Affiliations: The Michael Trimble Neuropsychiatry Research Group,
Department of Neuropsychiatry, University of Birmingham and BSMHFT, Birmingham,
UK | College of Medical and Dental Sciences, University of
Birmingham, Birmingham, UK | Sobell Department of Motor Neuroscience and Movement
Disorders, Institute of Neurology, UCL, London, UK
Note: [] Corresponding author: Prof. Andrea Eugenio Cavanna, MD PhD,
Department of Neuropsychiatry, University of Birmingham and BSMHFT, The
Barberry National Centre for Mental Health, Birmingham B152FG, UK. E-mail:
A.Cavanna@ion.ucl.ac.uk
Abstract: Tourette syndrome (TS) is a disorder characterised by multiple motor
and vocal tics and is frequently associated with behavioural problems. Tics are
known to be affected by internal factors such as inner tension and external
factors such as the surrounding environment. A number of behavioural treatments
have been suggested to treat the symptoms of TS, in addition to pharmacotherapy
and surgery for the most severe cases. This review compiled all the studies
investigating behavioural therapies for TS, briefly describing each technique
and assessing the evidence in order to determine which of these appear to be
effective. Different behavioural therapies that were used included habit
reversal training (HRT), massed negative practice, supportive psychotherapy,
exposure with response prevention, self-monitoring, cognitive-behavioural
therapy, relaxation therapy, assertiveness training, contingency management, a
tension-reduction technique and biofeedback training. Overall, HRT is the
best-studied and most widely-used technique and there is sufficient
experimental evidence to suggest that it is an effective treatment. Most of the
other treatments, however, require further investigation to evaluate their
efficacy. Specifically, evidence suggests that exposure with response
prevention and self-monitoring are effective, and more research is needed to
determine the therapeutic value of the other treatments. As most of the studies
investigating behavioural treatments for TS are small-sample or single-case
studies, larger randomised controlled trials are advocated.
