Randomized trial of behavior therapy for adults with tourette syndrome

Sabine Wilhelm*, Alan L. Peterson, John Piacentini, Douglas W. Woods, Thilo Deckersbach, Denis G. Sukhodolsky, Susanna Chang, Haibei Liu, James Dziura, John T. Walkup, Lawrence Scahill

*Corresponding author for this work

Research output: Contribution to journalArticle

125 Citations (Scopus)

Abstract

Context: Tics in Tourette syndrome begin in childhood, peak in early adolescence, and often decrease by early adulthood. However, some adult patients continue to have impairing tics. Medications for tics are often effective but can cause adverse effects. Behavior therapy may offer an alternative but has not been examined in a large-scale controlled trial in adults. Objective: To test the efficacy of a comprehensive behavioral intervention for tics in adults with Tourette syndrome of at least moderate severity. Design: Arandomized controlled trial with posttreatment evaluations at 3 and 6 months for positive responders. Setting: Three outpatient research clinics. Patients: Patients (N=122; 78 males; age range, 16-69 years) with Tourette syndrome or chronic tic disorder were recruited between December 27, 2005, and May 21, 2009. Interventions: Patients received 8 sessions of comprehensive behavioral intervention for tics or 8 sessions of supportive treatment for 10 weeks. Patients with a positive response were given 3 monthly booster sessions. Main Outcome Measures: Total tic score on the Yale Global Tic Severity Scale and the Clinical Global Impression-Improvement scale rated by a clinician masked to treatment assignment. Results: Behavior therapy was associated with a significantly greater mean (SD) decrease on the Yale Global Tic Severity Scale (24.0[6.47] to 17.8[7.32]) from baseline to end point compared with the control treatment (21.8[6.59] to 19.3[7.40]) (P < .001; effect size=0.57). Twenty-four of 63 patients (38.1%) were rated as much improved or very much improved on the Clinical Global Impression-Improvement scale compared with 4 of 63 (6.4%) in the control group (P < .001). Attrition was 13.9%, with no difference across groups. Patients receiving behavior therapy who were available for assessment at 6 months after treatment showed continued benefit. Conclusion: Comprehensive behavior therapy is a safe and effective intervention for adults with Tourette syndrome. Trial Registration: clinicaltrials.gov Identifier: NCT00231985

Original languageEnglish (US)
Pages (from-to)795-803
Number of pages9
JournalArchives of General Psychiatry
Volume69
Issue number8
DOIs
StatePublished - Aug 1 2012

Fingerprint

Tics
Tourette Syndrome
Behavior Therapy
Tic Disorders
Therapy
Syndrome
Therapeutics
Ambulatory Care Facilities
Outcome Assessment (Health Care)
Control Groups

