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Effect of behavior therapy for Tourette's disorder on psychiatric symptoms and functioning in adults

  • Joseph F. McGuire (a1), Emily J. Ricketts (a2), Lawrence Scahill (a3), Sabine Wilhelm (a4), Douglas W. Woods (a5), John Piacentini (a2), John T. Walkup (a6) and Alan L. Peterson (a7) (a8) (a9)...



Although behavior therapy reduces tic severity, it is unknown whether it improves co-occurring psychiatric symptoms and functional outcomes for adults with Tourette's disorder (TD). This information is essential for effective treatment planning. This study examined the effects of behavior therapy on psychiatric symptoms and functional outcomes in older adolescents and adults with TD.


A total of 122 individuals with TD or a chronic tic disorder participated in a clinical trial comparing behavior therapy to psychoeducation and supportive therapy. At baseline, posttreatment, and follow-up visits, participants completed assessments of tic severity, co-occurring symptoms (inattention, impulsiveness, hyperactivity, anger, anxiety, depression, obsessions, and compulsions), and psychosocial functioning. We compared changes in tic severity, psychiatric symptoms, and functional outcomes using repeated measure and one-way analysis of variance.


At posttreatment, participants receiving behavior therapy reported greater reductions in obsessions compared to participants in supportive therapy ( $\eta _p^2 $ = 0.04, p = 0.04). Across treatments, a positive treatment response on the Clinical Global Impression of Improvement scale was associated with a reduced disruption in family life ( $\eta _p^2 $ = 0.05, p = 0.02) and improved functioning in a parental role ( $\eta _p^2 $ = 0.37, p = 0.02). Participants who responded positively to eight sessions of behavior therapy had an improvement in tic severity ( $\eta _p^2 $ = 0.75, p < 0.001), inattention ( $\eta _p^2 $ = 0.48, p < 0.02), and functioning ( $\eta _p^2 $ = 0.39–0.42, p < 0.03–0.04) at the 6-month follow-up.


Behavior therapy has a therapeutic benefit for co-occurring obsessive symptoms in the short-term, and reduces tic severity and disability in adults with TD over time. Additional treatments may be necessary to address co-occurring symptoms and improve functional outcomes.


Corresponding author

Author for correspondence: Joseph F. McGuire, E-mail:


