An Empirical Examination of Symptom Substitution Associated With Behavior Therapy for Tourette's Disorder

Alan L. Peterson*, Joseph F. McGuire, Sabine Wilhelm, John Piacentini, Douglas W. Woods, John T. Walkup, John P. Hatch, Robert Villarreal, Lawrence Scahill

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Over the past six decades, behavior therapy has been a major contributor to the development of evidence-based psychotherapy treatments. However, a long-standing concern with behavior therapy among many nonbehavioral clinicians has been the potential risk for symptom substitution. Few studies have been conducted to evaluate symptom substitution in response to behavioral treatments, largely due to measurement and definitional challenges associated with treated psychiatric symptoms. Given the overt motor and vocal tics associated with Tourette's disorder, it presents an excellent opportunity to empirically evaluate the potential risk for symptom substitution associated with behavior therapy. The present study examined the possible presence of symptom substitution using four methods: (a) the onset of new tic symptoms, (b) the occurrence of adverse events, (c) change in tic medications, and (d) worsening of co-occurring psychiatric symptoms. Two hundred twenty-eight participants with Tourette's disorder or persistent motor or vocal tic disorders were randomly assigned to receive behavioral therapy or supportive therapy for tics. Both therapies consisted of eight sessions over 10 weeks. Results indicated that participants treated with behavior therapy were not more likely to have an onset of new tic symptoms, experience adverse events, increase tic medications, or have an exacerbation in co-occurring psychiatric symptoms relative to participants treated with supportive therapy. Further analysis suggested that the emergence of new tics was attributed with the normal waxing and waning nature of Tourette's disorder. Findings provide empirical support to counter the long-standing concern of symptom substitution in response to behavior therapy for individuals with Tourette's disorder.

Original languageEnglish (US)
Pages (from-to)29-41
Number of pages13
JournalBehavior Therapy
Volume47
Issue number1
DOIs
StatePublished - Jan 1 2016

Fingerprint

Tics
Tourette Syndrome
Behavior Therapy
Tic Disorders
Psychiatry
Therapeutics
Psychotherapy

Keywords

  • Behavior therapy
  • Chronic tic disorder
  • Comprehensive behavioral intervention for tics
  • Symptom substitution
  • Tourette's disorder

ASJC Scopus subject areas

  • Clinical Psychology

Cite this

Peterson, Alan L. ; McGuire, Joseph F. ; Wilhelm, Sabine ; Piacentini, John ; Woods, Douglas W. ; Walkup, John T. ; Hatch, John P. ; Villarreal, Robert ; Scahill, Lawrence. / An Empirical Examination of Symptom Substitution Associated With Behavior Therapy for Tourette's Disorder. In: Behavior Therapy. 2016 ; Vol. 47, No. 1. pp. 29-41.
@article{39139c922e3446238aa420acd49a1c4b,
title = "An Empirical Examination of Symptom Substitution Associated With Behavior Therapy for Tourette's Disorder",
abstract = "Over the past six decades, behavior therapy has been a major contributor to the development of evidence-based psychotherapy treatments. However, a long-standing concern with behavior therapy among many nonbehavioral clinicians has been the potential risk for symptom substitution. Few studies have been conducted to evaluate symptom substitution in response to behavioral treatments, largely due to measurement and definitional challenges associated with treated psychiatric symptoms. Given the overt motor and vocal tics associated with Tourette's disorder, it presents an excellent opportunity to empirically evaluate the potential risk for symptom substitution associated with behavior therapy. The present study examined the possible presence of symptom substitution using four methods: (a) the onset of new tic symptoms, (b) the occurrence of adverse events, (c) change in tic medications, and (d) worsening of co-occurring psychiatric symptoms. Two hundred twenty-eight participants with Tourette's disorder or persistent motor or vocal tic disorders were randomly assigned to receive behavioral therapy or supportive therapy for tics. Both therapies consisted of eight sessions over 10 weeks. Results indicated that participants treated with behavior therapy were not more likely to have an onset of new tic symptoms, experience adverse events, increase tic medications, or have an exacerbation in co-occurring psychiatric symptoms relative to participants treated with supportive therapy. Further analysis suggested that the emergence of new tics was attributed with the normal waxing and waning nature of Tourette's disorder. Findings provide empirical support to counter the long-standing concern of symptom substitution in response to behavior therapy for individuals with Tourette's disorder.",
keywords = "Behavior therapy, Chronic tic disorder, Comprehensive behavioral intervention for tics, Symptom substitution, Tourette's disorder",
author = "Peterson, {Alan L.} and McGuire, {Joseph F.} and Sabine Wilhelm and John Piacentini and Woods, {Douglas W.} and Walkup, {John T.} and Hatch, {John P.} and Robert Villarreal and Lawrence Scahill",
year = "2016",
month = "1",
day = "1",
doi = "10.1016/j.beth.2015.09.001",
language = "English (US)",
volume = "47",
pages = "29--41",
journal = "Behavior Therapy",
issn = "0005-7894",
publisher = "Elsevier Inc.",
number = "1",

