Behavioral Treatment – Habit Reversal Therapy (AKA HRT or CBIT) for Tourette Syndrome (TS)
The behavioral treatment for tics is called Habit Reversal Therapy (HRT). The newest version of HRT is called Comprehensive Behavioral Intervention for Tics (CBIT). The treatment teaches individuals with tics management strategies that can decrease selected tics over time. It can work well in combination with or as an alternative option to medications for tics. Below are the answers to several common questions about this treatment. Also, more information about HRT can be found in my sections on Common Concerns about HRT and on the Environmental Cuing of Tics.
Who does HRT work for? There is good scientific evidence that HRT works well for children, adolescents and adults with TS. The current published researched focuses on children who are 8 years old or older. However, within my clinic, the TS Program at Rutgers University, we have done some successful slightly modified HRT treatments with children as young as 5. Ideally, the person who has tics gains motivation to practice HRT strategies outside of treatment sessions. As ADHD can result in difficulties with motivation, HRT can be more challenging (but still successful) for individuals with ADHD (or other difficulties that interfere with motivation). In addition, the treatment works best for individuals who are aware of the urges that come before their tics (see section on Premonitory Urges); a big part of treatment will focus on increasing this awareness.
How does HRT work? HRT teaches three main skills for the management of selected tics. First, Awareness Training helps individuals to consistently recognize cues that a tic is about to happen before it happens. Second, Stimulus Control allows individuals to make changes that can reduce the urge to tic in situations where tics are high. Third, Competing Response Training teaches individuals to replace their tics with incompatible actions that serve as alternatives to tics helping to hold back a tic until the urge to tic decreases. Sounds easy, right? Indeed, learning the basic ideas of HRT is pretty straightforward. Professional expertise is required to navigate all of the unpredictable challenges that arise within most HRT treatments. In an ideal treatment, an individual learns two things: First, they learn specific HRT strategies that reduce current problematic tics. Second, they learn the general ideas for how to apply HRT, becoming experts at managing future tics.
Where do I go to get HRT? It is best to receive HRT from a psychologist or other counselor who has expertise in TS and specialized training in HRT or CBIT. As a psychologist with considerable experience in providing HRT and in training other clinicians on how to do HRT, I know how much the treatment can improve the quality of life for someone with disruptive tics. I encourage individuals with tics, parents of children with tics, and doctors with experience in providing medication for tics to see if there are nearby clinicians with expertise in HRT who could be helpful for problematic tics. If you have concerns about HRT as treatment, please see Addressing Common Concerns about HRT.