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American Psychiatric Association (2013) Diagnostic and Statistic Manual of Mental Disorders. Arlington, VA: American Psychiatric Publishing.
Beck, AT, Epstein, N, Brown, G and Steer, RA (1988) An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology 56, 893897.
Beck, AT, Steer, RA and Brown, GK (1996) Beck depression inventory-II. San Antonio 78, 490498.
Bloch, MH and Leckman, JF (2009) Clinical course of Tourette syndrome. Journal of Psychosomatic Research 67, 497501.
Bloch, MH, Peterson, BS, Scahill, L, Otka, J, Katsovich, L, Zhang, H and Leckman, JF (2006) Adulthood outcome of tic and obsessive-compulsive symptom severity in children with Tourette syndrome. Archives of Pediatric and Adolescent Medicine 160, 6569.
Cavanna, AE, David, K, Bandera, V, Termine, C, Balottin, U, Schrag, A and Selai, C (2013) Health-related quality of life in Gilles de la Tourette syndrome: a decade of research. Behavioural Neurology 27, 8393.
Deckersbach, T, Rauch, S, Buhlmann, U and Wilhelm, S (2006) Habit reversal versus supportive psychotherapy in Tourette's disorder: a randomized controlled trial and predictors of treatment response. Behaviour Research and Therapy 44, 10791090.
DuPaul, GJ, Power, TJ, McGoey, KE, Ikeda, MJ and Anastopoulos, AD (1998) Reliability and validity of parent and teacher ratings of attention-deficit/hyperactivity disorder symptoms. Journal of Psychoeducational Assessment 16, 5568.
Eapen, V, Snedden, C, Črnčec, R, Pick, A and Sachdev, P (2016) Tourette syndrome, co-morbidities and quality of life. Australian & New Zealand Journal of Psychiatry 50, 8293.
Elstner, K, Selai, CE, Trimble, MR and Robertson, MM (2001) Quality of life (QoL) of patients with Gilles de la Tourette's syndrome. Acta Psychiatrica Scandinavica 103, 5259.
Evans, J, Seri, S and Cavanna, AE (2016) The effects of Gilles de la Tourette syndrome and other chronic tic disorders on quality of life across the lifespan: a systematic review. European Child & Adolescent Psychiatry 25, 939948.
Goodman, W, Price, L, Rasmussen, S, Mazure, C, Fleischmann, R, Hill, C, Heninger, G and Charney, D (1989) The Yale-Brown Obsessive Compulsive Scale: development, use and reliability. Archives of General Psychiatry 46, 10061011.
Groth, C, Debes, NM, Rask, CU, Lange, T and Skov, L (2017) Course of Tourette syndrome and comorbidities in a large prospective clinical study. Journal of the American Academy of Child & Adolescent Psychiatry 56, 304312.
Guy, W (1976) ECDEU Assessment Manual for Psychopharmacology. Rockville, MD: National Institute for Mental Health.
Haddad, A, Umoh, G, Bhatia, V and Robertson, M (2009) Adults with tourette's syndrome with and without attention deficit hyperactivity disorder. Acta Psychiatrica Scandinavica 120, 299307.
Hewitt, PL and Norton, GR (1993) The beck anxiety inventory: a psychometric analysis. Psychological Assessment 5, 408412.
Hirschtritt, ME, Lee, PC, Pauls, DL, Dion, Y, Grados, MA, Illmann, C, King, RA, Sandor, P, McMahon, WM and Lyon, GJ (2015) Lifetime prevalence, age of risk, and genetic relationships of comorbid psychiatric disorders in Tourette syndrome. JAMA Psychiatry 72, 325333.
Jalenques, I, Galland, F, Malet, L, Morand, D, Legrand, G, Auclair, C, Hartmann, A, Derost, P and Durif, F (2012) Quality of life in adults with Gilles de la Tourette Syndrome. BMC Psychiatry 12, 109.
Jeon, S, Walkup, JT, Woods, DW, Peterson, A, Piacentini, J, Wilhelm, S, Katsovich, L, McGuire, JF, Dziura, J and Scahill, L (2013) Detecting a clinically meaningful change in tic severity in Tourette syndrome: a comparison of three methods. Contemporary Clinical Trials 36, 414420.
Knight, T, Steeves, T, Day, L, Lowerison, M, Jette, N and Pringsheim, T (2012) Prevalence of tic disorders: a systematic review and meta-analysis. Pediatric Neurology 47, 7790.
Leckman, JF, Riddle, MA, Hardin, MT and Ort, SI (1989) The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. Journal of the American Academy of Child & Adolescent Psychiatry 28, 566573.
Leon, A, Shear, MK, Portera, L and Klerman, G (1992) Assessing impairment in patients with panic disorder: the Sheehan Disability Scale. Social Psychiatry and Psychiatric Epidemiology 27, 7882.
Lievaart, M, Franken, IH and Hovens, JE (2016) Anger assessment in clinical and nonclinical populations: further validation of the State–Trait Anger Expression Inventory-2. Journal of Clinical Psychology 72, 263278.
McGuire, JF, Nyirabahizi, E, Kircanski, K, Piacentini, J, Peterson, AL, Woods, DW, Wilhelm, S, Walkup, JT and Scahill, L (2013) A cluster analysis of tic symptoms in children and adults with Tourette syndrome: clinical correlates and treatment outcome. Psychiatry Research 210, 11981204.
McGuire, JF, Arnold, E, Park, JM, Nadeau, JM, Lewin, AB, Murphy, TK and Storch, EA (2014) Living with tics: reduced impairment and improved quality of life for youth with chronic tic disorders. Psychiatry Research 225, 571579.
McGuire, JF, Piacentini, J, Storch, EA, Murphy, TK, Ricketts, EJ, Woods, DW, Walkup, JW, Peterson, AL, Wilhelm, S, Lewin, AB, McCracken, JT, Leckman, JF and Scahill, L (2018) A multicenter examination and strategic revisions of the Yale Global Tic Severity Scale. Neurology 90, e1711e1719.
