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Bootes KR, Himle MB, Stiede JT, Wellen BCM, Mouton-Odum S, Woods DW. Predictors of Impairment and Self-Concept in Children and Adolescents with Persistent Tic Disorder. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01696-0. [PMID: 38619754 DOI: 10.1007/s10578-024-01696-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/16/2024]
Abstract
This study examined predictors of, and associations between, self-concept, demographic variables, and clinical measures in fifty-eight children and adolescents with Persistent Tic Disorder (PTD; 44 males, Mage = 11.9 years, SD = 2.74). Participants completed measures that assessed self-concept, tic severity, tic-related impairment, and comorbid psychological symptoms. Results showed that generalized anxiety disorder, major depressive disorder, persistent depressive disorder, total tic severity, number and complexity of tics, and total and social tic-related impairment were associated with self-concept. Tic-related social impairment mediated the relationship between tic severity and self-concept. Exploratory analyses found that total tic severity, motor tic severity, and vocal tic severity, as well as the number, intensity, and interference of tics predicted social tic-related impairment. Results suggest that treatments to reduce the number and complexity of tics, with additional focus on navigating social interactions, may serve to decrease tic severity and impairment, and in turn, improve self-concept.
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Affiliation(s)
- Kirsten R Bootes
- Department of Psychology, the University of Utah, 380 S. 1530 E. Room 1316, Salt Lake City, UT, 84112, USA.
| | - Michael B Himle
- Department of Psychology, the University of Utah, 380 S. 1530 E. Room 1316, Salt Lake City, UT, 84112, USA
| | - Jordan T Stiede
- Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Brianna C M Wellen
- Department of Psychology, the University of Utah, 380 S. 1530 E. Room 1316, Salt Lake City, UT, 84112, USA
| | | | - Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, WI, USA
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2
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Barber KE, Pitts BX, Stiede JT, Espil FM, Woods DW, Specht MW, Bennett SM, Walkup JT, Ricketts EJ, McGuire JF, Peterson AL, Compton SN, Wilhelm S, Scahill L, Piacentini JC. Perceived Negative Effects of Tic Management Strategies in Adults With Tic Disorders. Behav Modif 2024:1454455241236446. [PMID: 38557310 DOI: 10.1177/01454455241236446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Behavior therapy is a well-established and empirically supported treatment for tic disorders (TDs). However, concerns have been expressed about the negative effects of behavioral interventions, such as tic worsening, tic substitution, and excessive effort. This study explored perceived negative effects of tic management strategies in adults with TDs and predictors of these experiences. Participants (N = 72) completed semi-structured interviews 11 years after receiving behavior therapy or supportive therapy in a randomized clinical trial. We examined responses to interview questions about managing tics and predictors of reported negative effects. Most participants did not experience tic worsening (84%) or tic substitution (75%) from tic management strategies. The majority felt they could manage tics while participating in their environment (87%) and did not report life interference from tic management (77%). About half (45%) felt less present when managing tics. Treatment non-responders in the original trial were more likely to report negative effects of tic management strategies. No differences in reported negative consequences were found between those who received behavior therapy versus supportive therapy, suggesting that behavior therapy specifically does not lead to such adverse effects. These findings could reduce misconceptions about behavior therapy for TDs and enhance its acceptability and utilization.
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Affiliation(s)
| | | | | | | | | | | | | | - John T Walkup
- Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Emily J Ricketts
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | | | - Alan L Peterson
- The University of Texas Health Science Center at San Antonio, San Antonio, USA
| | | | | | - Lawrence Scahill
- Emory University School of Medicine Marcus Center, Atlanta, GA, USA
| | - John C Piacentini
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
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3
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Church MJ, Mangen KH, Stiede JT, Spencer SD, Storch EA. The role of between-session homework in cognitive-behavioral therapy for comorbid obsessive-compulsive disorder and autism: A case vignette. J Clin Psychol 2024; 80:855-870. [PMID: 37561065 PMCID: PMC10858296 DOI: 10.1002/jclp.23580] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/26/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE Cognitive-behavioral therapy (CBT), which includes a decided emphasis on exposure and response/ritual prevention (ERP) and between-session practice of treatment principles, has consistently demonstrated efficacy for the treatment of obsessive-compulsive disorder (OCD) and is a gold standard, recommended first-line treatment. CBT with ERP has been successfully adapted to fit the needs of autistic individuals with OCD. The present article provides a brief overview of CBT for OCD and outlines special considerations and adaptations needed when working with patients with OCD and comorbid autism, with an emphasis on the importance of between-session homework. METHOD A case vignette is presented. RESULTS This case study illustrates the role of homework in the exposure-based treatment of an adult autistic individual with comorbid OCD. CONCLUSION Implications of this case vignette are discussed, and recommendations are offered for clinicians working with autistic individuals with OCD, especially in regard to bolstering completion of between-session ERP homework.
