المؤلفون: Essoe, Joey K-Y, Ricketts, Emily J, Ramsey, Kesley A, Piacentini, John, Woods, Douglas W, Peterson, Alan L, Scahill, Lawrence, Wilhelm, Sabine, Walkup, John T, McGuire, Joseph F

مصطلحات موضوعية: Mind and Body, Clinical Trials and Supportive Activities, Neurodegenerative, Pediatric, Mental Health, Clinical Research, Behavioral and Social Science, Brain Disorders, Tourette Syndrome, Adolescent, Adult, Behavior Therapy, Humans, Treatment Outcome, Tics, Homework adherence, Behavior therapy, Comprehensive behavioral intervention for tics, Psychology, Cognitive Sciences, Clinical Psychology

الوصف: Behavior therapy is a first-line intervention for Tourette's Disorder (TD), and a key component is the practice of therapeutic skills between treatment visits (i.e., homework). This study examined the relationship between homework adherence during behavior therapy for TD and therapeutic outcomes, and explored baseline predictors of homework adherence during treatment. Participants included 119 individuals with TD (70 youth, 49 adults) who received behavior therapy in a clinical trial. After a baseline assessment of tic severity and clinical characteristics, participants received 8 sessions of behavior therapy. Therapists recorded homework adherence at each therapy session. After treatment, tic severity was re-assessed by independent evaluators masked to treatment condition. Greater overall homework adherence predicted tic severity reductions and treatment response across participants. Early homework adherence predicted therapeutic improvement in youth, whereas late adherence predicted improvement in adults. Baseline predictors of greater homework adherence in youth included lower hyperactivity/impulsivity and caregiver strain. Meanwhile in adults, baseline predictors of increased homework adherence included younger age, lower hyperactivity/impulsivity, obsessive-compulsive severity, anger, and greater work-related disability. Homework adherence is an integral component of behavior therapy and linked to therapeutic improvement. Strategies that improve homework adherence may optimize the efficacy of behavioral treatments and improve treatment outcomes.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/37m8k94dTest

المؤلفون: Weingarden, Hilary, Scahill, Lawrence, Hoeppner, Susanne, Peterson, Alan L, Woods, Douglas W, Walkup, John T, Piacentini, John, Wilhelm, Sabine

مصطلحات موضوعية: Clinical and Health Psychology, Psychology, Mental Health, Serious Mental Illness, Depression, Brain Disorders, Mind and Body, Neurodegenerative, Behavioral and Social Science, Neurosciences, Tourette Syndrome, Mental health, Adolescent, Adult, Behavior Therapy, Child, Chronic Disease, Cognitive Behavioral Therapy, Comorbidity, Depressive Disorder, Female, Follow-Up Studies, Humans, Linear Models, Male, Self Concept, Severity of Illness Index, Stereotyping, Tic Disorders, Treatment Outcome, Self-esteem, Tourette syndrome, Chronic tic disorder, Comprehensive Behavioral Intervention for Tics, Clinical Sciences, Psychiatry, Clinical sciences, Clinical and health psychology

الوصف: BackgroundTourette syndrome (TS) and chronic tic disorders (CTD) are stigmatizing disorders that may significantly impact self-esteem. Alternatively, comorbid psychiatric illnesses may affect self-esteem more than tics themselves. Extant research on self-esteem in TS/CTD is limited, has inconsistently examined the effect of comorbidities on self-esteem, and yields mixed findings.MethodThis study aimed to clarify the roles of tics versus comorbid diagnoses on self-esteem in a large, carefully diagnosed sample of adults with TS/CTD (N = 122) receiving 10 weeks of Comprehensive Behavioral Intervention for Tics (CBIT) or Psychoeducation and Supportive Therapy (PST).ResultsBaseline self-esteem did not differ between adults with TS/CTD only and normative means, whereas self-esteem was significantly lower among adults with TS/CTD with a comorbid psychiatric illness. In a multiple regression testing the baseline association between tic severity, presence of comorbid psychiatric illness, and depression severity with self-esteem, comorbidity and depression severity were significantly associated with self-esteem, whereas tic severity was not. Finally, using a generalized linear model, we tested the effects of treatment assignment, comorbidity, and their interaction on changes in self-esteem across treatment, controlling for baseline depression severity. Results showed that for those with a comorbid illness, self-esteem improved significantly more with CBIT than with PST.ConclusionsComorbid illnesses appear to affect self-esteem more so than tics among adults with TS/CTD. Therapeutic attention should be paid to treating comorbid diagnoses alongside tics when treating TS/CTD.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/95b318ctTest

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

المصدر: Behavior Therapy. 47(1)

