Behavioral interventions for tic disorders

Behavioral interventions are now recommended within evidence-based treatment guidelines as an alternative or adjunct to medication for the management of tic disorders (TD). The behavioral model of TD conceptualizes tics as neurologic based yet modifiable behaviors that are influenced by internal and external contextual antecedents and tic-contingent consequences. The behavioral interventions with the strongest empirical support are habit reversal training (HRT), an expanded version of HRT referred to as comprehensive behavioral intervention for tics (CBIT), and a version of exposure and response prevention (ERP) adapted from an evidence-based cognitive-behavioral intervention for obsessive-compulsive disorder. Each of these interventions involves teaching volitional tic suppression and environmental modifications aimed at reducing contextual worsening of tics. In this chapter, we review the behavioral model of TD, the core components of HRT, CBIT, and ERP, and discuss their supporting evidence base. We then briefly review several persistent and unfounded concerns and misunderstandings regarding behavior interventions for TD that inhibit adoption among some professionals and patients. Finally, despite evidence supporting their efficacy, access to behavior therapies for TD remains limited. We conclude with a review of existing and emerging approaches aimed at increasing dissemination and implementation and future directions for research.