TY - JOUR
T1 - Effect of behavior therapy for Tourette's disorder on psychiatric symptoms and functioning in adults
AU - McGuire, Joseph F.
AU - Ricketts, Emily J.
AU - Scahill, Lawrence
AU - Wilhelm, Sabine
AU - Woods, Douglas W.
AU - Piacentini, John
AU - Walkup, John T.
AU - Peterson, Alan L.
N1 - Funding Information:
Financial support. This work was supported in part by grants and/or contracts to Dr McGuire [Tourette Association of America (TAA), American Academy of Neurology (AAN), and American Brain Foundation (ABF)], Dr Ricketts (K23MH113884), Dr Scahill (R01MH069874), Dr Wilhelm (R01MH069877), and Dr Peterson (RO1MH069875). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIMH, NIH, or other grant organization. The authors report no conflicts of interest associated with this work. This work was supported in part by grants from the National Institute of Mental Health [NIMH: R01MH069877 (to Dr Wilhelm), R01MH069874 (to Dr Scahill), R01MH69875 (to Dr Peterson), K23MH113884 (to Dr Ricketts)]; and a Clinical Research Training Fellowship from the American Academy of Neurology and Tourette Association of America (to Dr McGuire). Dr McGuire reports receiving research support from the TAA, AAN, and ABF. He has served as a consultant to Bracket, Syneos Health, and Luminopia, and received royalties from Elsevier. Dr Ricketts has received research support from the NIH and TAA. Dr Scahill has served as a consultant for Roche, Neuren, Bracket, Coronado, and Supernus as well as participates in the Speakers Bureau of the TAA. Dr Wilhelm has received research support in the form of free medication and matching placebo for NIMH–funded studies from Forest Laboratories, presenters for the Massachusetts General Hospital Psychiatry Academy in educational programs supported through independent medical education grants from pharmaceutical companies, and salary support from Novartis. She receives royalties from Elsevier Publications, Springer Publications, Guilford Publications, New Harbinger Publications, and Oxford University Press, and speaking honoraria from the IOCDF and the TAA. She received payment from the Association for Behavioral and Cognitive Therapies for her role as Associate Editor for Behavior Therapy as well as from John Wiley & Sons, Inc., for her role as Associate Editor for Depression & Anxiety. Dr Woods has received speaker’s honoraria from the TAA and royalties from Guilford Press and Oxford University Press. Dr Piacentini has received grant or research support from the NIMH, Pfizer Pharmaceuticals through the Duke University Clinical Research Institute CAPTN Network, Psyadon Pharmaceuticals, and the TAA. He has received financial support from the Petit Family Foundation and the Tourette Syndrome Association Center of Excellence Gift Fund. He has received royalties from Guilford Press and Oxford University Press. He has served on the speakers’ bureau of the TAA, the International Obsessive Compulsive Disorder Foundation (IOCDF), and the Trichotillomania Learning Center (TLC). Dr Walkup has received research support from the Hartwell Foundation and the TAA. He is an unpaid advisor to the Anxiety and Depression Association of America (ADAA), the TLC, and the American Foundation for Suicide Prevention. He has received royalties for books from Guilford Press and Oxford University Press and educational materials from Wolters Kluwer. He has served as a paid speaker for the Tourette Syndrome–Centers for Disease Control and Prevention outreach educational programs, the American Academy of Child and Adolescent Psychiatry, and the American Psychiatric Association. Dr Peterson has received research support and speaker’s honoraria from the TAA and receives royalties from Oxford University Press.
Publisher Copyright:
Copyright © Cambridge University Press 2019.
PY - 2020/9/1
Y1 - 2020/9/1
N2 - 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 (= 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 (= 0.05, p = 0.02) and improved functioning in a parental role (= 0.37, p = 0.02). Participants who responded positively to eight sessions of behavior therapy had an improvement in tic severity (= 0.75, p < 0.001), inattention (= 0.48, p < 0.02), and functioning (= 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.
AB - 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 (= 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 (= 0.05, p = 0.02) and improved functioning in a parental role (= 0.37, p = 0.02). Participants who responded positively to eight sessions of behavior therapy had an improvement in tic severity (= 0.75, p < 0.001), inattention (= 0.48, p < 0.02), and functioning (= 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.
KW - Behavior therapy
KW - comorbidity
KW - comprehensive behavioral intervention for tics
KW - disability
KW - functioning.
UR - http://www.scopus.com/inward/record.url?scp=85071835194&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85071835194&partnerID=8YFLogxK
U2 - 10.1017/S0033291719002150
DO - 10.1017/S0033291719002150
M3 - Article
C2 - 31451122
AN - SCOPUS:85071835194
SN - 0033-2917
VL - 50
SP - 2046
EP - 2056
JO - Psychological Medicine
JF - Psychological Medicine
IS - 12
ER -