Studies seek better understanding and treatment of depression

AUGUSTA, Ga. – Connecting the dots between two molecules whose levels are decreased in depression and increased by current antidepressants could yield new therapies, researchers say. Serotonin is a neurotransmitter that enables brain cells to communicate and brain-derived neurotropic factor, or BDNF, is a brain-nourishing molecule that also aids connectivity. Popular antidepressants such as Prozac, developed to increase levels of serotonin, have recently been found to also increase BDNF levels, said Dr. Anilkumar Pillai, neuroscientist at the Medical College of Georgia at Georgia Health Sciences University. "We don't know how the molecule, serotonin, which is well-studied in depression, regulates BDNF signaling," Pillai said. He's principal investigator on a five year, $1.5 million grant from the National Institute of Mental Health to help him make the connection He suspects a critical piece is the protein transglutaminase 2, or TG2, expressed by brain cells and most other cell types. TG2 plays a role in natural serotonin recycling and potentially is a factor in the serotonin deficiency associated with depression. It also may help explain why levels of serotonin and BDNF seem to rise and fall in sync, Pillai said. TG2 coverts serotonin to Rac1, a protein that helps rejuvenate BDNF receptors, which typically sit on the surface of brain cells but must periodically move inside to reinvigorate. Depression appears to upset the balance of these complex, critical inner workings. Pillai hypothesizes that the high levels he has found in depression, likely result in too much serotonin conversion leaving too little of the neurotransmitter to properly support brain cell communication. Instead, more Rac1 is produced but – inexplicably – its degradation also increases ultimately decreasing BDNF signaling as well. Pillai has seen the unfortunate chain of events play out in an animal model with increased levels of TG2 and clear signs of depression. "If you can fix problems with the receptor, you should be able to reverse depressive symptoms in these mice," he said One of the many questions he wants to answer is whether existing antidepressants impact TG2. To help clarify the role of the impaired BDNF receptors, Pillai also wants to know whether giving BDNF to the depressed animal model improves depression. He's using a viral particle to directly activate the BDNF receptor. And he's also giving the TG2 inhibitor cysteamine to an animal model developed by administering stress hormones. He recently published in the journal PLoS ONE findings that the inhibitor appears effective in normalizing depressive behavior and BDNF levels in that model. Mental stress is a major factor in numerous psychiatric disorders including depression, schizophrenia and anxiety, he noted. Some antidepressants, such as Prozac, were designed to interfere with a natural recycling of serotonin called reuptake so more serotonin is available where needed to enable cell communication. Pillai said it's not yet clear if serotonin reuptake is the same thing as its conversion to Rac-1. "We need to learn more about how all these pieces fit to ultimately design new therapies for depression and related psychiatric disorders," he said. Dr. Alvin V. Terry Jr., MCG pharmacologist, is co-investigator on the studies MHC continuing education Major depressive disorder is the leading cause of disability in Americans age 15-44, affects about 14.8 million adults and is more prevalent in women, according to the National Institute of Mental Health. ###

