Habit reveral for Tourette’s Disorder-Multimodal Assessment of Change

Grant Type
Grant Year
Institution Location
Institution Organization Name
Massachusetts General Hospital
Investigators Name
Deckersbach, Thilo, PhD

Habit Reversal is a behavioral treatment for Tourette Syndrome (TS). Patients learn to recognize the early sensations that precede tics, use relaxation techniques, and employ competing movement to inhibit the occurrence of tics. Consistent with earlier findings, preliminary results from a TSA-sponsored study conducted at the Massachusetts General Hospital indicate that habit reversal can reduce or inhibit tics. However, this earlier research leaves several important questions unanswered. First, habit reversal may affect only tics addressed in treatment providing patients with a “circumscribed” skill to inhibit specific tic responses. On the other hand, inhibitory skills may help with tics not addressed in treatment, and may even influence the pathophysiological mechanisms underlying impairments in response inhibition in TS. In addition, current investigations may have underestimated beneficial effects of supportive psychotherapy by including relatively global measures of psychosocial functioning. The present project proposes a multimodal assessment of the efficacy of habit reversal compared to supportive psychotherapy. This includes (1) a comprehensive assessment of generalization effects of habit reversal over the course of treatment and at follow-up, (2) a comprehensive cognitive neuroscience investigation to determine whether response inhibition abilities in patients with TS change differently with habit reversal in comparison with supportive psychotherapy and, (3) a comprehensive assessment of psychosocial functioning before, during, and after treatment in both patient groups. Forty adult patients with DSM-IV Tourette Syndrome will be recruited from the Obsessive-Compulsive Disorder/Tourette Syndrome Clinic at the Massachusetts General Hospital, the TSA, and via advertisement in local newspapers over the course of two years. After a one-month baseline evaluation period, patients will be randomly assigned to one of two groups: individual habit reversal or individual supportive psychotherapy. The patients in both groups will be treated for 14 sessions (over a period of 20 weeks). Assessments of tic severity (e.g. Yale-Global Tic Severity Scale; Leckman et al., 1989), associated psychopathology (e.g. OCD, major depression) and psychosocial functioning will be conducted twice at baseline (every other week), and every four weeks during the 20-week treatment as well as at 6 month-follow-up. Response inhibition pre and post treatment will be assessed using computerized tasks. Thilo Deckersbach, Ph.D., OCD Clinic, Massachusetts General Hospital/Harvard Medical School, Charlestown, MA Award $25,000 IN MEMORY OF JOHN MALINO Tourette Association of America Inc. – Research Grant Award 2000-2001