ASJC Scopus subject areas

  • Arts and Humanities (miscellaneous)
  • Psychiatry and Mental health

Cite this

Wilhelm, S., Peterson, A. L., Piacentini, J., Woods, D. W., Deckersbach, T., Sukhodolsky, D. G., ... Scahill, L. (2012). Randomized trial of behavior therapy for adults with tourette syndrome. Archives of General Psychiatry, 69(8), 795-803. https://doi.org/10.1001/archgenpsychiatry.2011.1528
Wilhelm, Sabine ; Peterson, Alan L. ; Piacentini, John ; Woods, Douglas W. ; Deckersbach, Thilo ; Sukhodolsky, Denis G. ; Chang, Susanna ; Liu, Haibei ; Dziura, James ; Walkup, John T. ; Scahill, Lawrence. / Randomized trial of behavior therapy for adults with tourette syndrome. In: Archives of General Psychiatry. 2012 ; Vol. 69, No. 8. pp. 795-803.
@article{f252ba366c0b4e0a931e6ae8500859e3,
title = "Randomized trial of behavior therapy for adults with tourette syndrome",
abstract = "Context: Tics in Tourette syndrome begin in childhood, peak in early adolescence, and often decrease by early adulthood. However, some adult patients continue to have impairing tics. Medications for tics are often effective but can cause adverse effects. Behavior therapy may offer an alternative but has not been examined in a large-scale controlled trial in adults. Objective: To test the efficacy of a comprehensive behavioral intervention for tics in adults with Tourette syndrome of at least moderate severity. Design: Arandomized controlled trial with posttreatment evaluations at 3 and 6 months for positive responders. Setting: Three outpatient research clinics. Patients: Patients (N=122; 78 males; age range, 16-69 years) with Tourette syndrome or chronic tic disorder were recruited between December 27, 2005, and May 21, 2009. Interventions: Patients received 8 sessions of comprehensive behavioral intervention for tics or 8 sessions of supportive treatment for 10 weeks. Patients with a positive response were given 3 monthly booster sessions. Main Outcome Measures: Total tic score on the Yale Global Tic Severity Scale and the Clinical Global Impression-Improvement scale rated by a clinician masked to treatment assignment. Results: Behavior therapy was associated with a significantly greater mean (SD) decrease on the Yale Global Tic Severity Scale (24.0[6.47] to 17.8[7.32]) from baseline to end point compared with the control treatment (21.8[6.59] to 19.3[7.40]) (P < .001; effect size=0.57). Twenty-four of 63 patients (38.1{\%}) were rated as much improved or very much improved on the Clinical Global Impression-Improvement scale compared with 4 of 63 (6.4{\%}) in the control group (P < .001). Attrition was 13.9{\%}, with no difference across groups. Patients receiving behavior therapy who were available for assessment at 6 months after treatment showed continued benefit. Conclusion: Comprehensive behavior therapy is a safe and effective intervention for adults with Tourette syndrome. Trial Registration: clinicaltrials.gov Identifier: NCT00231985",
author = "Sabine Wilhelm and Peterson, {Alan L.} and John Piacentini and Woods, {Douglas W.} and Thilo Deckersbach and Sukhodolsky, {Denis G.} and Susanna Chang and Haibei Liu and James Dziura and Walkup, {John T.} and Lawrence Scahill",
year = "2012",
month = "8",
day = "1",
doi = "10.1001/archgenpsychiatry.2011.1528",
language = "English (US)",
volume = "69",
pages = "795--803",
journal = "JAMA Psychiatry",
issn = "2168-622X",
publisher = "American Medical Association",
number = "8",

}

Wilhelm, S, Peterson, AL, Piacentini, J, Woods, DW, Deckersbach, T, Sukhodolsky, DG, Chang, S, Liu, H, Dziura, J, Walkup, JT & Scahill, L 2012, 'Randomized trial of behavior therapy for adults with tourette syndrome', Archives of General Psychiatry, vol. 69, no. 8, pp. 795-803. https://doi.org/10.1001/archgenpsychiatry.2011.1528

Randomized trial of behavior therapy for adults with tourette syndrome. / Wilhelm, Sabine; Peterson, Alan L.; Piacentini, John; Woods, Douglas W.; Deckersbach, Thilo; Sukhodolsky, Denis G.; Chang, Susanna; Liu, Haibei; Dziura, James; Walkup, John T.; Scahill, Lawrence.

In: Archives of General Psychiatry, Vol. 69, No. 8, 01.08.2012, p. 795-803.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Randomized trial of behavior therapy for adults with tourette syndrome

AU - Wilhelm, Sabine

AU - Peterson, Alan L.

AU - Piacentini, John

AU - Woods, Douglas W.

AU - Deckersbach, Thilo

AU - Sukhodolsky, Denis G.

AU - Chang, Susanna

AU - Liu, Haibei

AU - Dziura, James

AU - Walkup, John T.

