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Mohamed ZA, Xue Y, Bai M, Dong H, Jia F. Efficacy of differential reinforcement of other behaviors therapy for tic disorder: a meta-analysis. BMC Neurol 2024; 24:3. [PMID: 38166709 PMCID: PMC10759470 DOI: 10.1186/s12883-023-03501-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION Recently, studies on behavioral tic suppression techniques have gained popularity as opposed to pharmacological alternatives that often have potentially dangerous side effects. Differential Reinforcement of Other Behaviors therapy (DRO) is one such behavioral technique whose efficacy in tic suppression has been experimentally demonstrated albeit in studies with very few patients, and lacking statistical power. Here, we conducted a meta-analysis of these studies to improve their overall power and explore whether DRO intervention is really effective for tic suppression. MATERIALS AND METHODS PubMed, Embase, PsycINFO, and Cochrane Library were searched from inception to August 30, 2023. Only original interventional studies that examined the efficacy of DRO for tic suppression were included. RESULTS A total of 8 no control interventional studies involving 79 children with tic disorders were recruited. Most of the children had moderate tic severity. The pooled mean Yale Global Tic Severity Scale (YGTSS) score was 24.64 (95% CI: 21.99 - 30.12, p = < 0.00001, I2 = 87%). In terms of efficacy of the DRO technique for tic suppression, the results showed that DRO was effective in reducing tic frequency among the children. The pooled standardized mean difference (SMD) was -10.25 (95% CI: -14.71 - -5.79, p = < 0.00001) with I2 = 94%. CONCLUSION In conclusion, this study revealed that DRO is potentially an effective tic suppression technique for temporarily managing tic disorder. It also showed that DRO could be employed for both moderate and severe tic disorders. However, the technique bears crucial limitations that limit its implementation outside of experimental settings. More studies are needed to address these limitations and improve its applicability in the real world.
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Affiliation(s)
- Zakaria Ahmed Mohamed
- Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, Changchun, China
| | - Yang Xue
- Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, Changchun, China
| | - Miaoshui Bai
- Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, Changchun, China
| | - Hanyu Dong
- Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, Changchun, China
| | - Feiyong Jia
- Department of Developmental and Behavioral Pediatrics, The First Hospital of Jilin University, Changchun, China.
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Rahman SM, Jafferany M, Barkauskaite R. Habit-reversal training: a psychotherapeutic approach in treating body-focused repetitive behaviour disorders. Clin Exp Dermatol 2023; 48:1310-1316. [PMID: 37470438 DOI: 10.1093/ced/llad247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 06/29/2023] [Accepted: 07/17/2023] [Indexed: 07/21/2023]
Abstract
Body-focused repetitive behaviours (BFRBs) are recurrent, compulsive, destructive behaviours directed towards the body. Although studies have demonstrated a 12-14% prevalence rate, researchers found that dermatologists and psychiatrists show a lack of knowledge regarding psychodermatology resources and information about BFRB disorders (BFRBDs) such as trichotillomania (TTM). There is limited research about treatments including ones investigating the clinical applications of various self-help training such as decoupling (DC) and DC in sensu (DC-is) as well as about habit-reversal training (HRT). HRT is a five-component behavioural intervention that aims to develop a competing response to a specific unwanted behaviour. Studies have found substantial support for HRT's efficacy in treating a variety of maladaptive repetitive behaviours including onychotillomania, TTM, skin-picking disorder and chronic cheek biting. Additionally, many psychotherapies can augmented HRT. Psychotherapies include acceptance and commitment therapy, dialectical behaviour therapy, psychodynamic psychotherapy, mindfulness mediation and the cognitive psychophysiological model. A recently investigated variant of HRT, DC-is, resulted in consistently satisfactory objective and subjective improvement for treating BFRBDs, and HRT showed good subjective but poor objective improvement compared with standard DC. HRT and HRT variants are effective therapeutic treatments for BFRBDs; however, further randomized double-blinded and placebo-controlled trials are required to examine HRT's therapeutic profile.
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Affiliation(s)
- Syed Minhaj Rahman
- Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Mohammad Jafferany
- Department of Psychiatry, Central Michigan University/CMU Medical Education Partners, Saginaw, MI, USA
| | - Ruta Barkauskaite
- Institute of Psychology, Mykoles Romeris University, Vilnius, Lithuania
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Goyal T, Kalra N, Tyagi R, Khatri A, Sabherwal P, Yangdol P. Evidence-based analysis of multi-pronged approaches for education and behavior management of autistic patients in a dental setting. SPECIAL CARE IN DENTISTRY 2023; 43:856-868. [PMID: 37080902 DOI: 10.1111/scd.12867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 01/09/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Autism spectrum disorder is a neurodevelopmental condition which has posed a challenge to carers, pediatricians and dentists through the years. Over the last four decades, the disorder has been better understood and management techniques have evolved. In the field of dentistry, the autistic child presents difficulty in management, even for the simplest dental procedures. A comprehensive understanding of other psychoeducational and behavioral approaches to manage autism is very important. This article aims to introduce various important key techniques such as Applied Behavior Analysis, TEACCH, Sensory Adapted Dental Environment, Picture Exchange Communication System, and Animal Assisted Therapy and analyze their application in dentistry. METHODS A search of literature was carried out in Clinicaltrials.gov, Medline and Scopus with the search terms "Applied Behavior Analysis," "TEACCH," "Sensory Adapted Dental Environment," "Picture Exchange Communication System," and "Animal Assisted Therapy" along with "autism OR autistic," "dental OR dentistry OR oral health." After the screening for inclusion and exclusion criteria, 10 eligible articles were included, in English, published within the last 10 years. RESULTS Limited research was available regarding these lesser-known behavioral approaches in dentistry. The few that were available showed encouraging results. The different techniques proved useful in increasing acceptance of dental treatment and reducing behavioral disturbances. The patients experienced reduced dental anxiety, lesser discomfort, improved communication, and knowledge. CONCLUSION Pediatric and special care dentists are likely to benefit by incorporating the recommended comprehensive behavior management techniques in their practice. There is evidence that these techniques will reduce behavioral disturbances in autistic children thereby making primary dental care possible without the need for sedation or general anesthesia.
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Affiliation(s)
- Tavisha Goyal
- Department of Pedodontics and Preventive Dentistry, University College of Medical Sciences, Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
| | - Namita Kalra
- Department of Pedodontics and Preventive Dentistry, University College of Medical Sciences, Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
| | - Rishi Tyagi
- Department of Pedodontics and Preventive Dentistry, University College of Medical Sciences, Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
| | - Amit Khatri
- Department of Pedodontics and Preventive Dentistry, University College of Medical Sciences, Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
| | - Puja Sabherwal
- Department of Pedodontics and Preventive Dentistry, University College of Medical Sciences, Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
| | - Padma Yangdol
- Department of Pedodontics and Preventive Dentistry, University College of Medical Sciences, Guru Teg Bahadur Hospital, University of Delhi, Delhi, India
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Gur N, Zimmerman-Brenner S, Fattal-Valevski A, Rotstein M, Pilowsky Peleg T. Group comprehensive behavioral intervention for tics contribution to broader cognitive and emotion regulation in children. Eur Child Adolesc Psychiatry 2023; 32:1925-1933. [PMID: 35695947 DOI: 10.1007/s00787-022-02018-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/29/2022] [Indexed: 11/03/2022]
Abstract
There is increasing evidence for the effectiveness of behavioral techniques in managing tics in youth with Tourette syndrome and tics disorders (TDs). One such intervention is Comprehensive Behavioral Intervention for Tics (CBIT), which focuses on reducing tic severity by training control and regulation. In view of the regulation deficits characteristic to TDs, in the current study, we aimed to explore the contribution of CBIT beyond tic control, to a wider expression of regulation abilities-cognitive inhibition and emotion regulation. A total of 55 participants with TDs, aged 8-15, who were randomly assigned to group-CBIT or group-Educational Intervention for Tics, were compared on cognitive inhibition tests and use of emotion-regulation strategies, pre- and post-intervention. Whereas on none of the scales a significant interaction effect was found reflecting superiority of CBIT over EIT, repeated measures ANOVA revealed a significant time effect, with post hoc analyses indicating that cognitive inhibition and cognitive reappraisal significantly increased following CBIT intervention only. Within the group-CBIT, the increase in cognitive reappraisal was associated with higher intellectual ability. These findings may lead to a broader understanding of CBIT contribution to more than tic control, but rather to better cognitive and emotional regulation abilities.