مصطلحات موضوعية: Tourette Syndrome, Clinical Trials and Supportive Activities, Clinical Research, Serious Mental Illness, Neurosciences, Mental Health, Neurodegenerative, Behavioral and Social Science, Brain Disorders, Mental health, Adolescent, Adult, Aged, Behavior Therapy, Child, Empirical Research, Female, Follow-Up Studies, Humans, Male, Middle Aged, Tic Disorders, Young Adult, Tourette's disorder, chronic tic disorder, behavior therapy, symptom substitution, comprehensive behavioral intervention for tics, Tourette’s disorder, Psychology, Clinical Psychology

الوصف: 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.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/11x874ktTest

المؤلفون: McGuire, Joseph F, Piacentini, John, Scahill, Lawrence, Woods, Douglas W, Villarreal, Robert, Wilhelm, Sabine, Walkup, John T, Peterson, Alan L

مصطلحات موضوعية: Mental Health, Tourette Syndrome, Neurodegenerative, Clinical Research, Brain Disorders, Mind and Body, Adolescent, Adult, Aged, Behavior Therapy, Child, Female, Humans, Male, Middle Aged, Severity of Illness Index, Tic Disorders, Tics, Treatment Outcome, Young Adult, Tourette's disorder, Behavior therapy, Habit reversal training, Comprehensive behavioral intervention for tics, Treatment outcome, Individualized treatment response, Psychology, Cognitive Sciences, Clinical Psychology

الوصف: This report examined the most frequently reported bothersome tics among individuals with chronic tic disorders and evaluated the improvement and remission of tics and their associated characteristics. Youths and adults (N = 240) were randomly assigned to receive the comprehensive behavioral intervention for tics (CBIT) or psychoeducation and supportive therapy (PST). At baseline, motor tics and tics with an urge were rated as more bothersome relative to vocal tics and tics without premonitory urges. The five most common bothersome tics included eye blinking, head jerks, sniffing, throat clearing, and other complex motor tics. While CBIT outperformed PST across tic type and urge presence, tics preceded by premonitory urges at baseline had higher severity at posttreatment across treatment condition. Six individual tic types had lower severity at posttreatment following CBIT relative to PST. Baseline urge presence was associated with tic remission for CBIT but not PST. Specific bothersome tics were more likely to remit with CBIT relative to PST. Findings suggest that individual tics respond and remit differently to CBIT relative to PST, with implications highlighting the negative reinforcement hypothesis in tic symptom maintenance. CLINICALTRIALS.Gov identifiersNCT00218777; NCT00231985.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/9b19n095Test

المؤلفون: Himle, Michael B, Capriotti, Matthew R, Hayes, Loran P, Ramanujam, Krishnapriya, Scahill, Lawrence, Sukhodolsky, Denis G, Wilhelm, Sabine, Deckersbach, Thilo, Peterson, Alan L, Specht, Matt W, Walkup, John T, Chang, Susanna, Piacentini, John

المصدر: Behavior Modification. 38(2)

مصطلحات موضوعية: Behavioral and Social Science, Clinical Research, Neurodegenerative, Pediatric, Mental Health, Brain Disorders, Tourette Syndrome, Rehabilitation, Adolescent, Adolescent Behavior, Analysis of Variance, Behavior Therapy, Child, Child Behavior, Chronic Disease, Comorbidity, Female, Humans, Interview, Psychological, Male, Tic Disorders, Tourette disorder, chronic tic disorder, Comprehensive Behavioral Intervention for Tics, function-based assessment, Psychology, Clinical Psychology

الوصف: Research has shown that motor and vocal tics fluctuate in frequency, intensity, and form in response to environmental and contextual cues. Behavioral models have proposed that some of the variation in tics may reflect context-dependent interactive learning processes such that once tics are performed, they are influenced by environmental contingencies. The current study describes the results of a function-based assessment of tics (FBAT) from a recently completed study comparing Comprehensive Behavioral Intervention for Tics (CBIT) with supportive psychotherapy. The current study describes the frequency with which antecedent and consequence variables were reported to exacerbate tics and the relationships between these functional variables and sample baseline characteristics, comorbidities, and measures of tic severity. Results showed that tic-exacerbating antecedents and consequences were nearly ubiquitous in a sample of children with chronic tic disorder. In addition, functional variables were related to baseline measures of comorbid internalizing symptoms and specific measures of tic severity.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/3qz6d8s4Test

المؤلفون: McGuire, Joseph F, Nyirabahizi, Epiphanie, Kircanski, Katharina, Piacentini, John, Peterson, Alan L, Woods, Douglas W, Wilhelm, Sabine, Walkup, John T, Scahill, Lawrence