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Affiliation(s)
- Molly J Church
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Katie H Mangen
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Jordan T Stiede
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Samuel D Spencer
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
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4
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Stiede JT, Spencer SD, Onyeka O, Mangen KH, Church MJ, Goodman WK, Storch EA. Obsessive-Compulsive Disorder in Children and Adolescents. Annu Rev Clin Psychol 2023; 20. [PMID: 38100637 DOI: 10.1146/annurev-clinpsy-080822-043910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Obsessive-compulsive disorder (OCD) in children and adolescents is a neurobehavioral condition that can lead to functional impairment in multiple domains and decreased quality of life. We review the clinical presentation, diagnostic considerations, and common comorbidities of pediatric OCD. An overview of the biological and psychological models of OCD is provided along with a discussion of developmental considerations in youth. We also describe evidence-based treatments for OCD in childhood and adolescence, including cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) and pharmacotherapy. Finally, research evaluating the delivery of CBT in different formats and modalities is discussed, and we conclude with suggestions for future research directions. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 20 is May 2024. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Jordan T Stiede
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA;
| | - Samuel D Spencer
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA;
| | - Ogechi Onyeka
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA;
| | - Katie H Mangen
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA;
| | - Molly J Church
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA;
| | - Wayne K Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA;
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA;
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5
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Shiu C, Chen W, Kim B, Ricketts E, Stiede JT, Espil FM, Specht MW, Woods DW, Piacentini J. The Roles of Lifetime Enacted Stigma in Tic Symptoms among Young Adults with Tourette Syndrome. Mov Disord Clin Pract 2023; 10:1759-1768. [PMID: 38094654 PMCID: PMC10715356 DOI: 10.1002/mdc3.13900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/24/2023] [Accepted: 10/04/2023] [Indexed: 02/01/2024] Open
Abstract
Background Although rarely framed as enacted stigma, adults with Tourette syndrome (ATS) have long suffered from discrimination associated with their tic symptoms. Given the high stress levels of enacted stigma that ATS experience, it is expected that their tic symptoms are profoundly impacted. However, the evidence linking enacted stigma to ATS's tic symptoms remains limited. Methods This study used a secondary data-analysis approach to reanalyze the data from the follow-up phase of a multi-centered, randomized controlled trial in which a behavioral intervention was tested for its efficacy in managing tic symptoms. This study first conducted psychometric testing on a list of 16 enacted stigma events across five life stages and identified the underlying factor structure. The Yale Global Tic Severity Scale (YGTSS) was used to assess severity and impairment of current tic symptoms, whereas the Clinical Global Impression of Severity scale (CGI) was used to obtain the gestalt of clinical judgment on tic severity. A series of multivariate linear models were then fitted to test the relationships between different types of lifetime enacted stigma and current tic symptoms. Results The analytic sample included 73 young ATS (average age of 23.2 [standard deviation = 2.5] years). The factor analysis identified three types of enacted stigmas: "traumatic events," "confrontations," and "subtle mistreatments." In multivariate models, traumatic events significantly associated with YGTSS-severity, whereas subtle mistreatments provided additional explanations for CGI. Conclusions Enacted stigma may play important roles in shaping ATS's current tics symptom severity and, therefore, should be carefully considered in future intervention development.
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Affiliation(s)
- Chengshi Shiu
- Department of Social Work and Taiwan Social Resilient Research CenterNational Taiwan UniversityTaipeiTaiwan
- School of NursingUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Wei‐Ti Chen
- School of NursingUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Boram Kim
- School of NursingUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Emily Ricketts
- Department of PsychologyMarquette UniversityMilwaukeeWisconsinUSA
| | - Jordan T. Stiede
- Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonTexasUSA
- Department of Psychiatry and Biobehavioral SciencesUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Flint M. Espil
- Department of Psychiatry and Behavioral SciencesStanford UniversityStanfordCaliforniaUSA
| | | | - Douglas W. Woods
- Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonTexasUSA
| | - John Piacentini
- Department of PsychologyMarquette UniversityMilwaukeeWisconsinUSA
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6
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Stiede JT, Trent ES, Viana AG, Guzick AG, Storch EA, Hershfield J. Cognitive Behavioral Therapy for Children and Adolescents with Anxiety Disorders. Child Adolesc Psychiatr Clin N Am 2023; 32:543-558. [PMID: 37201966 DOI: 10.1016/j.chc.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Anxiety disorders are the most common class of psychiatric conditions among children and adolescents. The cognitive behavioral model of childhood anxiety has a strong theoretic and empirical foundation that provides the basis for effective treatment. Cognitive behavioral therapy (CBT), with an emphasis on exposure therapy, is the gold standard treatment for childhood anxiety disorders, with strong empirical support. A case vignette demonstrating CBT for childhood anxiety disorders in practice, as well as recommendations for clinicians, are also provided.