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Affiliation(s)
- Noa Gur
- Department of Psychology, The Hebrew University of Jerusalem, Mount Scopus, 9190501, Jerusalem, Israel.
- The Neuropsychological Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
| | - Sharon Zimmerman-Brenner
- The Tourette Syndrome Association in Israel (TSAI), Tel Aviv-Yafo, Israel
- School of Psychology, Reichman University IDC, Herzliya, Israel
| | - Aviva Fattal-Valevski
- The Pediatric Neurology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Michael Rotstein
- The Pediatric Neurology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Pediatric Movement Disorders Clinic, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Tammy Pilowsky Peleg
- Department of Psychology, The Hebrew University of Jerusalem, Mount Scopus, 9190501, Jerusalem, Israel
- The Neuropsychological Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
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Woods DW, Himle MB, Stiede JT, Pitts BX. Behavioral Interventions for Children and Adults with Tic Disorder. Annu Rev Clin Psychol 2023; 19:233-260. [PMID: 37159286 DOI: 10.1146/annurev-clinpsy-080921-074307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Over the past decade, behavioral interventions have become increasingly recognized and recommended as effective first-line therapies for treating individuals with tic disorders. In this article, we describe a basic theoretical and conceptual framework through which the reader can understand the application of these interventions for treating tics. The three primary behavioral interventions for tics with the strongest empirical support (habit reversal, Comprehensive Behavioral Intervention for Tics, and exposure and response prevention) are described. Research on the efficacy and effectiveness of these treatments is summarized along with a discussion of the research evaluating the delivery of these treatments in different formats and modalities. The article closes with a review of the possible mechanisms of change underlying behavioral interventions for tics and areas for future research.
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Affiliation(s)
- Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA;
| | - Michael B Himle
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Jordan T Stiede
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Brandon X Pitts
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA;
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Svartdal F, Løkke JA. The ABC of academic procrastination: Functional analysis of a detrimental habit. Front Psychol 2022; 13:1019261. [PMID: 36405131 PMCID: PMC9669985 DOI: 10.3389/fpsyg.2022.1019261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
Academic procrastination – habitually delaying work with academic tasks to the extent that the delays become detrimental to performance, wellbeing, and health – represents a substantial personal, systemic, and societal problem. Still, efforts to prevent and reduce it are surprisingly scarce and often offered as treatment regimens rather than preventive efforts. Based on the principles of functional analysis and a broad examination of factors that are important for academic procrastinatory behaviors, this paper aims to describe a strategy for analyzing individual controlling conditions for procrastination and give parallel advice on how to change those controlling conditions. Both are ideographic, allowing for individual and dynamic analyses of factors responsible for instigating and maintaining procrastination, as well as tailor-made remedies that address controlling conditions in preventive and curative efforts to reduce procrastination. Although functional analysis integrates well with important research findings in the procrastination field, this approach suggests new criteria for identifying procrastinatory behaviors and an alternative model for analyzing their control conditions. We conclude that a functional approach may supplement procrastination research and efforts to prevent and alleviate this detrimental habit.
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Affiliation(s)
- Frode Svartdal
- Department of Psychology UiT The Arctic University of Norway, Tromsø, Norway
- *Correspondence: Frode Svartdal,
| | - Jon Arne Løkke
- Department of Welfare, Management and Organisation, Østfold University College, Halden, Østfold, Norway
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7
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Varrasi S, Castellano S, Platania GA, Guerrera CS, Caponnetto P, Pirrone C. "Don't Touch Your Face!" The Contribution of Habit Reversal in the COVID-19 Pandemic. Health Psychol Res 2022; 10:39650. [PMID: 36425226 PMCID: PMC9680863 DOI: 10.52965/001c.39650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
The Habit Reversal Training (HRT) is a behavioral procedure for treating the so-called nervous habits, such as nail biting, hair pulling and thumb sucking. In addition to being an established clinical procedure, HRT is also a strategy for behavioral change that can serve the entire community. For this reason, this review aims to explore the studies proposing the use of HRT for the reduction of hand-to-face habits in the context of COVID-19 pandemic. Touching one's nose, mouth and eyes, indeed, is one of the means of virus transmission that many awareness campaigns seek to highlight. After an overview of how HRT works and of the current epidemiological situation, studies supporting Habit Reversal Training for the reduction of risky hand-to-face habits are presented. The possible strategies are then exposed and critically discussed to identify their limitations and propose a new version according to the Relational Frame Theory.
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Affiliation(s)
- Simone Varrasi
- Department of Educational Sciences, University of Catania
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8
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Luiselli JK. Public speaking disfluencies: A review of habit reversal training and research. J Appl Behav Anal 2022; 55:1342-1348. [PMID: 35854406 DOI: 10.1002/jaba.948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/28/2022] [Indexed: 11/06/2022]
Abstract
From 2016 to 2022, the Journal of Applied Behavior Analysis published 7 studies that evaluated the effects of habit reversal training on speech disfluencies (filled pauses) during public speaking. This review summarizes the participants, dependent variables, procedures, experimental design, and outcomes from this research including practice implications and suggested areas of inquiry.
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Ortiz SM, Deshais MA, Miltenberger RG, Reeve KF. Decreasing nervous habits during public speaking: A component analysis of awareness training. J Appl Behav Anal 2021; 55:230-248. [PMID: 34545944 DOI: 10.1002/jaba.882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 09/03/2021] [Accepted: 09/05/2021] [Indexed: 11/06/2022]
Abstract
Awareness training can produce decreases in nervous habits during public speaking. A systematic replication of Montes et al. (2020) was conducted to evaluate the independent and additive effects of awareness training components (i.e., response description, response detection) on speech disfluencies during public speaking. We extended prior research by evaluating response description alone, delivering the intervention virtually, using novel videos and speech topics during training, and measuring collateral effects on untargeted responses and speech rate. Response description was sufficient at reducing speech disfluencies for 4 of 9 participants. Response detection (video training) was necessary for 2 participants, and the subsequent addition of response detection (in-vivo training) was necessary for 3 participants. Reductions were maintained during follow-up and generalization probes for most participants. Collateral effects of awareness training components were idiosyncratic. A post-hoc analysis revealed that response description, when effective as a stand-alone intervention, may be more efficient than the full awareness training package.