Girls with ADHD more prone to self-injury, suicide as they enter adulthood

Visible symptoms can go undercover, UC Berkeley psychologists find Girls with Attention Deficit Hyperactivity Disorder (ADHD) – and their families – often look forward to the likely decline in visible symptoms such as fidgety or disruptive behavior as they mature into young women. However, new findings from UC Berkeley caution that, as they enter adulthood, girls with histories of ADHD are more prone to internalize their struggles and feelings of failure – a development that can manifest itself in self-injury and even attempted suicide LPC continuing education "Like boys with ADHD, girls continue to have problems with academic achievement and relationships, and need special services as they enter early adulthood," said Stephen Hinshaw, UC Berkeley professor of psychology and lead author of a study that reports after 10 years on the largest-ever sample of girls whose ADHD was first diagnosed in childhood. "Our findings of extremely high rates of cutting and other forms of self-injury, along with suicide attempts, show us that the long-term consequences of ADHD females are profound," he added. The study is published today (Tuesday, August 14) in the Journal of Consulting and Clinical Psychology. Its results are consistent with earlier findings by the UC Berkeley team that, as girls with ADHD grow older, they show fewer visible symptoms of the disorder, but continue to suffer in hidden ways. The findings challenge assumptions that girls can "outgrow" ADHD, and underscore the need for long-term monitoring and treatment of the disorder, Hinshaw said. The longitudinal study, which began when the girls were ages 6 to 12, is funded by grants from the National Institute of Mental Health. Since 1997, Hinshaw and his team have tracked a racially and socio-economically diverse group of girls with ADHD in the San Francisco Bay Area through early childhood summer camps, adolescence and now early adulthood. In addition to this new study, many others have been published by the team about the girls every five years. In the United States, more than 5 million children ages 3-17 – approximately one in 11 – have been diagnosed with ADHD, according to the Centers for Disease Control and Prevention. ADHD is characterized by poor concentration, distractibility, hyperactivity, impulsiveness and other symptoms that are inappropriate for the child's age. Evidence-based treatment includes stimulant medications and various forms of behavior therapy. The new UC Berkeley study, assessing the girls 10 years after it began, examined 140 of them, ages 17-24, comparing their behavioral, emotional and academic development to that of a demographically similar group of 88 girls without ADHD. It also gauged the symptoms of two major ADHD subtypes: Those who entered the study with poor attention alone versus those who had a combination of inattention plus high rates of hyperactivity and impulsivity. The study's major finding was that the group with combined inattention and hyperactivity-impulsivity during childhood was by far the most likely to manifest self-injury and suicide attempts in early adulthood. In fact, the study pointed out, more than half of the members of this subgroup were reported to have engaged in self-injurious behavior, and more than one-fifth had attempted suicide, Hinshaw said. "A key question is why, by young adulthood, young women with ADHD would show a markedly high risk for self-harm … Impulse control problems appear to be a central factor," the study said. In the first study on this group, published in 2002, the 6- to- 12-year old girls attended five-week camps where they were closely monitored as they partook in art and drama classes and outdoor activities. Those taking ADHD medication volunteered to go off the drug treatment for much of the summer camp study. The counselors and staff observing all the participants did not know which of them had been diagnosed with ADHD. That study found that girls with ADHD were more likely to struggle academically and to be rejected by their peers, compared to the comparison peer group. The five-year follow-up study, when the girls were 12 to 17 and experiencing early to mid-adolescence, found that the fidgety and impulsive symptoms tended to subside in the early teen years, but that the learning gap between girls with ADHD and their non-ADHD peers had widened, and eating disorders and substance abuse had surfaced. For the latest study, in which 95 percent of the original sample of girls participated, the researchers conducted intensive interviews with the subjects and their families. Those interviews include personal reports on behaviors such as self-harm and suicide attempts, drug use, eating habits and driving behavior. Researchers also measured key cognitive functions such as executive planning skills, which include goal-setting and monitoring, planning and keeping on task despite distractions. While many girls in the study showed improvement in ADHD symptoms during the 10-year period, certain problems persisted and new ones emerged, suggesting that careful monitoring and treatment are essential, Hinshaw said. "The overarching conclusion is that ADHD in girls portends continuing problems, through early adulthood," the study concluded. "Our findings argue for the clinical impact of ADHD in female samples, the public health importance of this condition on girls and women, and the need for ongoing examination of underlying mechanisms, especially regarding the high risk of self-harm in young adulthood." That said, Hinshaw added, "ADHD is a treatable condition, as long as interventions are monitored carefully and pursued over a number of years." ### In addition to Hinshaw, authors and researchers of the study are Elizabeth Owens, Christine Zalecki, Emily Schrodek and Erika Swanson at UC Berkeley; Suzanne Perrigue Huggins at the University of Maryland and Adriana Montenegro-Nevado at Palo Alto University