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Affiliation(s)
- Jordan T Stiede
- Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX 77030, USA.
| | - Erika S Trent
- University of Houston, 4849 Calhoun Road, Room 373, Houston, TX 77204, USA
| | - Andres G Viana
- University of Houston, 4849 Calhoun Road, Room 373, Houston, TX 77204, USA
| | - Andrew G Guzick
- Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX 77030, USA
| | - Eric A Storch
- Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX 77030, USA
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7
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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8
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Spencer SD, Stiede JT, Wiese AD, Guzick AG, Cervin M, McKay D, Storch EA. Things that make you go Hmm: Myths and misconceptions within cognitive-behavioral treatment of obsessive-compulsive disorder. J Obsessive Compuls Relat Disord 2023; 37:100805. [PMID: 37193037 PMCID: PMC10168610 DOI: 10.1016/j.jocrd.2023.100805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
The past four decades have yielded a robust body of evidence supporting the efficacy and effectiveness of cognitive-behavioral therapy (CBT) as a gold-standard treatment for obsessive-compulsive disorder (OCD) across the lifespan. Exposure and response prevention (E/RP) has been identified as a key component of this approach. Despite robust research support for CBT with E/RP, several myths and misconceptions continue to proliferate in both research and practice settings. Such myths and misconceptions are concerning, as they lack empirical basis, may hinder widespread dissemination and implementation of CBT for OCD, and run contrary to the practice of evidence-based psychological medicine. Focusing on the importance of promoting evidence-based practice and generative clinical science, the present review article synthesizes relevant research within the field of treatments for OCD to address the following myths / misconceptions: (a) uncertainty exists concerning the evidence base supporting CBT for OCD, (b) E/RP attrition and dropout rates are unacceptably high due to excessive risk and perceived patient intolerability, and (c) alternative treatments for OCD need to be expeditiously developed due to major limitations of E/RP. Recommendations for future research and clinical dissemination and implementation to further advance a generative clinical science of OCD treatment are discussed.
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Affiliation(s)
- Samuel D. Spencer
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Jordan T. Stiede
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Andrew D. Wiese
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Andrew G. Guzick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Matti Cervin
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Department of Clinical Sciences Lund, Lund University, Lund Sweden
| | - Dean McKay
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - Eric A. Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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9
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Spencer SD, Stiede JT, Wiese AD, Goodman WK, Guzick AG, Storch EA. Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder. Psychiatr Clin North Am 2023; 46:167-180. [PMID: 36740350 DOI: 10.1016/j.psc.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Obsessive-compulsive disorder (OCD) is characterized by the presence of debilitating obsessions and compulsions. Cognitive and behavioral models of OCD provide a strong theoretic and empirical foundation for informing effective psychotherapeutic treatment. Cognitive-behavioral therapy (CBT) for OCD, which includes a deliberate emphasis on exposure and response/ritual prevention, has consistently demonstrated robust efficacy for the treatment of pediatric and adult OCD and is the front-line psychotherapeutic treatment for OCD. Two case vignettes describing CBT for OCD in practice as well as recommendations for clinicians are provided.
