Sage Journals: Discover world-class research

Abstract

Gilles de la Tourette’s syndrome (GTS) is a neuropsychiatric disorder that often presents with a complex array of motor and phonic tics that persist over the majority of a person’s life. GTS often presents with comorbidities such as attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), and mood disorders. Psychosocial sequelae are also common among this population. We present the case of a 49-year-old woman with severe, lifelong GTS complicated by OCD, inattention, impulsivity, disinhibition, mood disturbances, generalized anxiety, and pain secondary to motor tics. Habit reversal therapy (HRT) is used with full body relaxation conditioned as a competitive response to target her tics, anxiety, and pain simultaneously. The patient demonstrates significant reduction of symptoms and improvement in psychosocial status within four sessions. She is able to maintain this status at a 3-month follow-up session. Aspects of case conceptualization and therapeutic technique are discussed.

Keywords

Tourette’s disorder habit-reversal therapy relaxation therapy

Get full access to this article

View all access options for this article.

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.

Azrin, N.H. , & Nunn, R.G. ( 1973). Habit reversal: A method of eliminating nervous habits and tics. Behaviour Research and Therapy, 11, 619-628.

Azrin, N.H. , & Peterson, A.L. (1988). Habit reversal for the treatment of Tourette syndrome. Behaviour Research and Therapy , 26, 347-351.

Azrin, N.H. , & Peterson, A.L. (1990). Treatment of Tourette’s syndrome by habit reversal: A waiting-list control group comparison. Behavior Therapy, 21, 305-318.

Beck, A.T. , Steer, R.A. , & Brown, G.K. ( 1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.

Butcher, J.N. , Dahlstrom, W.G. , Graham, J.R. , Tellegen, A. , & Kaemmer, B. ( 1989). The Minnesota Multiphasic Personality Inventory-2 (MMPI-2): Manual for administration and scoring. Minneapolis, MN : University of Minnesota Press.

Carr, J.E. , & Chong, I.M. ( 2005). Habit reversal treatment of tic disorders: A methodological critique of the literature. Behavior Modification, 29, 858-875.

Cook, C.R. , & Blacher, J. ( 2007). Evidence-based psychosocial treatments for tic disorders . Clinical Psychology: Science and Practice, 14, 252-267.

Deckersbach, T. , Rauch, S. , Buhlmann, U. , & Wilhelm, S. ( 2006). Habit reversal versus supportive psychotherapy in Tourette’s disorder: A randomized controlled trial and predictors of treatment response . Behaviour Research and Therapy, 44, 1079-1090.

10.

Derogatis, L.R. , Rickels, K. , & Rock, A.F. ( 1976). The SCL-90 and the MMPI: A step in the validation of a new self-report scale. British Journal of Psychiatry, 128, 280-289.

11.

Jankovic, J. ( 2001). Tourette’s syndrome. New England Journal of Medicine, 345, 1184-1192.

12.

Kerns, R.D. , Turk, D.C. , & Rudy, T.E. ( 1985). The West Haven-Yale Multidimensional Pain Inventory (WHYMPI) . Pain, 23, 345-356.

13.

Leckman, J.F. , Riddle, M.A. , Hardin, M.T. , Ort, S.I. , Swartz, K.L. , Stevenson, J. , & Cohen, D.J. ( 1989). The Yale Global Tic Severity Scale: Initial testing of a clinician-rated scale of tic severity. Journal of the American Academy of Child & Adolescent Psychiatry, 28, 566-573.

14.

Miltenberger, R.W. , Fuqua, R.W. , & Woods, D.W. ( 1998) Applying behavior analysis to clinical problems: Review and analysis of habit reversal. Journal of Applied Behavior Analysis, 31, 447-469.

15.

Mink, J.W. ( 2009). Clinical review of DBS for Tourette syndrome. Frontiers in Bioscience, E1, 72-76.

16.

Scahill, L. , Erenberg, G. , Berlin, C.M., Jr. , Budman, C. , Coffey, B.J. , Jankovic, J. , . . . Walkup, J. (2006). Contemporary assessment and pharmacotherapy of Tourette syndrome. NeuroRX, 3, 192-206.

17.

Spielberger, C.D. , Gorsuch, R.L. , & Lushene, R.E. ( 1970). Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press.

18.

Temel, Y. , & Visser-Vandewalle, V. (2004). Surgery in Tourette syndrome . Movement Disorders, 19, 3-14.

19.

Wilhelm, S. , Deckersbach, T. , Coffey, B.J. , Bohne, A. , Peterson, A.L. , & Baer, L. ( 2003). Habit reversal versus supportive psychotherapy for Tourette’s disorder: A randomized controlled trial. American Journal of Psychiatry, 160, 1175-1177.

20.

Woods, D.W. ( 2001). Habit reversal treatment manual for tic disorders. In D. W. Woods & R. G. Miltenberger (Eds.), Tic disorders, trichotillomaina, and other repetitive behavior disorders: Behavioral approaches to analysis and treatment (pp. 97-132). Norwell, MA: Kluwer Academic.

21.

Woods, D.W. , Miltenberger, R.G. , & Lumley, V.A. ( 1996). Sequential application of major habit-reversal components to treat motor tics in children. Journal of Applied Behavior Analysis, 29, 483-493.

22.

Woods, D.W. , Twohig, M.P. , Flessner, C.A. , & Roloff, T.J. ( 2003). Treatment of phonic tics in children with Tourette syndrome: Investigating the efficacy of habit reversal. Journal of Applied Behavior Analysis, 36, 109-112.

23.

Woods, J.E. , & Luiselli, J.K. (2007). Habit reversal treatment of phonic and motor tics in a child with Tourette’s syndrome. Clinical Case Studies, 6, 181-189.