Miguel, EC, Coffey, BJ, Baer, L, Savage, CR, Rauch, SL and Jenike, MA (1995) Phenomenology of intentional repetitive behaviors in obsessive-compulsive disorder and Tourette's disorder. The Journal of clinical psychiatry 56, 246255.
Müller‐Vahl, K, Dodel, I, Müller, N, Münchau, A, Reese, JP, Balzer‐Geldsetzer, M, Dodel, R and Oertel, WH (2010) Health‐related quality of life in patients with Gilles de la Tourette's syndrome. Movement Disorders 25, 309314.
Murphy, TK, Lewin, AB, Storch, EA and Stock, S (2013) Practice parameter for the assessment and treatment of children and adolescents with tic disorders. Journal of the American Academy of Child and Adolescent Psychiatry 52, 13411359.
Peterson, AL, McGuire, JF, Wilhelm, S, Piacentini, J, Woods, DW, Walkup, JT, Hatch, JP, Villarreal, R and Scahill, L (2016) An empirical examination of symptom substitution associated with behavior therapy for Tourette's Disorder. Behavior Therapy 47, 2941.
Piacentini, J, Woods, DW, Scahill, L, Wilhelm, S, Peterson, AL, Chang, S, Ginsburg, GS, Deckersbach, T, Dziura, J, Levi-Pearl, S and Walkup, JT (2010) Behavior therapy for children with Tourette disorder: a randomized controlled trial. Journal of the American Medical Association 303, 19291937.
Scahill, L, Riddle, MA, McSwiggin-Hardin, M, Ort, SI, King, RA, Goodman, WK, Cicchetti, D and Leckman, JF (1997) Children's Yale-Brown obsessive compulsive scale: reliability and validity. Journal of the American Academy of Child & Adolescent Psychiatry 36, 844852.
Scahill, L, Chappell, P, Kim, Y, Schultz, R, Katsovich, L, Shepherd, E, Arnsten, A, Cohen, D and Leckman, J (2001) Guanfacine in the treatment of children with tic disorders and ADHD: a placebo-controlled study. American Journal of Psychiatry 158, 10671074.
Scharf, JM, Miller, LL, Gauvin, CA, Alabiso, J, Mathews, CA and Ben-Shlomo, Y (2015) Population prevalence of Tourette syndrome: a systematic review and meta-analysis. Movement Disorders 30, 221228.
Skinner, H, Steinhauer, PD and Santa-Barbara, J (1995). Family Assessment Measure III (FAM III). New York: Multi-Health Systems Inc.
Spielberger, CD (1999) STAXI-2: State-Trait Anger Expression Inventory-2: Professional Manual. Odessa, FL: Psychological Assessment Resources.
Steer, RA and Beck, AT (1997) Beck Anxiety Inventory.
Steer, RA, Kumar, G, Ranieri, WF and Beck, AT (1998) Use of the beck depression inventory-II with adolescent psychiatric outpatients. Journal of Psychopathology and Behavioral Assessment 20, 127137.
Storch, E, Murphy, T, Geffken, G, Sajid, M, Allen, P, Roberti, J and Goodman, W (2005) Reliability and validity of the Yale Global Tic Severity Scale. Psychological Assessment 17, 486491.
Storch, EA, De Nadai, AS, Lewin, AB, McGuire, JF, Jones, AM, Mutch, PJ, Shytle, RD and Murphy, TK (2011) Defining treatment response in pediatric tic disorders: a signal detection analysis of the Yale Global Tic Severity Scale. Journal of Child and Adolescent Psychopharmacology 21, 621627.
Storch, EA, Morgan, JE, Caporino, NE, Brauer, L, Lewin, AB, Piacentini, J and Murphy, TK (2012) Psychosocial treatment to improve resilience and reduce impairment in youth with tics: an intervention case series of eight youth. Journal of Cognitive Psychotherapy 26, 5770.
Sukhodolsky, DG, Woods, DW, Piacentini, J, Wilhelm, S, Peterson, AL, Katsovich, L, Dziura, J, Walkup, JT and Scahill, L (2017) Moderators and predictors of response to behavior therapy for tics in Tourette syndrome. Neurology 88, 10291036.
Thibert, AL, Day, HI and Sandor, P (1995) Self-concept and self-consciousness in adults with Tourette syndrome. The Canadian Journal of Psychiatry 40, 3539.
Weissman, MM, Prusoff, BA, Thompson, WD, Harding, PS and Myers, JK (1978) Social adjustment by self-report in a community sample and in psychiatric outpatients. Journal of Nervous and Mental Disease 166, 317326.
Wilens, TE, Biederman, J, Prince, J and Spencer, TJ (1996) Six-week, double-blind, placebo-controlled study of desipramine for adult attention deficit hyperactivity disorder. The American Journal of Psychiatry 153, 11471153.
Wilhelm, S, Peterson, AL, Piacentini, J, Woods, DW, Deckersbach, T, Sukhodolsky, DG, Chang, S, Liu, H, Dziura, J, Walkup, JT and Scahill, L (2012) Randomized trial of behavior therapy for adults with Tourette syndrome. Archives of General Psychiatry 69, 795803.
Woods, DW, Piacentini, J, Chang, SW, Deckersbach, T, Ginsburg, GS, Peterson, AL, Scahill, LD, Walkup, JT and Wilhelm, S (2008) Managing Tourette Syndrome: A Behavioral Intervention for Children and Adolescents. New York: Oxford University Press.
Woods, DW, Piacentini, JC, Scahill, L, Peterson, AL, Wilhelm, S, Chang, S, Deckersbach, T, McGuire, J, Specht, M, Conelea, CA, Rozenman, M, Dzuria, J, Liu, H, Levi-Pearl, S and Walkup, JT (2011) Behavior therapy for tics in children: acute and long-term effects on psychiatric and psychosocial functioning. Journal of Child Neurology 26, 858865.


Effect of behavior therapy for Tourette's disorder on psychiatric symptoms and functioning in adults

  • Joseph F. McGuire (a1), Emily J. Ricketts (a2), Lawrence Scahill (a3), Sabine Wilhelm (a4), Douglas W. Woods (a5), John Piacentini (a2), John T. Walkup (a6) and Alan L. Peterson (a7) (a8) (a9)...


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