Couple’s Therapy Appears to Decrease PTSD Symptoms, Improve Relationship

CHICAGO – Among couples in which one partner was diagnosed as having posttraumatic stress disorder (PTSD), participation in disorder-specific couple therapy resulted in decreased PTSD symptom severity and increased patient relationship satisfaction, compared with couples who were placed on a wait list for the therapy, according to a study in the August 15 issue of JAMA, a theme issue on violence and human rights. “There are well-documented associations between PTSD and intimate relationship problems, including relationship distress and aggression, and studies demonstrate that the presence of PTSD symptoms in one partner is associated with caregiver burden and psychological distress in the other partner. Although currently available individual psychotherapies for PTSD produce overall improvements in psychosocial functioning, these improvements are not specifically found in intimate relationship functioning. Moreover, it has been shown that even when patients receive state-of-the-art individual psychotherapy for the disorder, negative interpersonal relations predict worse treatment outcomes,” according to background information in the article. Candice M. Monson, Ph.D., of Ryerson University, Toronto, Canada, and colleagues conducted a study to examine the effect of a cognitive-behavioral conjoint therapy (CBCT) for PTSD, designed to treat PTSD and its symptoms and enhance intimate relationships in couples. The randomized controlled trial, conducted from 2008 to 2012, included heterosexual and same-sex couples (n = 40 couples; n = 80 individuals) in which one partner met criteria for PTSD according to the Clinician-Administered PTSD Scale. Symptoms of PTSD, co-existing conditions, and relationship satisfaction were collected by assessors at the beginning of the study, at mid treatment (median [midpoint], 8 weeks after baseline), and at post-treatment (median, 16 weeks after baseline). An uncontrolled 3-month follow-up was also completed. Couples were randomly assigned to take part in the 15-session cognitive-behavioral conjoint therapy for PTSD protocol immediately (n = 20) or were placed on a wait list for the therapy (n = 20). Clinician-rated PTSD symptom severity was the primary outcome; intimate relationship satisfaction, patient- and partner-rated PTSD symptoms, and co-existing symptoms were secondary outcomes. The researchers found that PTSD symptom severity and patients’ intimate relationship satisfaction were significantly more improved in couple therapy than in the wait-list condition. Also, change ratios (calculated by dividing the change in the CBCT condition from pretreatment to post-treatment by the change in the wait-list condition over this period) indicated that PTSD symptom severity decreased almost 3 times more in CBCT from pretreatment to post-treatment compared with the wait list; and patient-reported relationship satisfaction increased more than 4 times more in CBCT compared with the wait list. The secondary outcomes of depression, general anxiety, and anger expression symptoms also improved more in CBCT relative to the wait list. Treatment effects were maintained at 3-month follow-up. “This randomized controlled trial provides evidence for the efficacy of a couple therapy for the treatment of PTSD and comorbid symptoms, as well as enhancements in intimate relationship satisfaction. These improvements occurred in a sample of couples in which the patients varied with regard to sex, type of trauma experienced, and sexual orientation. The treatment effect size estimates found for PTSD and comorbid symptoms were comparable with or better than effects found for individual psychotherapies for PTSD. In addition, patients reported enhancements in relationship satisfaction consistent with or better than prior trials of couple therapy with distressed couples and stronger than those found for interventions designed to enhance relationship functioning in nondistressed couples,” the authors write. “Cognitive-behavioral conjoint therapy may be used to efficiently address individual and relational dimensions of traumatization and might be indicated for individuals with PTSD who have stable relationships and partners willing to engage in treatment with them.” (JAMA. 2012;308[7]:700-709. Available pre-embargo to the media at http://media.jamanetwork.com) Editor’s Note: This study was supported by a National Institute of Mental Health grant to Dr. Monson. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc. Editorial: Expanding the Boundaries of PTSD Treatment Lisa M. Najavits, Ph.D., of the Veterans Affairs Boston Healthcare System and Boston University School of Medicine, comments in an accompanying editorial on the 2 studies in this issue of JAMA on treating PTSD. “The results of the trials by Mills at al and Monson et al are important scientific attempts to study new options for treatment of PTSD. Overall, comparative studies of PTSD therapies find that they rarely outperform each other in efficacy. Thus, the cost and appeal of treatments to clinicians and patients, their intensity of intervention, and clinical setting and training issues may ultimately be as or more relevant than comparative efficacy in choosing a course of treatment for PTSD. In the current era, there is a focus on short-term treatments (in part an antidote to the overly long psychotherapies of much of the 20th century). However, it is not clear how long treatment needs to be maintained to produce enduring positive outcomes, especially for patients with PTSD and comorbidities and difficult social circumstances. The field of PTSD therapy is still young, and the pursuit of clinically meaningful treatments for all types of patients, like the process of recovery for patients with PTSD, is an ongoing challenge.” (JAMA. 2012;308[7]:714-716. Available pre-embargo to the media at http://media.jamanetwork.com) Editor’s Note: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of interest and reported receiving royalties from Guilford Press and New Harbinger Press and that she is director of Treatment Innovations, which provides consultation, training, and materials related to psychotherapy lcsw ceus # # #

