Although we know that a number of drugs are effective for Tourette Syndrome (TS) treatment, our scientific knowledge of successful psychosocial treatments for TS is limited. Although only very little research has been done in this area, the behavioral treatment known as habit reversal training has become the non-pharmacological treatment of choice. Clearly, this approach needs further investigation. The aim of this project is to test the clinical effectiveness of habit reversal training (HRT) in comparison to self-monitoring and supportive psychotherapy in adult individuals with TS. Since clinical observations suggest that TS symptoms fluctuate, we plan to examine patients for a one-month period prior to the initiation of treatment. Then subjects will be randomly assigned to either HRT or selfmonitoring and supportive psychotherapy. Subjects in the habit reversal group will be asked to record their symptoms in a diary, learn how to increase their awareness of tics and relaxation training, and will learn to engage in certain behaviors (i.e., competing responses) when the tics are about to occur. Those in the self-monitoring and supportive psychotherapy group will also be required to record their symptoms. Their clinicians will offer support and counseling to help them deal with conflicts and problems related to their symptoms. Subjects in both groups will be treated for 14 sessions (over a period of 20 weeks). We plan to evaluate the efficacy of the treatments for simple and complex motor and vocal tics, and for compulsions which clinically resemble, and frequently occur in TS. Major assessments will be conducted at baseline (two and four weeks after the initial intake evaluation), and every four weeks during the 20-week treatment phase. After the termination of treatment, we will follow subjects for six months to re-evaluate their symptoms. We believe that data from this research will advance our knowledge about the efficacy of treating TS using behavioral methods for symptom control. Sabine Wilhelm, Ph.D. Massachusetts General Hospital/ Harvard Medical School Charlestown, MA AWARD: $24,405 SHELDON NOVICK, M.D. MEMORIAL AWARD Tourette Association of America Inc. – Research Grant Award 1997