Skip to main content
Log in

Intensive Behavior Therapy for Tics: Implications for Clinical Practice and Overcoming Barriers to Treatment

  • Original Article
  • Published:
Journal of Developmental and Physical Disabilities Aims and scope Submit manuscript

Abstract

This case study illustrates the treatment of an individual diagnosed with Tourette syndrome (TS) treated with a behavior therapy (BT) protocol adapted from Woods and colleagues (2008). The client was a 25 year old, male who traveled from his country of origin for 2 weeks of intensive treatment for complex tics. The tics included multiple body movements and vocalizations that were both distressing and impairing. BT for tics is typically implemented weekly over the course of 10 weeks, and the efficacy of this regimen with adults has been demonstrated in several clinical trials (e.g., Wilhelm et al. American Journal of Psychiatry 160:1175–1177, 2003). In this report, we outline the case of a treatment-seeking adult with TS for which practical considerations necessitated a consolidated, intensive BT protocol involving massed rather than traditional spacing of sessions. To our knowledge, this is the first report of intensive BT for an adult with TS. Specific modifications to the protocol, as well as the specific steps for intensive BT, are discussed within the context of this client’s unique circumstances. Clinical considerations for intensive treatment for TS are also discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Abramowitz, J. S., Foa, E. B., & Franklin, M. E. (2003). Exposure and response prevention for obsessive-compulsive disorder: effects of intensive versus twice-weekly sessions. Journal of Consulting and Clinical Psychology, 71, 394–398.

    Article  PubMed  Google Scholar 

  • Azrin, N. H., & Nunn, R. G. (1973). Habit reversal: a method of eliminating nervous habits and tics. Behaviour Research and Therapy, 11, 619–628.

    Article  PubMed  Google Scholar 

  • Azrin, N. H., & Peterson, A. L. (1990). Treatment of Tourette syndrome by habit reversal: a waiting-list control group comparison. Behavior Therapy, 21, 305–318.

    Article  Google Scholar 

  • Cook, C. R., & Blacher, J. (2007). Evidence-based psychosocial treatments for tic disorders. Clinical Psychology: Science and Practice, 14, 252–267.

    Article  Google Scholar 

  • Deacon, B., & Abramowitz, J. (2006). A pilot study of two-day cognitive-behavioral therapy for panic disorder. Behaviour Research and Therapy, 44, 807–817.

    Article  PubMed  Google Scholar 

  • Deckersbach, T., Rauch, S., Buhlmann, U., & 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, 1079–1090.

    Article  PubMed  Google Scholar 

  • Foa, E. B., Jameson, J. S., Turner, R. M., & Paynes, L. L. (1980). Massed vs. spaced exposure sessions in the treatment of agoraphobia. Behaviour Research and Therapy, 18, 333–338.

    Article  PubMed  Google Scholar 

  • Himle, M. B., Woods, D. W., Piacentini, J., & Walkup, J. (2006). A brief review of habit reversal training for Tourette syndrome. Journal of Child Neurology, 21, 719–725.

    Article  PubMed  Google Scholar 

  • Himle, M. B., Olufs, E., Himle, J. A., Tucker, B. T. P., & Woods, D. W. (2010). Behavior therapy for tics via videoconference delivery: an initial pilot test in children. Cognitive and Behavioral Practice, 17, 329–337.

    Article  Google Scholar 

  • Jankovic, J. (2001). Tourette’s syndrome. The New England Journal of Medicine, 345, 1184–1192.

    Article  PubMed  Google Scholar 

  • Leckman, J. F., Walker, D. E., & Cohen, D. J. (1993). Premonitory urges in Tourette’s syndrome. The American Journal of Psychiatry, 150, 98–102.

    PubMed  Google Scholar 

  • Marcks, B. A., Woods, D. W., Teng, E. J., & Twohig, M. P. (2004). What do those who know, know? Investigating providers’ knowledge about Tourette’s syndrome and its treatment. Cognitive and Behavioral Practice, 11, 298–305.