New University of Houston research focuses on treatment for perpetrator, not victim

Batterers improve communication skills in experiment A new UH experiment takes an unconventional look at the treatment for domestic violence, otherwise known as intimate partner violence (IPV), by focusing on changing the perpetrators' psychological abuse during arguments rather than addressing his sexist beliefs nursing ceus "There is a lot of research that studies the victim of intimate partner violence, but not the perpetrator," said Julia Babcock, department of psychology and co-director of the Center for Couples Therapy, a clinical research center at UH that offers therapy for couples. "The predominant model for IPV intervention is based on what was gleaned from women in battered women shelters and focuses on men's patriarchal attitudes about power and control. Since most domestic violence occurs in the context of an argument, the experiment I conducted evaluated whether I could change how the communication goes during an argument with the batterer and his partner. The findings indicated the batterers could learn communications skills and when they applied them in an argument with their female partners, the argument improved and the participants felt better about the argument and more understood." Babcock notes this research is significant in that it breaks new ground in applying experiments to domestic violence and may improve batterers' intervention programs. In a review of the research studies on the efficacy of batterers' intervention programs, Babcock found the results disappointing. There was a small change when a perpetrator completed a batterers intervention program and only a 5 percent reduction rate in repeat offenses. "There is definitely a need to improve batterers' intervention programs, since research suggests that they're largely ineffective, but frequently prescribed by courts as a remedy for convicted IPV perpetrators," said Babcock. Babcock's research focuses on male batterers because men are the perpetrators in about 85 percent of the abuse cases, and women are 10 times more likely to be murdered by an intimate than are men. By listing an advertisement in local papers that said, "couples experiencing conflict," the research team recruited 120 couples in the Houston area qualified for the experiment. Candidates for the study were screened over the telephone to make sure they met criteria. To meet the criteria to participate in the study, two acts of violence had to occur in the last year that might include: pushing, shoving, choking, using a weapon or a beating. If there was no physical abuse, but the couple scored low for marital satisfaction, Babcock included them as a comparison group. The couples were then invited to participate in an experiment in the "Emotions in Marriage Lab," where the research team observed a couple in a 15-minute argument. Both male and female partner were connected to monitors to measure heart rate, respiration, skin conductance, movement, pulse, transit time of blood flow from the periphery to the heart, skin temperature while affect (such as anger, contempt, fear, disgust, etc.) was noted. Midway during the 15-minute argument, the researchers interrupted the argument at 7½ minutes and randomly assigned the male batterer to one of three conditions: 1) a time out; 2) a request to edit out the negative, where he makes the same points in a more neutral fashion; or, 3) a request to accept influence, where he listens to the female's ideas, trusts that the partner may be right and validates her idea even if his idea is different. The male batterer was taught these communication skills then asked to use them in the second half of the argument. "What we found is that the interventions worked to make the second half of the argument better," said Babcock. "Batterers could learn these communication skills and when they applied them in arguments with their female partner, it decreased aggressive attacks on the female partner, contemptuous behavior, criticism and put downs in both the woman and the man. The idea is that reducing such psychological abuse may reduce intimate partner violence. Whereas most therapies are built top down from theory, the new technology allows us to build a therapy package--technique by technique--from the lab up." Babcock's article based on this UH experiment, "A Proximal Change Experiment Testing Two Communication Exercises with Intimate Partner Violent Men," won the "Best of 2011 Violence Research" award for the most exemplary research being conducted on violence and aggression. Five senior researchers convened by the Psychology of Violence Journal selected articles they believe have the potential to advance the field and direct the future research on violence. About the Center for Couples Therapy The Center for Couples Therapy is a clinical research center to provide state- of-the-art services for couples in committed relationships. The services are appropriate for couples experiencing specific relationship difficulties as well as those who want to make an already good relationship even better. For more information, see www.psychology.uh.edu/couples/ or contact The Center for Couples Therapy at 713-743-8600 or couples@uh.edu. About the University of Houston The University of Houston is a Carnegie-designated Tier One public research university recognized by The Princeton Review as one of the nation's best colleges for undergraduate education. UH serves the globally competitive Houston and Gulf Coast Region by providing world-class faculty, experiential learning and strategic industry partnerships. Located in the nation's fourth-largest city, UH serves more than 39,500 students in the most ethnically and culturally diverse region in the country.