AU - Scahill, Lawrence

PY - 2012/8/1

Y1 - 2012/8/1

N2 - Context: Tics in Tourette syndrome begin in childhood, peak in early adolescence, and often decrease by early adulthood. However, some adult patients continue to have impairing tics. Medications for tics are often effective but can cause adverse effects. Behavior therapy may offer an alternative but has not been examined in a large-scale controlled trial in adults. Objective: To test the efficacy of a comprehensive behavioral intervention for tics in adults with Tourette syndrome of at least moderate severity. Design: Arandomized controlled trial with posttreatment evaluations at 3 and 6 months for positive responders. Setting: Three outpatient research clinics. Patients: Patients (N=122; 78 males; age range, 16-69 years) with Tourette syndrome or chronic tic disorder were recruited between December 27, 2005, and May 21, 2009. Interventions: Patients received 8 sessions of comprehensive behavioral intervention for tics or 8 sessions of supportive treatment for 10 weeks. Patients with a positive response were given 3 monthly booster sessions. Main Outcome Measures: Total tic score on the Yale Global Tic Severity Scale and the Clinical Global Impression-Improvement scale rated by a clinician masked to treatment assignment. Results: Behavior therapy was associated with a significantly greater mean (SD) decrease on the Yale Global Tic Severity Scale (24.0[6.47] to 17.8[7.32]) from baseline to end point compared with the control treatment (21.8[6.59] to 19.3[7.40]) (P < .001; effect size=0.57). Twenty-four of 63 patients (38.1%) were rated as much improved or very much improved on the Clinical Global Impression-Improvement scale compared with 4 of 63 (6.4%) in the control group (P < .001). Attrition was 13.9%, with no difference across groups. Patients receiving behavior therapy who were available for assessment at 6 months after treatment showed continued benefit. Conclusion: Comprehensive behavior therapy is a safe and effective intervention for adults with Tourette syndrome. Trial Registration: clinicaltrials.gov Identifier: NCT00231985

AB - Context: Tics in Tourette syndrome begin in childhood, peak in early adolescence, and often decrease by early adulthood. However, some adult patients continue to have impairing tics. Medications for tics are often effective but can cause adverse effects. Behavior therapy may offer an alternative but has not been examined in a large-scale controlled trial in adults. Objective: To test the efficacy of a comprehensive behavioral intervention for tics in adults with Tourette syndrome of at least moderate severity. Design: Arandomized controlled trial with posttreatment evaluations at 3 and 6 months for positive responders. Setting: Three outpatient research clinics. Patients: Patients (N=122; 78 males; age range, 16-69 years) with Tourette syndrome or chronic tic disorder were recruited between December 27, 2005, and May 21, 2009. Interventions: Patients received 8 sessions of comprehensive behavioral intervention for tics or 8 sessions of supportive treatment for 10 weeks. Patients with a positive response were given 3 monthly booster sessions. Main Outcome Measures: Total tic score on the Yale Global Tic Severity Scale and the Clinical Global Impression-Improvement scale rated by a clinician masked to treatment assignment. Results: Behavior therapy was associated with a significantly greater mean (SD) decrease on the Yale Global Tic Severity Scale (24.0[6.47] to 17.8[7.32]) from baseline to end point compared with the control treatment (21.8[6.59] to 19.3[7.40]) (P < .001; effect size=0.57). Twenty-four of 63 patients (38.1%) were rated as much improved or very much improved on the Clinical Global Impression-Improvement scale compared with 4 of 63 (6.4%) in the control group (P < .001). Attrition was 13.9%, with no difference across groups. Patients receiving behavior therapy who were available for assessment at 6 months after treatment showed continued benefit. Conclusion: Comprehensive behavior therapy is a safe and effective intervention for adults with Tourette syndrome. Trial Registration: clinicaltrials.gov Identifier: NCT00231985

UR - http://www.scopus.com/inward/record.url?scp=84865542584&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84865542584&partnerID=8YFLogxK

U2 - 10.1001/archgenpsychiatry.2011.1528

DO - 10.1001/archgenpsychiatry.2011.1528

M3 - Article

VL - 69

SP - 795

EP - 803

JO - JAMA Psychiatry

JF - JAMA Psychiatry

SN - 2168-622X

IS - 8

ER -

Wilhelm S, Peterson AL, Piacentini J, Woods DW, Deckersbach T, Sukhodolsky DG et al. Randomized trial of behavior therapy for adults with tourette syndrome. Archives of General Psychiatry. 2012 Aug 1;69(8):795-803. https://doi.org/10.1001/archgenpsychiatry.2011.1528