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Affiliation(s)
| | | | | | - Kenneth F Reeve
- Department of Applied Behavior Analysis, Caldwell University
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10
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Perrin CJ, Hensel SA, Lynch DL, Gallegos LR, Bell K, Carpenter K. Using brief habit reversal and an interdependent group contingency to reduce public-speaking speech disfluencies. J Appl Behav Anal 2021; 54:1553-1565. [PMID: 34289092 DOI: 10.1002/jaba.867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 11/11/2022]
Abstract
This study replicated and extended previous research on the effectiveness of brief habit reversal, consisting of awareness training and competing response training (silent pause) in reducing the rate of speech disfluencies during public speaking. Nine university students, divided into 3 groups, delivered short speeches on a novel topic. Brief habit reversal combined with an interdependent group contingency resulted in a meaningful reduction in speech disfluencies with only 1 group requiring booster sessions. Relative to baseline, competing responses increased for all participants but only remained high for 1 participant following training. Reductions in speech disfluencies maintained during follow-up when participants presented in front of a small audience.
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Affiliation(s)
| | - Sarah A Hensel
- Department of Psychology and Counseling, Georgian Court University
| | - Durie L Lynch
- Department of Psychology and Counseling, Georgian Court University
| | - Lisa R Gallegos
- Department of Psychology and Counseling, Georgian Court University
| | - Kendall Bell
- Department of Psychology and Counseling, Georgian Court University
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11
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Montes CC, Heinicke MR, Guendulain MA, Morales E. A component analysis of awareness training for reducing speech disfluencies. J Appl Behav Anal 2020; 54:770-782. [DOI: 10.1002/jaba.795] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 10/04/2020] [Accepted: 10/05/2020] [Indexed: 11/10/2022]
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12
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Pretty J, Barton J. Nature-Based Interventions and Mind-Body Interventions: Saving Public Health Costs Whilst Increasing Life Satisfaction and Happiness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7769. [PMID: 33114167 PMCID: PMC7660642 DOI: 10.3390/ijerph17217769] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/14/2020] [Accepted: 10/20/2020] [Indexed: 12/14/2022]
Abstract
A number of countries have begun to adopt prevention pays policies and practices to reduce pressure on health and social care systems. Most affluent countries have seen substantial increases in the incidence and costs of non-communicable diseases. The interest in social models for health has led to the growth in use of social prescribing and psychological therapies. At the same time, there has been growth in application of a variety of nature-based and mind-body interventions (NBIs and MBIs) aimed at improving health and longevity. We assess four NBI/MBI programmes (woodland therapy, therapeutic horticulture, ecotherapy/green care, and tai chi) on life satisfaction/happiness and costs of use of public services. These interventions produce rises in life satisfaction/happiness of 1.00 pts to 7.29 (n = 644; p < 0.001) (for courses or participation >50 h). These increases are greater than many positive life events (e.g., marriage or a new child); few countries or cities see +1 pt increases over a decade. The net present economic benefits per person from reduced public service use are £830-£31,520 (after 1 year) and £6450-£11,980 (after 10 years). We conclude that NBIs and MBIs can play a role in helping to reduce the costs on health systems, while increasing the well-being of participants.
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Affiliation(s)
- Jules Pretty
- School of Life Sciences, University of Essex, Colchester CO4 3SQ, UK
| | - Jo Barton
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester CO4 3SQ, UK;
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Heinicke MR, Stiede JT, Miltenberger RG, Woods DW. Reducing risky behavior with habit reversal: A review of behavioral strategies to reduce habitual hand-to-head behavior. J Appl Behav Anal 2020; 53:1225-1236. [PMID: 32686131 PMCID: PMC7404378 DOI: 10.1002/jaba.745] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/17/2020] [Accepted: 06/17/2020] [Indexed: 12/03/2022]
Abstract
Habit reversal training (HRT) has been a mainstay of behavior analysts' repertoire for nearly the last 50 years. HRT has been effective in treating a host of repetitive behavior problems. In the face of the current coronavirus pandemic, HRT has practical public health importance as a possible intervention for reducing hand‐to‐head behaviors that increase the risk of viral infection. The current paper provides a brief review of HRT for hand‐to‐head habits that is designed for a broad audience and concludes with practical suggestions, based on HRT, for reducing face‐touching behaviors.
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Mashayekhi Goyonlo V, Sardabi MS, Tavalaei AM, Khoshnevisan Z, Razmara M. Cognitive behavioral therapy as an adjuvant therapy in acne excoriée: a randomized controlled clinical trial. J DERMATOL TREAT 2020; 33:782-788. [PMID: 32502358 DOI: 10.1080/09546634.2020.1776207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Acne excoriée (AE) is a difficult challenge in dermatology practice. AE is mostly associated with some psychiatric disorders particularly mood disorders. Thus, patients generally continue to manipulate their lesions. It was aimed to compare the effectiveness of cognitive behavioral therapy (CBT) as an adjuvant treatment for AE in a randomized controlled clinical trial.Methods: Thirty-two adults with AE were randomly assigned to CBT or control group. Both the groups received similar standard medication. Furthermore, eight sessions of CBT were held during 2 months in CBT group. Self-reported Skin Picking Scale (SPS), clinical severity rating, beck anxiety and depression inventories were determined at the baseline and after 2-month follow-up.Results: Participants in CBT group showed significantly more improvement on clinical severity score (p=.01) as well as SPS score (p=.02) after 2-month follow-up, in comparison to the control group. Depression and anxiety scores were significantly diminished after two months among CBT group in comparison to controls (p value .01 for both anxiety and depression).Conclusion: CBT constitutes a utile treatment option for AE and should be considered as an adjuvant therapy in clinical setting.
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Affiliation(s)
| | - Maryam Saeidi Sardabi
- Department of Industrial and Organizational Psychology, Faculty of Educational Sciences and Psychology, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Arezoo Moradi Tavalaei
- Department of Psychology, Faculty of Educational Sciences and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran
| | | | - Mahdi Razmara
- Cutaneous Leishmaniasis Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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15
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Zelnik N. Drug and Non-drug Treatment of Tourette Syndrome. CURRENT DRUG THERAPY 2020. [DOI: 10.2174/1574885514666191121141923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:Tourette Syndrome (TS) is a neurodevelopmental disorder characterized by multiple repetitive motor and vocal tics. In most patients, its clinical course has a waxing and waning nature and most patients, usually children, will benefit from tolerant environmental and psychoeducation. Patients with more complicated tics, in particular, those with significant comorbidities will require drug therapy.Objective:The present paper is a mini-review of the current therapeutic arsenal for TS with reference to drug and non-drug management approach.Methods:A systematic survey of medical literature regarding the treatment decision making and the reported clinical trials or accumulating experience with different medications or other therapeutic modalities which were proven beneficial over the years.Results:Reviewing the literature indicates that dopamine antagonists, such as haloperidol and pimozoide, are the most reliable agents in terms of treatment response. Due to numerous adverse effects, newer atypical anti-psychotic drugs have been shown effective. Other widely accepted medications include alpha-2 adrenergic agonists, benzamides, dopamine depleting agents, benzodiazepines and dopamine depleting agents. In more selective and intractable cases botulinum toxin, dopamine agonists and cannabinoids should be also considered. Non-pharmacologic therapies reported beneficial effects, which include on the one hand, non-invasive behavioral techniques, such as comprehensive behavior therapy for tics. While on the other hand, in cases with particular protracted pharmaco-resistant tics electric stimulation techniques, such as deep brain stimulation, have been shown to be successful.Conclusion:Currently, there are numerous multifarious options for treatment of tics and other comorbid symptoms of TS. Nevertheless, treatment options and decision-making algorithms are still a clinical challenge.Area Covered:A step by step decision-making and various drugs and non-pharmacologic modalities appropriate for the management of TS.
