This post is part of a series of guest posts on GPS by the graduate students in my Psychopathology course during Spring 2014. As part of their work for the course, each student had to demonstrate mastery of the skill of “Educating the Public about Mental Health.” To that end, each student has to prepare two 1,000ish word posts on a particular class of mental disorders, with one of those focusing on evidence-based treatments for those disorders and the other focused on a particular myth or misunderstanding about mental illness.
Evidence-based Treatments for Tourette’s Syndrome by Bear Wilkerson
Tourette’s Syndrome (TS, also called Tourette’s Disorder) is a tic disorder that is commonly (but inaccurately) known as that “cussing disease” where people walk around blurting out obscenities involuntarily. Although this type of vocal tic (known as coprolalia) can exist, it is actually quite rare as a symptom of Tourette’s disorder, with perhaps 10-15% of those with TS displaying it.
So if it’s not just cussing and shit, what exactly is Tourette’s? The Center for Disease Control and Prevention uses the APA’s DSM-5 definition, which states that for a person to receive a diagnosis of TS they must have both motor and vocal tics that have been existent for longer than one year and began before the age of eighteen. These tics also cannot be the result of any medical conditions or due to any substances an individual is taking. The full definition can be found here. TS differs from the other motor disorders because it requires the presence of both motor and vocal tics.
Many treatment options exist for TS, but there are actually only a few evidence-based treatment options out there. These options include one type of treatment that mysteriously finds its way onto the “evidence-based, effective treatments list” time and time again across different mental disorders. What could this “miracle drug” or snake-oil possibly be? Low and behold, it is something called Cognitive Behavioral Therapy (CBT)! Who would have ever guessed that something as simple as training an individual to know when some type of maladaptive thinking is present and what to do could be successful? Hmmm, it is almost as if rational thought plays a key in adhering to society’s mental health standards.
CBT specifically designed for patients with motor disorders, like TS, is known as Comprehensive Behavioral Intervention for Tics (CBIT). Information and commonly asked questions about CBIT can be found here, but the basics are that CBIT is centered around three major principles:
- Training the patient to be aware of tics
- Training patients to do competing behavior when they feel the urge to tic
- Making changes in daily activities in ways that can be helpful in reducing tics.
CBIT has been shown to effectively reduce the number of tics an individual experiences but also tic-related impairment. In one study, researchers recorded an average of an over 30% drop in number of tics exhibited by patients. This study also was the first study of its type to include children that were taking medication (roughly 38% of the participants). The results found in this study have numerous clinical implications. This study allowed for the expansion of available treatment options of motor-related disorders. This study also illustrated that CBIT can aid in the development of skills that raise self-efficacy and self-reliance, which in turn raises an individual’s overall feelings of self-worth. Finally, this study shows the relevance of behavioral therapy which can be taught to many individuals whom otherwise may not qualify to administer other kinds of treatment. This really expands the number of persons available to treat those individuals suffering from motor disorders.
As mentioned before, this type of treatment can be administered by most individuals after just a couple training sessions. As a matter of fact, The Tourette’s Syndrome Association’s Behavior Therapy Institute provides programs and classes that teach people how to administer CBIT to individuals with motor disorders. The below video explains why CBIT works and how it is performed.
As mentioned, in the above study, CBIT can be administered in concordance with medication and although there isn’t any medication that alleviates TS completely, there are some medications that can be used to help reduce tics and or which can be given to patients who are suffering from another condition such as depression or anxiety. Although, most advocates of behavioral therapy don’t believe in medication as a sole means of combatting a medical condition, the majority don’t mind if it is supplemented correctly with therapy. The Tourette’s Syndrome Association has helpfully compiled a list of medications that can be used for various symptoms of TS based on comorbid conditions.
Evidence-based treatment options like those described above are, surprisingly, not the go-to fixes when dealing with most disorders in mental health, with many clinicians not practicing evidence-based treatment. With something as stressful for families and patients like motor disorders it isn’t hard to see why patients seek treatment any way that can. Unfortunately, a lot of the time they receive nothing more than a smaller bank account and more stress. The Tourette’s Syndrome Association understands the frustration of these victims but states that evidence-based treatment is the only type of treatment someone should be seeking. I don’t intend to stand on a soapbox with this blog post but I feel it is important for those with motor disorders, like myself, to seek treatment that can actually help rather than buy “Mr. Haney’s Snake Oil”.
Finally, for those of you who don’t understand exactly what life is like for an individual with TS, the following video does a really good job of illustrating the stress and difficulties that come along with it.