Perceived Negative Effects of Tic Management Strategies in Adults With Tic Disorders

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.

Behavioral Interventions for Children and Adults with Tic Disorder

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.

Public speaking disfluencies: A review of habit reversal training and research

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.

Decreasing nervous habits during public speaking: A component analysis of awareness training

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.

Serious and enduring anorexia nervosa from a developmental point of view: How to detect potential risks at an early stage and prevent chronic illness?

This commentary on serious and enduring anorexia nervosa adopts the position of a developmental psychiatrist. It argues that this perspective illuminates the etiology and course of severe and enduring anorexia nervosa (SE-AN) and could thus help to develop treatments targeting typical early characteristics of patients with SE-AN. Based on a detailed knowledge of contributing factors, a risk score for SE-AN should be designed by which the probability of chronicity could be calculated at an early stage and preventive measures be taken. As the formation of habits seems to play an important role in establishing a chronic course of AN, psychotherapeutic techniques that include "habit reversal" should be considered during the early stage. Another recommended step in preventing SE-AN is the identification of resilience factors that are associated with a late favorable outcome.

Reducing risky behavior with habit reversal: A review of behavioral strategies to reduce habitual hand-to-head behavior

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.

Comprehensive behavioral treatment for an adult with sensory-based trichotillomania: An illustrative case study

Trichotillomania (TTM) is a poorly understood condition that causes significant impairment, but effective behavioral management strategies exist. The phenomenology of TTM is complex and requires an individualized treatment approach, and there are some important facets of TTM that have only recently been recognized. Specifically, contemporary research indicates that hair pulling is often performed to regulate aversive sensations and provide somatosensory reward. In this article, we describe the complex phenomenology of TTM, evidence-based treatment options, and illustrate a case of sensory-based TTM treated effectively with a comprehensive behavioral intervention.

Targeting habits in anorexia nervosa: a proof-of-concept randomized trial

BACKGROUND

Habits are behavioral routines that are automatic and frequent, relatively independent of any desired outcome, and have potent antecedent cues. Among individuals with anorexia nervosa (AN), behaviors that promote the starved state appear habitual, and this is the foundation of a recent neurobiological model of AN. In this proof-of-concept study, we tested the habit model of AN by examining the impact of an intervention focused on antecedent cues for eating disorder routines.

METHODS

The primary intervention target was habit strength; we also measured clinical impact via eating disorder psychopathology and actual eating. Twenty-two hospitalized patients with AN were randomly assigned to 12 sessions of either Supportive Psychotherapy or a behavioral intervention aimed at cues for maladaptive behavioral routines, Regulating Emotions and Changing Habits (REaCH).

RESULTS

Covarying for baseline, REaCH was associated with a significantly lower Self-Report Habit Index (SRHI) score and significantly lower Eating Disorder Examination-Questionnaire (EDE-Q) global score at the end-of-treatment. The end-of-treatment effect size for SRHI was d = 1.28, for EDE-Q was d = 0.81, and for caloric intake was d = 1.16.

CONCLUSIONS

REaCH changed habit strength of maladaptive routines more than an active control therapy, and targeting habit strength yielded improvement in clinically meaningful measures. These findings support a habit-based model of AN, and suggest habit strength as a mechanism-based target for intervention.

A Preliminary Investigation of Metacognitive Therapy and Habit Reversal as a Treatment for Trichotillomania

BACKGROUND

Not all patients suffering from trichotillomania (TTM) recover completely using CBT and of those that do, only a few maintain their recovery over time.

AIMS

The purpose of the present study was to investigate the effectiveness of metacognitive methods combined with habit reversal (MCT/HRT) in trichotillomania with a relatively long-term follow-up.

METHOD

A case series (n = 8) and a randomized wait-list controlled trial (n = 34) design were conducted in this study. In the case series, three of the eight patients dropped out of the study. Therefore, TTM-related symptoms were evaluated in five patients suffering from TTM before and after brief metacognitive plus habit reversal therapy during 1-month, 6-month, and 12-month follow-ups. The treatment consisted of detached mindfulness (DM) techniques, ritual postponement and habit reversal training (HRT) in eight sessions.