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Affiliation(s)
- Nathanel Zelnik
- Child Neurology and Development, Carmel Medical Center & Clalit Health Services, Haifa District, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Wilder DA, Ertel H, Hodges AC, Thomas R, Luong N. The use of auditory feedback and edible reinforcement to decrease toe walking among children with autism. J Appl Behav Anal 2019; 53:554-562. [PMID: 31292961 DOI: 10.1002/jaba.607] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 04/08/2019] [Indexed: 11/06/2022]
Abstract
We replicated and extended previous research on the use of auditory feedback to decrease toe walking exhibited by 3 children with autism. After pretreatment screening analyses suggested that toe walking occurred independent of social consequences, we attached squeakers to the heels of each participants' shoes. The squeakers provided auditory feedback when participants walked appropriately (i.e., with a heel-to-toe gait). For all participants, the auditory feedback itself produced increases in appropriate walking. For 1 participant, this feedback was sufficient to reduce toe walking to clinically acceptable levels; however, for 2 other participants, delivery of edible items paired with the auditory feedback was necessary. Intervention effects maintained when the schedule for edible delivery was thinned for all participants. In addition, for 2 participants, effects maintained when the intervention was implemented in a different setting and with a different person with no edibles or a thin schedule of edibles.
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Affiliation(s)
| | - Hallie Ertel
- Florida Institute of Technology and Nemours Children's Hospital
| | - Ansley C Hodges
- Florida Institute of Technology and Nemours Children's Hospital
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Davidow JH, Grossman HL, Edge RL. Stuttering Frequency, Speech Rate, Speech Naturalness, and Speech Effort During the Production of Voluntary Stuttering. LANGUAGE AND SPEECH 2019; 62:318-332. [PMID: 29756528 DOI: 10.1177/0023830918766962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE Voluntary stuttering techniques involve persons who stutter purposefully interjecting disfluencies into their speech. Little research has been conducted on the impact of these techniques on the speech pattern of persons who stutter. The present study examined whether changes in the frequency of voluntary stuttering accompanied changes in stuttering frequency, articulation rate, speech naturalness, and speech effort. METHOD In total, 12 persons who stutter aged 16-34 years participated. Participants read four 300-syllable passages during a control condition, and three voluntary stuttering conditions that involved attempting to produce purposeful, tension-free repetitions of initial sounds or syllables of a word for two or more repetitions (i.e., bouncing). The three voluntary stuttering conditions included bouncing on 5%, 10%, and 15% of syllables read. Friedman tests and follow-up Wilcoxon signed ranks tests were conducted for the statistical analyses. RESULTS Stuttering frequency, articulation rate, and speech naturalness were significantly different between the voluntary stuttering conditions. Speech effort did not differ between the voluntary stuttering conditions. Stuttering frequency was significantly lower during the three voluntary stuttering conditions compared to the control condition, and speech effort was significantly lower during two of the three voluntary stuttering conditions compared to the control condition. CONCLUSIONS Due to changes in articulation rate across the voluntary stuttering conditions, it is difficult to conclude, as has been suggested previously, that voluntary stuttering is the reason for stuttering reductions found when using voluntary stuttering techniques. Additionally, future investigations should examine different types of voluntary stuttering over an extended period of time to determine their impact on stuttering frequency, speech rate, speech naturalness, and speech effort.
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Affiliation(s)
- Jason H Davidow
- Department of Speech-Language-Hearing Sciences, Hofstra University, USA
| | | | - Robin L Edge
- Brooks Rehabilitation Department of Communication Sciences and Disorders, Jacksonville University, USA
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Montes CC, Heinicke MR, Geierman DM. Awareness training reduces college students' speech disfluencies in public speaking. J Appl Behav Anal 2019; 52:746-755. [DOI: 10.1002/jaba.569] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 03/19/2019] [Indexed: 11/11/2022]
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Schenk M, Miltenberger R. A review of behavioral interventions to enhance sports performance. BEHAVIORAL INTERVENTIONS 2019. [DOI: 10.1002/bin.1659] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Merritt Schenk
- Child and Family StudiesUniversity of South Florida Tampa Florida USA
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Phillips LA, Fritz JN, Rettig LA, Martin KE. Diaphragmatic breathing as treatment for escape‐maintained aggression. BEHAVIORAL INTERVENTIONS 2019. [DOI: 10.1002/bin.1663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lauren A. Phillips
- Department of Clinical, Health, and Applied SciencesUniversity of Houston‐Clear Lake Houston Texas
| | - Jennifer N. Fritz
- Department of Clinical, Health, and Applied SciencesUniversity of Houston‐Clear Lake Houston Texas
| | - Lisa A. Rettig
- Department of Clinical, Health, and Applied SciencesUniversity of Houston‐Clear Lake Houston Texas
| | - Kaitlyn E. Martin
- Department of Clinical, Health, and Applied SciencesUniversity of Houston‐Clear Lake Houston Texas
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Psychiatric Treatment and Management of Psychiatric Comorbidities of Movement Disorders. Semin Pediatr Neurol 2018; 25:123-135. [PMID: 29735110 DOI: 10.1016/j.spen.2017.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pediatric movement disorders may present with psychiatric symptoms at many points during the course of the disease. For the relatively common pediatric movement disorder, Tourette syndrome, psychiatric comorbidities are well-described and treatment is well-studied. Managing these comorbidities may be more effective than improving the movements themselves. For more uncommon movement disorders, such as juvenile-onset Huntington disease, treatment of psychiatric comorbidities is not well-characterized, and best-practice recommendations are not available. For the least common movement disorders, such as childhood neurodegeneration with brain iron accumulation, psychiatric features may be nonspecific so that underlying diagnosis may be apparent only after recognition of other symptoms. However, psychiatric medication, psychotherapy, and psychosocial support for these disorders may prove helpful to many children and adolescents.
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Lochner C, Roos A, Stein DJ. Excoriation (skin-picking) disorder: a systematic review of treatment options. Neuropsychiatr Dis Treat 2017; 13:1867-1872. [PMID: 28761349 PMCID: PMC5522672 DOI: 10.2147/ndt.s121138] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Although pathological skin-picking has been documented in the medical literature since the 19th century, it has only recently been included as a distinct entity in psychiatric classification systems. In the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition and the proposed International Classification of Diseases, Eleventh Revision, excoriation (skin-picking) disorder (ED), also known as neurotic excoriation, psychogenic excoriation, or dermatillomania), is described as recurrent picking of skin, leading to skin lesions and significant distress or functional impairment. ED is listed as one of the obsessive-compulsive and related disorders, given its overlap with conditions such as trichotillomania (hair-pulling disorder). Arguably, its inclusion and delineation in the diagnostic nomenclature will lead to increased awareness of the condition, more research, and ultimately in treatment advances. This systematic review aims to provide readers with an up-to-date view of current treatment options for ED. A MEDLINE search of the ED treatment literature was conducted to collate relevant articles published between 1996 and 2017. The findings indicate that a number of randomized controlled trails on ED have now been published, and that current management options include behavioral therapy (habit reversal or acceptance-enhanced behavior therapy), and medication (selective serotonin reuptake inhibitors or N-acetyl cysteine).