المصدر: Psychiatry Research. 210(3)

مصطلحات موضوعية: Brain Disorders, Tourette Syndrome, Neurodegenerative, Clinical Trials and Supportive Activities, Mental Health, Serious Mental Illness, Pediatric, Clinical Research, Adolescent, Adult, Behavior Therapy, Child, Cluster Analysis, Female, Humans, Male, Severity of Illness Index, Tic Disorders, Tics, Treatment Outcome, Habit reversal training, Comprehensive behavioral intervention for tics, Tic symptom profiles, Chronic tic disorders, Treatment outcome, Cluster analysis, Medical and Health Sciences, Psychology and Cognitive Sciences, Psychiatry

الوصف: Cluster analytic methods have examined the symptom presentation of chronic tic disorders (CTDs), with limited agreement across studies. The present study investigated patterns, clinical correlates, and treatment outcome of tic symptoms. 239 youth and adults with CTDs completed a battery of assessments at baseline to determine diagnoses, tic severity, and clinical characteristics. Participants were randomly assigned to receive either a comprehensive behavioral intervention for tics (CBIT) or psychoeducation and supportive therapy (PST). A cluster analysis was conducted on the baseline Yale Global Tic Severity Scale (YGTSS) symptom checklist to identify the constellations of tic symptoms. Four tic clusters were identified: Impulse Control and Complex Phonic Tics; Complex Motor Tics; Simple Head Motor/Vocal Tics; and Primarily Simple Motor Tics. Frequencies of tic symptoms showed few differences across youth and adults. Tic clusters had small associations with clinical characteristics and showed no associations to the presence of coexisting psychiatric conditions. Cluster membership scores did not predict treatment response to CBIT or tic severity reductions. Tic symptoms distinctly cluster with little difference across youth and adults, or coexisting conditions. This study, which is the first to examine tic clusters and response to treatment, suggested that tic symptom profiles respond equally well to CBIT. Clinical trials.gov. identifiers: NCT00218777; NCT00231985.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/61t5h8z7Test

المؤلفون: McGuire, Joseph F., Ricketts, Emily J., Scahill, Lawrence, Wilhelm, Sabine, Woods, Douglas W., Piacentini, John, Walkup, John T., Peterson, Alan L.

المصدر: Psychology Faculty Research and Publications

مصطلحات موضوعية: Behavior therapy, comorbidity, comprehensive behavioral intervention for tics, disability, functioning, Psychology, psy, socio

الوصف: Background Although behavior therapy reduces tic severity, it is unknown whether it improves co-occurring psychiatric symptoms and functional outcomes for adults with Tourette's disorder (TD). This information is essential for effective treatment planning. This study examined the effects of behavior therapy on psychiatric symptoms and functional outcomes in older adolescents and adults with TD. Method A total of 122 individuals with TD or a chronic tic disorder participated in a clinical trial comparing behavior therapy to psychoeducation and supportive therapy. At baseline, posttreatment, and follow-up visits, participants completed assessments of tic severity, co-occurring symptoms (inattention, impulsiveness, hyperactivity, anger, anxiety, depression, obsessions, and compulsions), and psychosocial functioning. We compared changes in tic severity, psychiatric symptoms, and functional outcomes using repeated measure and one-way analysis of variance. Results At posttreatment, participants receiving behavior therapy reported greater reductions in obsessions compared to participants in supportive therapy (η2p= 0.04, p = 0.04). Across treatments, a positive treatment response on the Clinical Global Impression of Improvement scale was associated with a reduced disruption in family life (η2p = 0.05, p = 0.02) and improved functioning in a parental role (η2p = 0.37, p = 0.02). Participants who responded positively to eight sessions of behavior therapy had an improvement in tic severity (η2p = 0.75, p < 0.001), inattention (η2p = 0.48, p < 0.02), and functioning (η2p = 0.39–0.42, p < 0.03–0.04) at the 6-month follow-up. Conclusion Behavior therapy has a therapeutic benefit for co-occurring obsessive symptoms in the short-term, and reduces tic severity and disability in adults with TD over time. Additional treatments may be necessary to address co-occurring symptoms and improve functional outcomes.

العلاقة: https://epublications.marquette.edu/context/psych_fac/article/1517/viewcontent/Woods_14715.pdfTest; https://epublications.marquette.edu/psych_fac/509Test

الإتاحة: https://epublications.marquette.edu/context/psych_fac/article/1517/viewcontent/Woods_14715.pdfTest
https://epublications.marquette.edu/psych_fac/509Test

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

المصدر: Psychology Faculty Research and Publications

مصطلحات موضوعية: Tourette's disorder, chronic tic disorder, behavior therapy, symptom substitution, comprehensive behavioral intervention for tics, Psychology, psy, socio

الوصف: 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.