Brain imaging can predict how intelligent you are, study finds

'Global Brain Connectivity' explains 10 percent of variance in individual intelligence When it comes to intelligence, what factors distinguish the brains of the exceptionally smart from those of average humans? As science has long suspected, overall brain size matters somewhat, accounting for about 6.7 percent of individual variation in intelligence. More recent research has pinpointed the brain's lateral prefrontal cortex, a region just behind the temple, as a critical hub for high-level mental processing, with activity levels there predicting another 5 percent of variation in individual intelligence. Now, new research from Washington University in St. Louis suggests that another 10 percent of individual differences in intelligence can be explained by the strength of neural pathways connecting the left lateral prefrontal cortex to the rest of the brain. Published in the Journal of Neuroscience, the findings establish "global brain connectivity" as a new approach for understanding human intelligence. "Our research shows that connectivity with a particular part of the prefrontal cortex can predict how intelligent someone is," suggests lead author Michael W. Cole, PhD, a postdoctoral research fellow in cognitive neuroscience at Washington University. The study is the first to provide compelling evidence that neural connections between the lateral prefrontal cortex and the rest of the brain make a unique and powerful contribution to the cognitive processing underlying human intelligence, says Cole, whose research focuses on discovering the cognitive and neural mechanisms that make human behavior uniquely flexible and intelligent. "This study suggests that part of what it means to be intelligent is having a lateral prefrontal cortex that does its job well; and part of what that means is that it can effectively communicate with the rest of the brain," says study co-author Todd Braver, PhD, professor of psychology in Arts & Sciences and of neuroscience and radiology in the School of Medicine. Braver is a co-director of the Cognitive Control and Psychopathology Lab at Washington University, in which the research was conducted. One possible explanation of the findings, the research team suggests, is that the lateral prefrontal region is a "flexible hub" that uses its extensive brain-wide connectivity to monitor and influence other brain regions in a goal-directed manner. "There is evidence that the lateral prefrontal cortex is the brain region that 'remembers' (maintains) the goals and instructions that help you keep doing what is needed when you're working on a task," Cole says. "So it makes sense that having this region communicating effectively with other regions (the 'perceivers' and 'doers' of the brain) would help you to accomplish tasks intelligently." While other regions of the brain make their own special contribution to cognitive processing, it is the lateral prefrontal cortex that helps coordinate these processes and maintain focus on the task at hand, in much the same way that the conductor of a symphony monitors and tweaks the real-time performance of an orchestra. "We're suggesting that the lateral prefrontal cortex functions like a feedback control system that is used often in engineering, that it helps implement cognitive control (which supports fluid intelligence), and that it doesn't do this alone," Cole says. The findings are based on an analysis of functional magnetic resonance brain images captured as study participants rested passively and also when they were engaged in a series of mentally challenging tasks associated with fluid intelligence, such as indicating whether a currently displayed image was the same as one displayed three images ago. Previous findings relating lateral prefrontal cortex activity to challenging task performance were supported. Connectivity was then assessed while participants rested, and their performance on additional tests of fluid intelligence and cognitive control collected outside the brain scanner was associated with the estimated connectivity. Results indicate that levels of global brain connectivity with a part of the left lateral prefrontal cortex serve as a strong predictor of both fluid intelligence and cognitive control abilities. Although much remains to be learned about how these neural connections contribute to fluid intelligence, new models of brain function suggested by this research could have important implications for the future understanding — and perhaps augmentation — of human intelligence. The findings also may offer new avenues for understanding how breakdowns in global brain connectivity contribute to the profound cognitive control deficits seen in schizophrenia and other mental illnesses, Cole suggests. Alcoholism and Drug Abuse Counselors Continuing Education ### Other co-authors include Tal Yarkoni, PhD, a postdoctoral fellow in the Department of Psychology and Neuroscience at the University of Colorado at Boulder; Grega Repovs, PhD, professor of psychology at the University of Ljubljana, Slovenia; and Alan Anticevic, an associate research scientist in psychiatry at Yale University School of Medicine. Funding from the National Institute of Mental Health supported the study (National Institutes of Health grants MH66088, NR012081, MH66078, MH66078-06A1W1, and 1K99MH096801).