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Affiliation(s)
- Christine Lochner
- SU/UCT MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, South Africa
| | - Annerine Roos
- SU/UCT MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, South Africa
| | - Dan J Stein
- SU/UCT MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
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Edwards KR, Specht M. A Review of the Literature Regarding Behavioral Therapy for Chronic Tic Disorders (CTDs): Where Do We Go from Here? CURRENT DEVELOPMENTAL DISORDERS REPORTS 2016. [DOI: 10.1007/s40474-016-0100-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Spieler C, Miltenberger R. Using awareness training to decrease nervous habits during public speaking. J Appl Behav Anal 2016; 50:38-47. [DOI: 10.1002/jaba.362] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 05/25/2016] [Indexed: 11/06/2022]
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Gilman R, Connor N, Haney M. A School-Based Application of Modified Habit Reversal for Tourette Syndrome Via a Translator. Behav Modif 2016; 29:823-38. [PMID: 16204418 DOI: 10.1177/0145445505279254] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A school-based modified habit reversal intervention was utilized with an adolescent diagnosed with Tourette syndrome who recently immigrated from Mexico. Because the student possessed little proficiency of the English language, an interpreterwas needed to help implement the procedure. The frequency of motor tics markedly decreased from baseline to intervention across classroom settings. Results of two follow-up phases revealed that motor tic levels remained below those observed in the baseline phase. Implications and limitations of these findings are noted.
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Affiliation(s)
- Rich Gilman
- Department of Counseling and Psychological Services, Georgia State University, Atlanta 30303-3083, USA.
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Abstract
Habit reversal (HR) is a multicomponent treatment for tic disorders. This case study incorporated elements of HR (awareness training, self-monitoring, response competition), combined with relaxation, as an intervention for vocal and motor tics in a 10-year-old boy with Tourette's syndrome (TS). Therapy was provided on an outpatient basis at a pediatric clinic. In-home data collection by the boy's mother documented decreased tic frequency during the course of treatment. Clinical improvement was maintained at a 3-month follow-up. These results support previous research demonstrating efficacy of simplified HR in controlling multiple tics associated with TS.
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Leclerc JB, O'Connor KP, J-Nolin G, Valois P, Lavoie ME. The Effect of a New Therapy for Children with Tics Targeting Underlying Cognitive, Behavioral, and Physiological Processes. Front Psychiatry 2016; 7:135. [PMID: 27563292 PMCID: PMC4980689 DOI: 10.3389/fpsyt.2016.00135] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/19/2016] [Indexed: 11/29/2022] Open
Abstract
Tourette disorder (TD) is characterized by motor and vocal tics, and children with TD tend to present a lower quality of life than neurotypical children. This study applied a manualized treatment for childhood tics disorder, Facotik, to a consecutive case series of children aged 8-12 years. The Facotik therapy was adapted from the adult cognitive and psychophysiological program validated on a range of subtypes of tics. This approach aims to modify the cognitive-behavioral and physiological processes against which the tic occurs, rather than only addressing the tic behavior. The Facotik therapy lasted 12-14 weeks. Each week 90-min session contained 20 min of parental training. The therapy for children followed 10 stages including: awareness training; improving motor control; modifying style of planning; cognitive and behavioral restructuring; and relapse prevention. Thirteen children were recruited as consecutive referrals from the general population, and seven cases completed therapy and posttreatment measures. Overall results showed a significant decrease in symptom severity as measured by the YGTSS and the TSGS. However, there was a discrepancy between parent and child rating, with some children perceiving an increase in tics, possibly due to improvement of awareness along therapy. They were also individual changes on adaptive aspects of behavior as measured with the BASC-2, and there was variability among children. All children maintained or improved self-esteem posttreatment. The results confirm the conclusion of a previous pilot study, which contributed to the adaptation of the adult therapy. In summary, the Facotik therapy reduced tics in children. These results underline that addressing processes underlying tics may complement approaches that target tics specifically.
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Affiliation(s)
- Julie B Leclerc
- Centre d'études troubles obsessionnels-compulsifs et tics, Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada; Laboratoire d'étude des troubles de l'ordre de la psychopathologie en enfance, Département de psychologie, Université du Québec à Montréal, Montreal, QC, Canada
| | - Kieron P O'Connor
- Centre d'études troubles obsessionnels-compulsifs et tics, Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada; Département de Psychiatrie, Université de Montréal, Montreal, QC, Canada
| | - Gabrielle J-Nolin
- Centre d'études troubles obsessionnels-compulsifs et tics, Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada; Laboratoire d'étude des troubles de l'ordre de la psychopathologie en enfance, Département de psychologie, Université du Québec à Montréal, Montreal, QC, Canada
| | - Philippe Valois
- Centre d'études troubles obsessionnels-compulsifs et tics, Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada; Laboratoire d'étude des troubles de l'ordre de la psychopathologie en enfance, Département de psychologie, Université du Québec à Montréal, Montreal, QC, Canada
| | - Marc E Lavoie
- Centre d'études troubles obsessionnels-compulsifs et tics, Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada; Département de Psychiatrie, Université de Montréal, Montreal, QC, Canada; Laboratoire de Psychophysiologie Cognitive et Sociale, Montreal, QC, Canada
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Mancuso C, Miltenberger RG. Using habit reversal to decrease filled pauses in public speaking. J Appl Behav Anal 2015; 49:188-92. [DOI: 10.1002/jaba.267] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 07/21/2015] [Indexed: 11/08/2022]
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Rudy BM, Lewin AB, Storch EA. Introduction to the Special Issue: Considerations of the Effects of Extra-Symptom Variables Among Youth With Chronic Tic Disorders and Tourette’s Syndrome. CHILDRENS HEALTH CARE 2015. [DOI: 10.1080/02739615.2014.948167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Cognitive behavior therapy (CBT) is considered a first-line intervention for obsessive-compulsive disorder (OCD) across the lifespan. Efficacy studies of CBT with exposure and response prevention suggest robust symptom reduction, often with sustained remission. Acceptability of CBT is high, and the treatment is devoid of adverse side effects. The primary mechanism of CBT is based on operant principles, specifically extinction learning. The efficacy of extinction-based treatments such as CBT is being shown for other obsessive-compulsive spectrum disorders. This article reviews the theoretic basis, clinical application, and relevant treatment outcome research for CBT and related therapies for several obsessive-compulsive spectrum disorders.
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Zawoyski AM, Bosch A, Vollmer TR, Walker SF. Evaluating the Effects of Matched and Unmatched Stimuli on Nail Biting in Typically Developing Children. Behav Modif 2014; 38:428-47. [DOI: 10.1177/0145445514541615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We evaluated the effects of matched and unmatched stimuli on nail biting for three typically developing children and adolescents. Antecedent-based assessments identified conditions when subjects were most likely to engage in nail biting. Treatment included the noncontingent delivery of four types of highly preferred stimuli: items hypothesized to match the oral, the tactile, or both the oral and tactile stimulation inherent to nail biting, as well as items that did not involve oral or tactile stimulation. Results suggested that all forms of alternative stimulation decreased nail biting.