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Affiliation(s)
- Samuel D Spencer
- Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX 77030, USA.
| | - Jordan T Stiede
- Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX 77030, USA
| | - Andrew D Wiese
- Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX 77030, USA
| | - Wayne K Goodman
- Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX 77030, USA
| | - Andrew G Guzick
- Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX 77030, USA
| | - Eric A Storch
- One Baylor Plaza, MS:350, 1977 Butler Boulevard, Houston, TX 77030, USA
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10
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Ricketts EJ, Woods DW, Espil FM, McGuire JF, Stiede JT, Schild J, Yadegar M, Bennett SM, Specht MW, Chang S, Scahill L, Wilhelm S, Peterson AL, Walkup JT, Piacentini J. Childhood Predictors of Long-Term Tic Severity and Tic Impairment in Tourette's Disorder. Behav Ther 2022; 53:1250-1264. [PMID: 36229120 PMCID: PMC9872160 DOI: 10.1016/j.beth.2022.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 05/29/2022] [Accepted: 07/07/2022] [Indexed: 01/26/2023]
Abstract
Tics peak in late childhood and decline during adolescence. Yet, for some with Tourette's disorder, tics persist into adulthood. We evaluated childhood predictors of adult tic severity and tic impairment, and change over time. Eighty adolescents/adults were evaluated 11 years following a randomized-controlled trial of behavior therapy. An independent evaluator rated tic severity and tic impairment at baseline, posttreatment, and long-term follow-up. At baseline, parents completed demographics/medical history, and youth tic, internalizing, and externalizing symptom ratings. Youth rated premonitory urge severity and family functioning. After controlling for prior tic treatment effects, female sex and higher tic severity predicted higher tic severity in adulthood; and female sex, no stimulant medication use, higher tic severity, and poorer family functioning predicted higher tic impairment. Higher tic severity and premonitory urge severity predicted smaller reductions in tic severity, whereas higher externalizing symptoms predicted greater reduction in tic severity. Female sex predicted smaller reduction in tic impairment, and externalizing symptoms predicted greater reduction in tic impairment. Female sex and childhood tic severity are important predictors of tic severity and tic impairment in adulthood. Family functioning, premonitory urge severity, and tic severity are important modifiable targets for early or targeted intervention to improve long-term outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - John T Walkup
- Ann and Robert H. Lurie Children's Hospital of Chicago; Northwestern University Feinberg School of Medicine
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11
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Espil FM, Woods DW, Specht MW, Bennett SM, Walkup JT, Ricketts EJ, McGuire JF, Stiede JT, Schild JS, Chang SW, Peterson AL, Scahill L, Wilhelm S, Piacentini JC. Long-term Outcomes of Behavior Therapy for Youth With Tourette Disorder. J Am Acad Child Adolesc Psychiatry 2022; 61:764-771. [PMID: 34508805 DOI: 10.1016/j.jaac.2021.08.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 08/06/2021] [Accepted: 09/01/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine the long-term durability of behavior therapy for tics among youth with Tourette disorder and persistent (chronic) motor or vocal tic disorders. METHOD Of the 126 youth who participated in a randomized controlled trial of behavior therapy 11 years prior, 80 were recruited for this longitudinal follow-up. Consenting participants were interviewed in person or remotely (Web-based video) by trained evaluators to determine the course of tics, current tic severity, and tic-related impairment. Recruitment and data collection occurred between 2014 and 2019, with an average follow-up duration of 11.2 years. RESULTS Treatment responders to both conditions in the original trial achieved partial, but not full, tic remission. Tic severity also decreased significantly across the sample, with 40% reporting partial remission. Behavior therapy responders (n = 21) in the original trial were more likely (67%) to achieve remission at follow-up (Total Tic Score = 12.52, SD = 10.75) compared to psychoeducation/supportive therapy responders (n = 6, 0%) at follow-up (Total Tic Score = 20.67, SD = 6.92) on the Yale Global Tic Severity Scale. Tic-related impairment decreased across the sample, with no significant differences between treatment groups or responders. CONCLUSION Despite limitations of unmeasured variables and veracity of self-report at follow-up, this study supports guidelines recommending behavior therapy as the first-line intervention for tics. Further investigation of behavior therapy as an early preventive intervention also merits attention.
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Affiliation(s)
| | | | | | | | - John T Walkup
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Emily J Ricketts
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - Joseph F McGuire
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Susanna W Chang
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - Alan L Peterson
- University of Texas Health Sciences Center at San Antonio, Texas
| | | | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard School of Medicine, Boston, Massachusetts
| | - John C Piacentini
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
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12
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Stiede JT, Woods DW, Idnani AK, Pritchard J, Klobe K, Kumar S. Pilot trial of a technology assisted treatment for trichotillomania. J Obsessive Compuls Relat Disord 2022; 33:100726. [PMID: 37305101 PMCID: PMC10256116 DOI: 10.1016/j.jocrd.2022.100726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The present study examined the usability, acceptability, feasibility, and preliminary efficacy of a prototype wrist-worn motion detection device and accompanying mobile app, developed by HabitAware®, as a system for delivering self-administered Habit Reversal Training (HRT). As an exploratory aim, the effect of the device and HRT app combination was compared to a reminder bracelet. The pilot trial included 15 adults with trichotillomania who interacted with the device and app system (n = 10) or reminder bracelet (n = 5) for 4 weeks. Participants in the device and app condition reported high usability, acceptability, and perceived efficacy of the system. The device and HRT app combination reduced hair pulling severity. Individuals in the reminder bracelet condition also showed a significant improvement in hair pulling. A future efficacy study with a larger sample size, longer timeframe, and improved gesture detection algorithm is warranted.