العلاقة: https://epublications.marquette.edu/context/psych_fac/article/1252/viewcontent/woods_9752.pdfTest; https://epublications.marquette.edu/psych_fac/244Test

الإتاحة: https://epublications.marquette.edu/context/psych_fac/article/1252/viewcontent/woods_9752.pdfTest
https://epublications.marquette.edu/psych_fac/244Test

المؤلفون: Peterson, Alan L.^1,2,3 (AUTHOR) petersona3@uthscsa.edu, Blount, Tabatha H.¹ (AUTHOR), Villarreal, Robert¹ (AUTHOR), Raj, Jeslina J.¹ (AUTHOR), McGuire, Joseph F.⁴ (AUTHOR)

المصدر: Journal of Behavior Therapy & Experimental Psychiatry. Mar2022, Vol. 74, pN.PAG-N.PAG. 1p.

مصطلحات موضوعية: *TIC disorders, *TOURETTE syndrome, *BEHAVIOR therapy

مستخلص: Background and Objectives: Behavioral therapies such as the Comprehensive Behavioral Intervention for Tics (CBIT) are recommended as the first-line treatment for Tourette's Disorder. This treatment approach is comprised of three central components: habit reversal training, functional assessment/intervention, and relaxation training. Despite its combined efficacy, the contribution of each therapeutic component in CBIT for reducing tic severity remains undetermined. The study evaluated the efficacy of relaxation training alone or alongside other CBIT components for reducing tic severity.Methods: In this multiple-baseline study, participants completed a baseline assessment (A), 4 weekly sessions of relaxation training followed by a posttreatment assessment (B), 8 weekly sessions of CBIT followed by a posttreatment assessment (C), and a 1 month posttreatment follow up assessment (D). Six participants (83% male) aged 10-18 with Tourette's Disorder completed study procedures. Primary outcomes of tic severity was the Yale Global Tic Severity Scale (YGTSS).Results: A repeated measures ANOVA revealed a significance reduction in tic severity over time (p = .010). While post-hoc tests revealed a moderate non-significant reduction in tic severity after relaxation training (d =.23), large significant reductions in tic severity were observed after the combined treatment of relaxation training and CBIT (d = 1.17) that were maintained at a 1-month follow-up visit (d = 1.53).Limitations: Findings are limited by the small sample size.Conclusions: While relaxation training is effective when included in conjunction with CBIT, relaxation training alone is not effective in reducing tic severity in patients with Tourette's Disorder. [ABSTRACT FROM AUTHOR]

المؤلفون: McGuire, Joseph F.¹ jfmcguire@mednet.ucla.edu, Piacentini, John¹ jpiacentini@mednet.ucla.edu, Scahill, Lawrence² lawrence.scahill@emory.edu, Woods, Douglas W.³ dowoods@tamu.edu, Villarreal, Robert⁴ villarrear10@uthscsa.edu, Wilhelm, Sabine⁵ swilhelm@mgh.harvard.edu, Walkup, John T.⁶ jtw9001@med.cornell.edu, Peterson, Alan L.^4,7,8 petersona3@uthscsa.edu

المصدر: Behaviour Research & Therapy. Jul2015, Vol. 70, p56-63. 8p.

مصطلحات موضوعية: *TIC disorders, *BEHAVIOR therapy, *PSYCHOEDUCATION, *CLINICAL trials, *HEALTH outcome assessment, *PATIENTS, *THERAPEUTICS

مستخلص: This report examined the most frequently reported bothersome tics among individuals with chronic tic disorders and evaluated the improvement and remission of tics and their associated characteristics. Youths and adults ( N = 240) were randomly assigned to receive the comprehensive behavioral intervention for tics (CBIT) or psychoeducation and supportive therapy (PST). At baseline, motor tics and tics with an urge were rated as more bothersome relative to vocal tics and tics without premonitory urges. The five most common bothersome tics included eye blinking, head jerks, sniffing, throat clearing, and other complex motor tics. While CBIT outperformed PST across tic type and urge presence, tics preceded by premonitory urges at baseline had higher severity at posttreatment across treatment condition. Six individual tic types had lower severity at posttreatment following CBIT relative to PST. Baseline urge presence was associated with tic remission for CBIT but not PST. Specific bothersome tics were more likely to remit with CBIT relative to PST. Findings suggest that individual tics respond and remit differently to CBIT relative to PST, with implications highlighting the negative reinforcement hypothesis in tic symptom maintenance. Clinicaltrials.gov identifiers NCT00218777; NCT00231985. [ABSTRACT FROM AUTHOR]