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Affiliation(s)
| | - Amanda Bosch
- Sam Houston State University, Huntsville, TX, USA
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McGuire JF, Piacentini J, Brennan EA, Lewin AB, Murphy TK, Small BJ, Storch EA. A meta-analysis of behavior therapy for Tourette Syndrome. J Psychiatr Res 2014; 50:106-12. [PMID: 24398255 DOI: 10.1016/j.jpsychires.2013.12.009] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 11/30/2013] [Accepted: 12/18/2013] [Indexed: 10/25/2022]
Abstract
Individual randomized controlled trials (RCTs) of habit reversal training and a Comprehensive Behavioral Intervention for Tics (collectively referred to as behavior therapy, BT) have demonstrated efficacy in reducing tic severity for individuals with Tourette Syndrome and Chronic Tic Disorders (collectively referred to as TS), with no examination of treatment moderators. The present meta-analysis synthesized the treatment effect sizes (ES) of BT relative to comparison conditions, and examined moderators of treatment. A comprehensive literature search identified eight RCTs that met inclusion criteria, and produced a total sample of 438 participants. A random effects meta-analysis found a medium to large ES for BT relative to comparison conditions. Participant mean age, average number of therapy sessions, and the percentage of participants with co-occurring attention deficit hyperactivity disorder (ADHD) were found to moderate treatment effects. Participants receiving BT were more likely to exhibit a treatment response compared to control interventions, and identified a number needed to treat (NNT) of three. Sensitivity analyses failed to identify publication bias. Overall, BT trials yield medium to large effects for TS that are comparable to treatment effects identified by meta-analyses of antipsychotic medication RCTs. Larger treatment effects may be observed among BT trials with older participants, more therapeutic contact, and less co-occurring ADHD.
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Affiliation(s)
- Joseph F McGuire
- Department of Psychology, University of South Florida, 4202 E. Fowler Avenue, PCD 4118G, Tampa, FL 33620, USA; Department of Pediatrics, University of South Florida Tampa, FL, USA.
| | - John Piacentini
- Semel Institute of Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Erin A Brennan
- Department of Pediatrics, University of South Florida Tampa, FL, USA
| | - Adam B Lewin
- Department of Psychology, University of South Florida, 4202 E. Fowler Avenue, PCD 4118G, Tampa, FL 33620, USA; Department of Pediatrics, University of South Florida Tampa, FL, USA; Departments of Psychiatry and Behavioral Neurosciences, University of South Florida Tampa, FL, USA
| | - Tanya K Murphy
- Department of Pediatrics, University of South Florida Tampa, FL, USA; Departments of Psychiatry and Behavioral Neurosciences, University of South Florida Tampa, FL, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida Tampa, FL, USA
| | - Eric A Storch
- Department of Psychology, University of South Florida, 4202 E. Fowler Avenue, PCD 4118G, Tampa, FL 33620, USA; Department of Pediatrics, University of South Florida Tampa, FL, USA; Departments of Psychiatry and Behavioral Neurosciences, University of South Florida Tampa, FL, USA
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Ersser SJ, Cowdell F, Latter S, Gardiner E, Flohr C, Thompson AR, Jackson K, Farasat H, Ware F, Drury A. Psychological and educational interventions for atopic eczema in children. Cochrane Database Syst Rev 2014; 2014:CD004054. [PMID: 24399641 PMCID: PMC6457897 DOI: 10.1002/14651858.cd004054.pub3] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Psychological and educational interventions have been used as an adjunct to conventional therapy for children with atopic eczema to enhance the effectiveness of topical therapy. This is an update of the original Cochrane review. OBJECTIVES To assess the effect of psychological and educational interventions for atopic eczema in children. SEARCH METHODS We updated our searches of the following databases to January 2013: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2012, Issue 12), MEDLINE (from 1946), EMBASE (from 1974), OpenGrey, and PsycINFO (from 1806). We also searched six trials registers and checked the reference lists of included and excluded studies for further references to relevant randomised controlled trials (RCTs). SELECTION CRITERIA Randomised controlled trials of psychological or educational interventions, or both, used to assist children and their carers in managing atopic eczema. DATA COLLECTION AND ANALYSIS Three authors independently applied eligibility criteria, assessed trial quality, and extracted data. A lack of comparable data prevented data synthesis, and we were unable to conduct meta-analysis because there were insufficient data. MAIN RESULTS We included 10 RCTs, of which 5 were new to this update; all interventions were adjuncts to conventional therapy and were delivered in primary- and secondary-care settings. There were 2003 participants in the 9 educational interventions and 44 participants in the 1 psychological study. Some included studies had methodological weaknesses; for example, we judged four studies to have high risk of detection bias, attrition bias, or other bias. Our primary outcomes were participant-rated global assessment, reduction in disease severity (reported as objective SCORAD (SCORing Atopic Dermatitis)), and improvement in sleep and quality of life. No study reported participant-rated global assessment or improvement of sleep.The largest and most robust study (n = 992) demonstrated significant reduction in disease severity and improvement in quality of life, in both nurse- and dermatologist-led intervention groups. It provided six standardised, age-appropriate group education sessions. Statistically significant improvements in objective severity using the SCORAD clinical tool were recorded for all intervention groups when compared with controls. Improvements in objective severity (intervention minus no intervention) by age group were as follows: age 3 months to 7 years = 4.2, 95% confidence interval (CI) 1.7 to 6.8; age 8 to 12 years = 6.7, 95% CI 2.1 to 11.2; and age 13 to 18 years = 9.9, 95% CI 4.3 to 15.5. In three of five studies, which could not be combined because of their heterogeneity, the objective SCORAD measure was statistically significantly better in the intervention group compared with the usual care groups. However, in all of the above studies, the confidence interval limits do not exceed the minimum clinically important difference of 8.2 for objective SCORAD.The largest study measured quality of life using the German 'Quality of life in parents of children with atopic dermatitis' questionnaire, a validated tool with five subscales. Parents of children under seven years had significantly better improvements in the intervention group on all five subscales. Parents of children aged 8 to 12 years experienced significantly better improvements in the intervention group on 3 of the 5 subscales. AUTHORS' CONCLUSIONS This update has incorporated five new RCTs using educational interventions as an adjunct to conventional treatment for children with atopic eczema. We did not identify any further studies using psychological interventions. The inclusion of new studies has not substantially altered the conclusions from the original review. The educational studies in both the original review and this update lack detail about intervention design and do not use a complex interventions framework. Few use an explicit theoretical base, and the components of each intervention are not sufficiently well described to allow replication. A relative lack of rigorously designed trials provides limited evidence of the effectiveness of educational and psychological interventions in helping to manage the condition of atopic eczema in children. However, there is some evidence from included paediatric studies using different educational intervention delivery models (multiprofessional eczema interventions and nurse-led clinics) that these may lead to improvements in disease severity and quality of life. Educational and psychological interventions require further development using a complex interventions framework. Comparative evaluation is needed to examine their impact on eczema severity, quality of life, psychological distress, and cost-effectiveness. There is also a need for comparison of educational interventions with stand-alone psychosocial self-help.
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Affiliation(s)
- Steven J Ersser
- University of YorkDepartment of Health SciencesRoom ATB/249: 2nd Floor ‐ Area 5Seebohm Rowntree Building, HeslingtonYorkUKYO10 5DD
| | - Fiona Cowdell
- Birmingham City UniversityFaculty of Health, Education and Life SciencesCity South CampusWestbourne Road, EdgbastonBirminghamUKB15 3TN
| | - Sue Latter
- University of SouthamptonFaculty of Health SciencesBuilding 67HighfieldSouthamptonHampshireUKSO17 1BJ
| | - Eric Gardiner
- University of HullFaculty of Health and Social CareCottingham RoadHullUKHU6 7RX
| | - Carsten Flohr
- St Thomas' HospitalDepartment of Paediatric Dermatology and Children's AllergiesLambeth Palace RoadLondonUKSE1 7EH
| | | | - Karina Jackson
- Guy's and St Thomas' NHS Foundation Trust (and King's College London)St John's Institute of DermatologyGuy's HospitalLondonUKSE1 9RT
| | - Helen Farasat
- Bournemouth UniversityThe Centre for Wellbeing and Quality of LifeBournemouth House17 Christchurch RoadBournemouthUKBH1 3LH
| | - Fiona Ware
- University of HullLibrary and Learning InnovationCottingham RoadHullUKHU6 7RX
| | - Alison Drury
- The University of Nottinghamc/o Cochrane Skin GroupA103, King's Meadow CampusLenton LaneNottinghamUKNG7 2NR
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Cavalari RNS, DuBard M, Luiselli JK. Simplified Habit Reversal and Treatment Fading for Chronic Skin Picking in an Adolescent With Autism. Clin Case Stud 2013. [DOI: 10.1177/1534650113510348] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We evaluated the effects of simplified habit reversal (HR) that combined competing response training and differential reinforcement on skin picking by an adolescent female with autism attending a classroom at a specialized school. The competing response training procedure allowed her to manipulate preferred sensory stimuli independently and when instructed by classroom staff. Differential reinforcement included praise and tokens that she received following intervals without skin picking and when she performed competing response training. Compared with a baseline phase, skin picking decreased with simplified HR and during a subsequent phase when treatment was faded by implementing differential reinforcement without competing response training. We discuss the clinical implications of these findings.