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13
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Ramsey KA, De Nadai AS, Espil FM, Ricketts E, Stiede JT, Schild J, Specht MW, Woods DW, Bennet S, Walkup JT, Chang S, Piacentini J, McGuire JF. Urge intolerance predicts tic severity and impairment among adults with Tourette syndrome and chronic tic disorders. Front Psychiatry 2022; 13:929413. [PMID: 36032236 PMCID: PMC9399515 DOI: 10.3389/fpsyt.2022.929413] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/11/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Individuals with Tourette Syndrome and Persistent Tic Disorders (collectively TS) often experience premonitory urges-aversive physical sensations that precede tics and are temporarily relieved by tic expression. The relationship between tics and premonitory urges plays a key role in the neurobehavioral treatment model of TS, which underlies first-line treatments such as the Comprehensive Behavioral Intervention for Tics (CBIT). Despite the efficacy of CBIT and related behavioral therapies, less than 40% of adults with TS respond to these treatments. Further examination of the relationship between premonitory urges, tic severity, and tic impairment can provide new insights into therapeutic targets to optimize behavioral treatment outcomes. This study examined whether urge intolerance-difficulty tolerating premonitory urges-predicted tic severity and tic-related impairment among adults with TS. METHODS Participants were 80 adults with TS. Assessments characterized premonitory urge, distress tolerance, tic severity, and tic impairment. We used structural equation modeling (SEM) to examine the construct of urge intolerance-comprised of premonitory urge ratings and distress tolerance ratings. We first evaluated a measurement model of urge intolerance through bifactor modeling, including tests of the incremental value of subfactors that reflect premonitory urge severity and distress tolerance within the model. We then evaluated a structural model where we predicted clinician-rated tic severity and tic impairment by the latent variable of urge intolerance established in our measurement model. RESULTS Analyses supported a bifactor measurement model of urge intolerance among adults with TS. Consistent with theoretical models, higher levels of urge intolerance predicted greater levels of clinician-rated tic severity and tic impairment. CONCLUSION This investigation supports the construct of urge intolerance among adults with TS and distinguishes it from subcomponents of urge severity and distress tolerance. Given its predictive relationship with tic severity and tic impairment, urge intolerance represents a promising treatment target to improve therapeutic outcomes in adults with TS.
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Affiliation(s)
- Kesley A Ramsey
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Center for OCD, Anxiety, and Related Disorders for Children (COACH), Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Flint M Espil
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Emily Ricketts
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, United States
| | - Jordan T Stiede
- Department of Psychology, Behavior Therapy and Research Lab, Marquette University, Milwaukee, WI, United States
| | - Jennifer Schild
- Department of Psychology, Choices Youth Psychopathology Lab, Suffolk University, Boston, MA, United States
| | - Matthew W Specht
- Department of Psychiatry, Weill-Cornell Medicine, New York, NY, United States
| | - Douglas W Woods
- Department of Psychology, Behavior Therapy and Research Lab, Marquette University, Milwaukee, WI, United States
| | - Shannon Bennet
- Department of Psychiatry, Weill-Cornell Medicine, New York, NY, United States
| | - John T Walkup
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Susanna Chang
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, United States
| | - John Piacentini
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, United States
| | - Joseph F McGuire
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Center for OCD, Anxiety, and Related Disorders for Children (COACH), Johns Hopkins University School of Medicine, Baltimore, MD, United States
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14
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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Abstract
It is not clear whether the development of tics can be prevented. Contextual variables can impact tic expression; therefore, shifting attention to behaviors that reduce tics is an important part of decreasing tic severity. Several medications are effective in reducing tic severity, but side effects restrict their use. Behavioral treatment is the gold standard psychotherapy intervention for tic disorders, with Comprehensive Behavioral Intervention for Tics being the most well-supported nonpharmacological treatment. Although children may be unable to prevent the development of tics, they can still use several strategies to reduce tic severity and impairment.
