ScholarPubMed
Murphy, TK, Lewin, AB, Storch, EA and Stock, S (2013) Practice parameter for the assessment and treatment of children and adolescents with tic disorders. Journal of the American Academy of Child and Adolescent Psychiatry 52, 13411359.CrossRefGoogle ScholarPubMed
Peterson, AL, McGuire, JF, Wilhelm, S, Piacentini, J, Woods, DW, Walkup, JT, Hatch, JP, Villarreal, R and Scahill, L (2016) An empirical examination of symptom substitution associated with behavior therapy for Tourette's Disorder. Behavior Therapy 47, 2941.CrossRefGoogle ScholarPubMed
Piacentini, J, Woods, DW, Scahill, L, Wilhelm, S, Peterson, AL, Chang, S, Ginsburg, GS, Deckersbach, T, Dziura, J, Levi-Pearl, S and Walkup, JT (2010) Behavior therapy for children with Tourette disorder: a randomized controlled trial. Journal of the American Medical Association 303, 19291937.CrossRefGoogle ScholarPubMed
Scahill, L, Riddle, MA, McSwiggin-Hardin, M, Ort, SI, King, RA, Goodman, WK, Cicchetti, D and Leckman, JF (1997) Children's Yale-Brown obsessive compulsive scale: reliability and validity. Journal of the American Academy of Child & Adolescent Psychiatry 36, 844852.CrossRefGoogle ScholarPubMed
Scahill, L, Chappell, P, Kim, Y, Schultz, R, Katsovich, L, Shepherd, E, Arnsten, A, Cohen, D and Leckman, J (2001) Guanfacine in the treatment of children with tic disorders and ADHD: a placebo-controlled study. American Journal of Psychiatry 158, 10671074.CrossRefGoogle ScholarPubMed
Scharf, JM, Miller, LL, Gauvin, CA, Alabiso, J, Mathews, CA and Ben-Shlomo, Y (2015) Population prevalence of Tourette syndrome: a systematic review and meta-analysis. Movement Disorders 30, 221228.CrossRefGoogle ScholarPubMed
Skinner, H, Steinhauer, PD and Santa-Barbara, J (1995). Family Assessment Measure III (FAM III). New York: Multi-Health Systems Inc.Google Scholar
Spielberger, CD (1999) STAXI-2: State-Trait Anger Expression Inventory-2: Professional Manual. Odessa, FL: Psychological Assessment Resources.Google Scholar
Steer, RA and Beck, AT (1997) Beck Anxiety Inventory.Google Scholar
Steer, RA, Kumar, G, Ranieri, WF and Beck, AT (1998) Use of the beck depression inventory-II with adolescent psychiatric outpatients. Journal of Psychopathology and Behavioral Assessment 20, 127137.CrossRefGoogle Scholar
Storch, E, Murphy, T, Geffken, G, Sajid, M, Allen, P, Roberti, J and Goodman, W (2005) Reliability and validity of the Yale Global Tic Severity Scale. Psychological Assessment 17, 486491.CrossRefGoogle ScholarPubMed
Storch, EA, De Nadai, AS, Lewin, AB, McGuire, JF, Jones, AM, Mutch, PJ, Shytle, RD and Murphy, TK (2011) Defining treatment response in pediatric tic disorders: a signal detection analysis of the Yale Global Tic Severity Scale. Journal of Child and Adolescent Psychopharmacology 21, 621627.CrossRefGoogle ScholarPubMed
Storch, EA, Morgan, JE, Caporino, NE, Brauer, L, Lewin, AB, Piacentini, J and Murphy, TK (2012) Psychosocial treatment to improve resilience and reduce impairment in youth with tics: an intervention case series of eight youth. Journal of Cognitive Psychotherapy 26, 5770.CrossRefGoogle Scholar
Sukhodolsky, DG, Woods, DW, Piacentini, J, Wilhelm, S, Peterson, AL, Katsovich, L, Dziura, J, Walkup, JT and Scahill, L (2017) Moderators and predictors of response to behavior therapy for tics in Tourette syndrome. Neurology 88, 10291036.CrossRefGoogle ScholarPubMed
Thibert, AL, Day, HI and Sandor, P (1995) Self-concept and self-consciousness in adults with Tourette syndrome. The Canadian Journal of Psychiatry 40, 3539.CrossRefGoogle ScholarPubMed
Weissman, MM, Prusoff, BA, Thompson, WD, Harding, PS and Myers, JK (1978) Social adjustment by self-report in a community sample and in psychiatric outpatients. Journal of Nervous and Mental Disease 166, 317326.CrossRefGoogle Scholar
Wilens, TE, Biederman, J, Prince, J and Spencer, TJ (1996) Six-week, double-blind, placebo-controlled study of desipramine for adult attention deficit hyperactivity disorder. The American Journal of Psychiatry 153, 11471153.Google ScholarPubMed
Wilhelm, S, Peterson, AL, Piacentini, J, Woods, DW, Deckersbach, T, Sukhodolsky, DG, Chang, S, Liu, H, Dziura, J, Walkup, JT and Scahill, L (2012) Randomized trial of behavior therapy for adults with Tourette syndrome. Archives of General Psychiatry 69, 795803.CrossRefGoogle ScholarPubMed
Woods, DW, Piacentini, J, Chang, SW, Deckersbach, T, Ginsburg, GS, Peterson, AL, Scahill, LD, Walkup, JT and Wilhelm, S (2008) Managing Tourette Syndrome: A Behavioral Intervention for Children and Adolescents. New York: Oxford University Press.Google Scholar
Woods, DW, Piacentini, JC, Scahill, L, Peterson, AL, Wilhelm, S, Chang, S, Deckersbach, T, McGuire, J, Specht, M, Conelea, CA, Rozenman, M, Dzuria, J, Liu, H, Levi-Pearl, S and Walkup, JT (2011) Behavior therapy for tics in children: acute and long-term effects on psychiatric and psychosocial functioning. Journal of Child Neurology 26, 858865.CrossRefGoogle ScholarPubMed
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