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Rowe J, Yuen HK, Dure LS. Comprehensive behavioral intervention to improve occupational performance in children with Tourette disorder. Am J Occup Ther 2013; 67:194-200. [PMID: 23433274 DOI: 10.5014/ajot.2013.007062] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE. We evaluated the efficacy of a comprehensive behavioral intervention for tics (CBIT) program to reduce tic severity and improve occupational performance in children with tic disorder using a one-group pretest-posttest design. METHOD. Thirty children with tic disorder completed an eight-session CBIT program. The program focused on habit reversal, relaxation training, and function-based approaches to address how the environment and social situations (antecedents and consequences) sustain or influence tic severity. RESULTS. We observed significant reduction in the number of tics and improvement in scores on the Parent Tic Questionnaire, Subjective Units of Distress Scale, and Child Occupational Self Assessment after CBIT compared with scores at baseline. CONCLUSION. Findings provided support that CBIT reduced the number of tic expressions, tic severity, and level of distress associated with tic and improved these children's self-perception of their competence in and importance of performing everyday activities (i.e., occupational performance).
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Affiliation(s)
- Jan Rowe
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
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Lavoie ME, Leclerc J, O’Connor KP. Bridging neuroscience and clinical psychology: cognitive behavioral and psychophysiological models in the evaluation and treatment of Gilles de la Tourette syndrome. NEUROPSYCHIATRY 2013; 3:75-87. [PMID: 24795782 PMCID: PMC4006829 DOI: 10.2217/npy.12.70] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Cognitive neuroscience and clinical psychology have long been considered to be separate disciplines. However, the phenomenon of brain plasticity in the context of a psychological intervention highlights the mechanisms of brain compensation and requires linking both clinical cognition and cognitive psychophysiology. A quantifiable normalization of brain activity seems to be correlated with an improvement of the tic symptoms after cognitive behavioral therapy in patients with Gilles de la Tourette syndrome (GTS). This article presents broad outlines of the state of the current literature in the field of GTS. We present our clinical research model and methodology for the integration of cognitive neuroscience in the psychological evaluation and treatment of GTS to manage chronic tic symptoms.
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Affiliation(s)
- Marc E Lavoie
- Département de Psychiatrie, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche Fernand Seguin, Hôpital Louis-H Lafontaine, 7331 Hochelaga, Montréal, QC, H1N 3V2, Canada
| | - Julie Leclerc
- Centre de Recherche Fernand Seguin, Hôpital Louis-H Lafontaine, 7331 Hochelaga, Montréal, QC, H1N 3V2, Canada
- Département de Psychologie, Université de Québec à Montréal, QC, Canada
| | - Kieron P O’Connor
- Département de Psychiatrie, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche Fernand Seguin, Hôpital Louis-H Lafontaine, 7331 Hochelaga, Montréal, QC, H1N 3V2, Canada
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Ottoboni G, Iacono M. An integrative body therapy approach: The Neo-Functionalism approach. BODY MOVEMENT AND DANCE IN PSYCHOTHERAPY 2013. [DOI: 10.1080/17432979.2012.749813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Capriotti MR, Brandt BC, Ricketts EJ, Espil FM, Woods DW. Comparing the effects of differential reinforcement of other behavior and response-cost contingencies on tics in youth with Tourette syndrome. J Appl Behav Anal 2013; 45:251-63. [PMID: 22844135 DOI: 10.1901/jaba.2012.45-251] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 12/05/2011] [Indexed: 10/27/2022]
Abstract
Tics are rapid, repetitive, stereotyped movements or vocalizations that arise from neurobiological dysfunction and are influenced by environmental factors. Although persons with tic disorders often experience aversive social reactions in response to tics, little is known about the behavioral effects of such consequences. Along several dimensions, the present study compared the effects of two treatments on tics: response cost (RC) and differential reinforcement of other behavior (DRO). Four children with Tourette syndrome were exposed to free-to-tic baseline, DRO, RC, and quasibaseline rebound evaluation conditions using an alternating treatments design. Both DRO and RC produced substantial decreases in tics from baseline levels. No differential effects of DRO and RC contingencies were seen on self-reported stress or in the strength of the reflexive motivating operation (i.e., premonitory urge) believed to trigger tics, and neither condition produced tic-rebound effects. Implications of these findings and directions for future research are discussed.
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Bayer JB, Campbell SW. Texting while driving on automatic: Considering the frequency-independent side of habit. COMPUTERS IN HUMAN BEHAVIOR 2012. [DOI: 10.1016/j.chb.2012.06.012] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Leclerc J, O’Connor K, Forget J, Lavoie M. Évaluation de l’effet d’un programme d’entraînement à l’autogestion des épisodes explosifs chez des enfants atteints du syndrome de Gilles de la Tourette. PRAT PSYCHOL 2012. [DOI: 10.1016/j.prps.2010.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bate KS, Malouff JM, Thorsteinsson ET, Bhullar N. The efficacy of habit reversal therapy for tics, habit disorders, and stuttering: A meta-analytic review. Clin Psychol Rev 2011; 31:865-71. [DOI: 10.1016/j.cpr.2011.03.013] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2010] [Revised: 01/28/2011] [Accepted: 03/29/2011] [Indexed: 10/18/2022]
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Abstract
A variety of treatment approaches have been used to manage tic symptoms in Tourette syndrome and other tic disorders. Pharmacological interventions remain the most common approach, but in the past 3 decades, various nonpharmacological treatment options have emerged including: (1) massed practice, (2) relaxation training, (3) self-monitoring, (4) function-based/contingency management procedures, (5) habit reversal training, (6) exposure and response prevention, and (7) cognitive behavior therapy. Each of these procedures is described along with the evidence reflecting its efficacy and usefulness. A synthesis of the findings and implications is provided, including directions and recommendations for future treatment and research.
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Affiliation(s)
- Shana A Franklin
- Psychology Department, The University of Wisconsin-Milwaukee, 224 Garland Hall, 2441 East Hartford Avenue, Milwaukee, WI 53211, USA
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Bryson WJ, Edwards CL, Sommer DB, Scott BL. Integrated Behavior Therapy in the Treatment of Complicated Tourette’s Disorder and Its Comorbidities. Clin Case Stud 2010. [DOI: 10.1177/1534650110368261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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.