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Affiliation(s)
- Jordan T Stiede
- Psychology Department, Marquette University, Cramer Hall, 307, PO Box 1881, Milwaukee, WI 53201-1881, USA
| | - Douglas W Woods
- Marquette University, Holthusen Hall, 305, PO Box 1881, Milwaukee, WI 5320-1881, USA.
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16
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Ricketts EJ, Snorrason I, Kircanski K, Alexander JR, Stiede JT, Thamrin H, Flessner CA, Franklin ME, Keuthen NJ, Walther MR, Piacentini J, Stein DJ, Woods DW. A latent profile analysis of age of onset in trichotillomania. Ann Clin Psychiatry 2019; 31:169-178. [PMID: 31369656 PMCID: PMC9528732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Trichotillomania (TTM) onset may occur across the lifespan; however, adolescent onset is most frequently reported. Several studies have explored clinical differences between TTM age-of-onset groups with mixed results. We investigated empirically defined age-of-onset groups in adults with TTM, and clinical differences between groups. METHODS Participants included 1,604 adult respondents to an internet survey who endorsed DSM-IV-TR TTM criteria. Latent profile analysis was performed to identify TTM age-of-onset subgroups, which were then compared on demographic and clinical features. RESULTS The most optimal model was a 2-class solution comprised of a large group with average TTM onset during adolescence (n = 1,539; 95.9% of the sample; mean age of onset = 12.4) and a small group with average onset in middle adulthood (n = 65; 4.1% of the sample; mean age of onset = 35.6). The late-onset group differed from the early-onset group on several clinical variables (eg, less likely to report co-occurring bodyfocused repetitive behaviors). CONCLUSIONS Findings suggest the presence of at least 2 distinct TTM age-of-onset subgroups: an early-onset group with onset during adolescence, and a late-onset group with onset in middle adulthood. Future research is needed to further validate these subgroups and explore their clinical utility.
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Affiliation(s)
- Emily J Ricketts
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90024-5055 USA. E-MAIL:
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17
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Stiede JT, Alexander JR, Wellen B, Bauer CC, Himle MB, Mouton-Odum S, Woods DW. Differentiating tic-related from non-tic-related impairment in children with persistent tic disorders. Compr Psychiatry 2018; 87:38-45. [PMID: 30195099 PMCID: PMC6240497 DOI: 10.1016/j.comppsych.2018.07.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 11/20/2022] Open
Abstract
Children with persistent (chronic) tic disorders (PTDs) experience impairment across multiple domains of functioning, but given high rates of other non-tic-related conditions, it is often difficult to differentiate the extent to which such impairment is related to tics or to other problems. The current study used the Child Tourette's Syndrome Impairment Scale - Parent Report (CTIM-P) to examine parents' attributions of their child's impairment in home, school, and social domains in a sample of 58 children with PTD. Each domain was rated on the extent to which the parents perceived that impairment was related to tics versus non-tic-related concerns. In addition, the Yale Global Tic Severity Scale (YGTSS) was used to explore the relationship between tic-related impairment and tic severity. Results showed impairment in school and social activities was not differentially attributed to tics versus non-tic-related impairment, but impairment in home activities was attributed more to non-tic-related concerns than tics themselves. Moreover, tic severity was significantly correlated with tic-related impairment in home, school, and social activities, and when the dimensions of tic severity were explored, impairment correlated most strongly with motor tic complexity. Results suggest that differentiating tic-related from non-tic-related impairment may be clinically beneficial and could lead to treatments that more effectively target problems experienced by children with PTDs.
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Affiliation(s)
- Jordan T Stiede
- Marquette University, 604 N. 16th St., Milwaukee, WI 53233, United States of America
| | - Jennifer R Alexander
- Marquette University, 604 N. 16th St., Milwaukee, WI 53233, United States of America
| | - Brianna Wellen
- University of Utah, 201 Presidents Cir., Salt Lake City, UT 84112, United States of America
| | - Christopher C Bauer
- Marquette University, 604 N. 16th St., Milwaukee, WI 53233, United States of America
| | - Michael B Himle
- University of Utah, 201 Presidents Cir., Salt Lake City, UT 84112, United States of America
| | - Suzanne Mouton-Odum
- Psychology Houston, PC, 7660 Woodway, Suite 599, Houston, TX 77063, United States of America
| | - Douglas W Woods
- Marquette University, 604 N. 16th St., Milwaukee, WI 53233, United States of America.
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