    Article  Google Scholar 

  • Ost, L. G. (1989). A maintenance program for behavioral treatment of anxiety disorders. Behaviour Research and Therapy, 27, 123–130.

    Article  PubMed  Google Scholar 

  • O’Connor, K. P., Brault, M., Robillard, S., Loiselle, J., Borgeat, F., & Stip, E. (2001). Evaluation of a cognitive-behavioural program for the management of chronic tic and habit disorders. Behaviour Research and Therapy, 39, 667–681.

    Article  PubMed  Google Scholar 

  • Piacentini, J., & Chang, S. (2001). Behavioral treatments for Tourette syndrome and tic disorders: state of the art. Advances in Neurology, 85, 319–331.

    PubMed  Google Scholar 

  • Piacentini, J. C., Woods, D. W., Scahill, L. D., Wilhelm, S., Peterson, A., Chang, S., et al. (2010). Behavior therapy for children with Tourette syndrome: a randomized controlled trial. Journal of the American Medical Association, 303, 1929–1937.

    Article  PubMed  Google Scholar 

  • Rees, C. S., McEvoy, P., & Nathan, P. R. (2005). Relationship between homework completion and outcome in cognitive behaviour therapy. Cognitive Behaviour Therapy, 34, 242–247.

    Article  PubMed  Google Scholar 

  • Richardson, L. K., Frueh, B. C., Grubaugh, A. L., Egede, L., & Elhai, J. D. (2009). Current directions in videoconferencing tele-mental health research. Clinical Psychology: Science and Practice, 16, 323–338.

    Article  Google Scholar 

  • Rowe, M. K., & Craske, M. G. (1998). Effects of an expanding-spaced vs. massed exposure schedule on fear reduction and return of fear. Behaviour Research and Therapy, 36, 701–717.

    Article  PubMed  Google Scholar 

  • Schmidt, R. A., & Bjork, R. A. (1992). New conceptualizations: common principles in three paradigms suggest new concepts for training. Psychological Science, 3, 201–217.

    Article  Google Scholar 

  • Storch, E. A., Geffken, G. R., Merlo, L. J., Mann, G., Duke, D., Munson, M., et al. (2007). Family-based cognitive-behavioral therapy for pediatric obsessive-compulsive disorder: comparison of intensive and weekly approaches. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 469–478.

    Article  PubMed  Google Scholar 

  • Verdellen, C. W. J., Keijsers, G. P. J., Cath, D. C., & Hoogduin, C. A. L. (2004). Exposure and response prevention versus habit reversal in Tourette’s syndrome: a controlled study. Behaviour Research and Therapy, 42, 501–511.

    Article  PubMed  Google Scholar 

  • Wilhelm, S., Deckersbach, T., Coffey, B., Bohne, A., Peterson, A. L., & Baer, L. (2003). Habit reversal versus supportive psychotherapy for Tourette’s disorder: a randomized controlled trial. The American Journal of Psychiatry, 160, 1175–1177.

    Article  PubMed  Google Scholar 

  • Woods, D. W., Piacentini, J. C., Chang, S. W., Deckersbach, T., Ginsburg, G. S., Peterson, A. K., et al. (2008). Managing Tourette syndrome: A behavioral intervention for children and adults. New York: Oxford University Press.

    Google Scholar 

Download references

Acknowledgement

The authors would like to thank Atara Hiller for her helpful feedback on earlier drafts of this manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Meir Flancbaum.

Additional information

Meir Flancbaum, Tourette Syndrome Program, Graduate School of Applied and Professional Psychology, Rutgers University; Lori Rockmore, Tourette Syndrome Program, Graduate School of Applied and Professional Psychology, Rutgers University; Martin E. Franklin, Child and Adolescent OCD, Tic, Trichotillomania, and Anxiety Group, University of Pennsylvania School of Medicine.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Flancbaum, M., Rockmore, L. & Franklin, M.E. Intensive Behavior Therapy for Tics: Implications for Clinical Practice and Overcoming Barriers to Treatment. J Dev Phys Disabil 23, 61–69 (2011). https://doi.org/10.1007/s10882-010-9222-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10882-010-9222-0

Keywords

Navigation