}

Peterson, AL, McGuire, JF, Wilhelm, S, Piacentini, J, Woods, DW, Walkup, JT, Hatch, JP, Villarreal, R & Scahill, L 2016, 'An Empirical Examination of Symptom Substitution Associated With Behavior Therapy for Tourette's Disorder', Behavior Therapy, vol. 47, no. 1, pp. 29-41. https://doi.org/10.1016/j.beth.2015.09.001

An Empirical Examination of Symptom Substitution Associated With Behavior Therapy for Tourette's Disorder. / Peterson, Alan L.; McGuire, Joseph F.; Wilhelm, Sabine; Piacentini, John; Woods, Douglas W.; Walkup, John T.; Hatch, John P.; Villarreal, Robert; Scahill, Lawrence.

In: Behavior Therapy, Vol. 47, No. 1, 01.01.2016, p. 29-41.

Research output: Contribution to journalArticle

TY - JOUR

T1 - An Empirical Examination of Symptom Substitution Associated With Behavior Therapy for Tourette's Disorder

AU - Peterson, Alan L.

AU - McGuire, Joseph F.

AU - Wilhelm, Sabine

AU - Piacentini, John

AU - Woods, Douglas W.

AU - Walkup, John T.

AU - Hatch, John P.

AU - Villarreal, Robert

AU - Scahill, Lawrence

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Over the past six decades, behavior therapy has been a major contributor to the development of evidence-based psychotherapy treatments. However, a long-standing concern with behavior therapy among many nonbehavioral clinicians has been the potential risk for symptom substitution. Few studies have been conducted to evaluate symptom substitution in response to behavioral treatments, largely due to measurement and definitional challenges associated with treated psychiatric symptoms. Given the overt motor and vocal tics associated with Tourette's disorder, it presents an excellent opportunity to empirically evaluate the potential risk for symptom substitution associated with behavior therapy. The present study examined the possible presence of symptom substitution using four methods: (a) the onset of new tic symptoms, (b) the occurrence of adverse events, (c) change in tic medications, and (d) worsening of co-occurring psychiatric symptoms. Two hundred twenty-eight participants with Tourette's disorder or persistent motor or vocal tic disorders were randomly assigned to receive behavioral therapy or supportive therapy for tics. Both therapies consisted of eight sessions over 10 weeks. Results indicated that participants treated with behavior therapy were not more likely to have an onset of new tic symptoms, experience adverse events, increase tic medications, or have an exacerbation in co-occurring psychiatric symptoms relative to participants treated with supportive therapy. Further analysis suggested that the emergence of new tics was attributed with the normal waxing and waning nature of Tourette's disorder. Findings provide empirical support to counter the long-standing concern of symptom substitution in response to behavior therapy for individuals with Tourette's disorder.

AB - Over the past six decades, behavior therapy has been a major contributor to the development of evidence-based psychotherapy treatments. However, a long-standing concern with behavior therapy among many nonbehavioral clinicians has been the potential risk for symptom substitution. Few studies have been conducted to evaluate symptom substitution in response to behavioral treatments, largely due to measurement and definitional challenges associated with treated psychiatric symptoms. Given the overt motor and vocal tics associated with Tourette's disorder, it presents an excellent opportunity to empirically evaluate the potential risk for symptom substitution associated with behavior therapy. The present study examined the possible presence of symptom substitution using four methods: (a) the onset of new tic symptoms, (b) the occurrence of adverse events, (c) change in tic medications, and (d) worsening of co-occurring psychiatric symptoms. Two hundred twenty-eight participants with Tourette's disorder or persistent motor or vocal tic disorders were randomly assigned to receive behavioral therapy or supportive therapy for tics. Both therapies consisted of eight sessions over 10 weeks. Results indicated that participants treated with behavior therapy were not more likely to have an onset of new tic symptoms, experience adverse events, increase tic medications, or have an exacerbation in co-occurring psychiatric symptoms relative to participants treated with supportive therapy. Further analysis suggested that the emergence of new tics was attributed with the normal waxing and waning nature of Tourette's disorder. Findings provide empirical support to counter the long-standing concern of symptom substitution in response to behavior therapy for individuals with Tourette's disorder.

KW - Behavior therapy

KW - Chronic tic disorder

KW - Comprehensive behavioral intervention for tics

KW - Symptom substitution

KW - Tourette's disorder

UR - http://www.scopus.com/inward/record.url?scp=84944937202&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84944937202&partnerID=8YFLogxK

U2 - 10.1016/j.beth.2015.09.001

DO - 10.1016/j.beth.2015.09.001

M3 - Article

VL - 47

SP - 29

EP - 41

JO - Behavior Therapy

JF - Behavior Therapy

SN - 0005-7894

IS - 1

ER -