RESULTS

All patients were responders at post-treatment in case series. After the 12-month follow-up, the results were associated with higher pre-treatment levels of self-esteem and global functioning and lower pre-treatment levels of depression and anxiety with nearly complete abstinence from hair pulling immediately after treatment. A randomized wait-list controlled trial with experimental (n = 17) and waiting list group (n = 17) was then conducted to confirm the case series results. There were significant differences between the two groups regarding changes in MGH-HPS, Y-BOCS-TM, RSES, GAF, BDI, BAI and self-monitoring. Therefore, the MCT/HRT treatment was found to be more effective than the waiting list group.

CONCLUSIONS

A combined treatment including metacognitive and habit reversal techniques is remarkably effective in patients with TTM.

Treating Trichotillomania (Hair-Pulling Disorder) in a Child

Although cognitive behavioral treatments (CBTs) have been recommended as first-line interventions for trichotillomania (hair-pulling disorder [HPD]), research on CBT for young children with HPD is limited. We illustrate the use of family-based CBT for HPD in an 8-year-old boy. The client had a 5-year history of chronic HPD and several large bald spots on the crown of his head. Treatment primarily comprised habit reversal training (HRT) and function-based interventions. The child showed significant improvement in HPD severity and impairment after 8 weekly sessions, although complete abstinence was not achieved. The findings underscore the importance of parental involvement in the treatment and show that children as young as 8 years of age can successfully use strategies taught in HRT.

Counselling and self-management therapies for temporomandibular disorders: a systematic review

The aim of this review was to investigate the effectiveness of counselling and other self-management-based therapies on muscle and temporomandibular joint (TMJ) pain relief and increasing the functional abilities of patients with temporomandibular disorders (TMD). A systematic literature review was conducted by three independent reviewers and included articles published up to 2012. PubMed and Cochrane Library electronic databases were used in addition to hand-searching to assess clinical outcomes for counselling and self-management approaches for TMD treatment. The review yielded 581 records that were narrowed down to 7. All included studies were classified as blind-randomized controlled clinical trials. The selected articles analysed revealed that counselling was able to improve tenderness upon masticatory muscle palpation and maximum mouth opening with and without pain in patients with TMD, with similar results to those of interocclusal appliances approaches. Thus, counselling- and self-management-based therapies could be considered a conservative low-cost and beneficial treatment alternative for treating TMD to potentially improve psychological domains and remove harmful behaviours for the control of the signs and symptoms of TMD.

The effects of awareness training on tics in a young boy with Tourette syndrome, Asperger syndrome, and attention deficit hyperactivity disorder

Previous research has shown habit reversal training (HRT) to be effective in reducing tics. In some studies, tics have been reduced by implementing only a few components of HRT. The current study investigated the first step, awareness training, for treating tics in a young boy with Asperger syndrome, Tourette syndrome, and attention deficit hyperactivity disorder. The results showed a reduction in all tics.

Psychological interventions in dermatology

The objective of this paper is to introduce and emphasize the importance of psychological interventions for those with dermatological conditions. In keeping with the current literature, the author envisages a two-tier approach in the provision of such psychological interventions. Firstly, most patients with dermatology conditions may not require psychological change. Instead, they could be approached with effective doctor–patient communication skills, within a context of empathy and positive regard. At the second tier, however, based on the clinical interview, some patients may require varying degrees of psychological change in order to better manage their illness. In such a context, a dermatologist with training in psychotherapy would be required. In the absence of such a person, the patient may be referred to a psychologist or another mental health professional trained in psychotherapy.

Cognitive-behavioral therapy for childhood repetitive behavior disorders: tic disorders and trichotillomania

This article provides an overview of cognitive-behavioral therapy (CBT) for repetitive behavior disorders. Because tic disorders and trichotillomania are the most often studied and most debilitating of these conditions, this article focuses on the efficacy of CBT for these 2 conditions. An overview of CBT for children presenting with these concerns is provided. This review focuses particularly on habit reversal training, which is at the core of most CBT-based interventions. Two recent empirical studies on the immense potential of CBT in treating childhood repetitive behavior disorders and future areas of research are also discussed.