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Affiliation(s)
- W. Jeff Bryson
- Duke University Medical Center, Durham, NC, Jacksonville State University, Jacksonville, AL
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Bryson WJ, Edwards CL, Sommer DB, Scott BL. Integrated Behavior Therapy in the Treatment of Complicated Tourette’s Disorder and Its Comorbidities. Clin Case Stud 2010. [DOI: 10.1177/1534650109357929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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 female with severe, lifelong GTS complicated by OCD, inattention, impulsivity, disinhibition, mood disturbances, generalized anxiety, and pain secondary to motor tics. Habit reversal therapy (HRT) was used with full body relaxation conditioned as a competitive response to target her tics, anxiety, and pain simultaneously. The patient demonstrated significant reduction of symptoms and improvement in psychosocial status within four sessions. She was able to maintain this status at a 3 month follow-up session. Aspects of case conceptualization and therapeutic technique are discussed.
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Walther MR, Ricketts EJ, Conelea CA, Woods DW. Recent Advances in the Understanding and Treatment of Trichotillomania. J Cogn Psychother 2010; 24:46-64. [PMID: 26658787 PMCID: PMC4674792 DOI: 10.1891/0889-8391.24.1.46] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Trichotillomania (TTM), or chronic hair pulling, is associated with significant levels of distress and impairment. While research is in its infancy, more data are accumulating regarding the impact, phenomenology, maintaining variables, etiology, and treatment of TTM. Behavior therapy and clomipramine have been moderately effective in reducing TTM symptoms in clinical trials. Enhancing behavior therapy with techniques designed to address TTM patients' emotional control tendencies (e.g., acceptance-based procedures) represents a promising direction in treating TTM.
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Cognitive behavioral treatment to improve adherence to hemodialysis fluid restrictions: a case report. Case Rep Med 2009; 2009:835262. [PMID: 20069105 PMCID: PMC2801524 DOI: 10.1155/2009/835262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2009] [Accepted: 11/05/2009] [Indexed: 11/17/2022] Open
Abstract
This case report describes outpatient psychological treatment targeting adherence to fluid restrictions in a hemodialysis patient. The consequences of nonadherence to fluid restrictions in hemodialysis patients range from minor discomfort to increased hospitalizations and mortality rates. In addition, when patients chronically fail to adhere, they may no longer be candidates for kidney transplant. The interventions focused on polydipsia, characterized by excessive fluid intake. The methods involved 11-sessions of individual psychotherapy incorporating strategies including increasing awareness, decreasing motivation, increasing effort, engaging in competing events, conducting thought stopping, breaking repetitive routines, eliciting social support, and receiving reinforcement. Results demonstrated that the patient successfully restricted his fluid intake at or below recommended levels 83% of days after fading of treatment began. This case report demonstrates the success of cognitive behavioral treatment strategies with a nonpsychiatric hemodialysis patient.
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Tourette's syndrome, trichotillomania, and obsessive-compulsive disorder: how closely are they related? Psychiatry Res 2009; 170:32-42. [PMID: 19801170 DOI: 10.1016/j.psychres.2008.06.008] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2007] [Revised: 08/24/2007] [Accepted: 06/12/2008] [Indexed: 11/22/2022]
Abstract
The question of whether Tourette's syndrome (TS) and trichotillomania (TTM) are best conceptualized as obsessive-compulsive spectrum disorders was raised by family studies demonstrating a close relationship between TS and obsessive-compulsive disorder (OCD), and by psychopharmacological research indicating that both TTM and OCD respond more robustly to clomipramine than to desipramine. A range of studies have subsequently allowed comparison of the phenomenology, psychobiology, and management of TS and TTM, with that of OCD. Here we briefly review this literature. The data indicate that there is significant psychobiological overlap between TS and OCD, supporting the idea that TS can be conceptualized as an OCD spectrum disorder. TTM and OCD have only partial overlap in their phenomenology and psychobiology, but there are a number of reasons for why it may be useful to classify TTM and other habit disorders as part of the obsessive-compulsive spectrum of disorders.
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Shumaker DM. Habit Reversal Treatment of Repetitive Hand Writing in a 7-Year-Old Child with a Learning Disability. Clin Case Stud 2009. [DOI: 10.1177/1534650109335503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Habit reversal (HR) is a cognitive—behavioral treatment for tic disorders, Tourette syndrome, stereotypic movements, and habit disorders. This case study utilizes aspects of habit reversal, including awareness training, self-monitoring, and competing response training, as an intervention for obsessive—compulsive repetitive air handwriting in a 7-year-old girl with a significant learning disability. Therapy is provided on an outpatient basis in a private practice setting. Analysis of in-home, at-school, and in-session data collected by the parents, teacher, and therapist show decreased frequency in repetitive handwriting. Supplemental and cojoint administration of antianxiety medication extinguishes all obsessive handwriting within a 6-month period. These results support previous research demonstrating the efficacy of cojoint cognitive—behavioral and medication treatment of acute obsessive—compulsive symptomatology in children.
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Kuhn D, Hagopian L, Terlonge C. Treatment of life-threatening self-injurious behavior secondary to hereditary sensory and autonomic neuropathy type II: a controlled case study. J Child Neurol 2008; 23:381-8. [PMID: 18184934 DOI: 10.1177/0883073807309236] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although self-injurious behavior is present in all subtypes of hereditary sensory and autonomic neuropathy, the literature has not sufficiently addressed the issue of treatment of self-injury in this population. Therefore, the purpose of the current case study was to describe a method for assessing and treating self-injurious behavior associated with hereditary sensory and autonomic neuropathies. This study was conducted with an 11-year-old boy diagnosed with hereditary sensory and autonomic neuropathy type II admitted to an inpatient behavioral unit over a 4-month period. A simplified version of a habit reversal treatment was used, consisting of awareness training, self-monitoring, competing responses, and social support. Treatment resulted in a 98% reduction in the rate of self-injurious behavior relative to pretreatment baseline rates. This case study illustrates that behavioral interventions may be a viable option for treating self-injury secondary to hereditary sensory and autonomic neuropathies.
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Affiliation(s)
- David Kuhn
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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O'Connor KP, Lavoie ME, Stip E, Borgeat F, Laverdure A. Cognitive-behaviour therapy and skilled motor performance in adults with chronic tic disorder. Neuropsychol Rehabil 2008; 18:45-64. [PMID: 18058387 DOI: 10.1080/09602010701390835] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The first aim of the present study was to compare performance of people with tic disorders (TD) and controls on executive function and a range of skilled motor tests requiring complex performance, guided movements, hand co-ordination, and fine control of steadiness. The second aim was to investigate the effect of cognitive behaviour therapy (CBT) on motor performance. A total of 55 patients with TD were recruited at baseline from participants in a behavioural management programme. A comparison group of 55 patients suffering from a variety of habit disorders (HD) involving complex manual movements, were matched on age and level of education to 34 non-psychiatric controls. Participants were evaluated pre- and post-treatment and post-waitlist with a neuropsychological evaluation focusing on executive function (Wisconsin Card Sorting Test, WCST) and skilled motor performance (Purdue Pegboard, Hole Steadiness Test, and the Groove Test). Results revealed WCST scores in the normal range, while motor performance differed significantly on the Purdue Pegboard Tests in both TD and HD as compared to the control group. Cognitive-behavioural treatment selectively improved motor performance in both clinical groups compared to waitlist control, and this improvement related to clinical outcome measures.
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Affiliation(s)
- Kieron P O'Connor
- Centre de recherche Fernand-Seguin, Hôpital Louis-H. Lafontaine, Montréal, Québec, Canada.
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