A Peek into the Hoarding Brain

Brain Hubs Boil when Hoarders Face Pitching Their Own Stuff Under-Activate when Making Decisions about Others’ Possessions In patients with hoarding disorder, parts of a decision-making brain circuit under-activated when dealing with others’ possessions, but over-activated when deciding whether to keep or discard their own things, a NIMH-funded study has found. Brain scans revealed the abnormal activation in areas of the anterior cingulate cortex and insula known to process error monitoring, weighing the value of things, assessing risks, unpleasant feelings, and emotional decisions. NIMH grantee David Tolin, Ph.D., of Hartford Hospital, and colleagues, report on their functional magnetic resonance imaging (fMRI) study in the August 2012 issue of the journal Archives of General Psychiatry. Hoarding disorder, a proposed diagnosis under DSM-V, is characterized by avoidance of decision-making about possessions. The new findings pinpoint brain circuit activity suspected of underlying the lack of self-insight, indecisiveness, sense that the wrong decision is being made, inflated estimates of the desirability of objects, and exaggerated perception of risk that are often experienced with the disorder. In the study, brain activity of 43 hoarding disorder patients was compared to that of 31 obsessive compulsive disorder (OCD) patients and 33 healthy controls while they had to decide whether to keep or discard their own or others’ junk mail and newspapers. Notably, such ownership did not appear to differentially affect brain activity in the OCD patients. Hoarding disorder patients, as expected, decided to keep many more items than the other groups. The implicated brain areas are hubs of a “salience network” that weighs the emotional significance of things and regulates emotional responses and states. Hoarding patients’ severity of symptoms, self-ratings of indecisiveness, and feeling of things being “not just right” were correlated with the degree of aberrant activity in these hubs. The results add to evidence of impaired decision-making in hoarding disorder and may help to disentangle its brain workings from those of OCD and depression. Anterior cingulate cortex (center) over-activated when hoarding disorder patients had to decide whether to keep or discard their own possessions; it under-activated during decision-making about others’ possessions. The left and right insula (upper left and right) similarly differentially activated in hoarding disorder patients during this task. Picture shows fMRI data superimposed on structural MRI scan LPC Continuing Education Source: David Tolin, Ph.D., Hartford Hospital Reference Neural Mechanisms of Decision Making in Hoarding Disorder Tolin DF, Stevens, MC, Villavicencio AL, Norberg MM, Calhoun VD, Frost RO, Steketee G, Rauch SL, Pearlson GD. Arch Gen Psychiatry. 2012;69(8):832-841. doi:10.1001.

Targeted Behavioral Therapy Can Effectively Control Tics in Adults with Tourette Syndrome

A comprehensive behavioral intervention is more effective than supportive therapy and education in helping adults control the tics associated with Tourette syndrome, according to an NIMH-funded study published in the August 2012 issue of the Archives of General Psychiatry. The study follows a previous study involving children with the disorder, which showed similar results. Background Tourette syndrome (TS) is a chronic neurological disorder associated with motor or vocal tics that can be disruptive and difficult to control. Tics begin in childhood, typically peak in early adolescence and often decrease by adulthood. For some adults, the tics persist and can be difficult to control. Many individuals with TS describe an unwanted urge or sensation prior to the tic that is relieved by performing the tic. TS is commonly treated with an antipsychotic medication such as pimozide or risperidone. But these medications rarely eliminate tics entirely and can cause troubling side effects such as weight gain and sedation. Because of these adverse side effects, many patients decline or discontinue use of these medications. Until now, few large-scale studies have examined the effectiveness of behavioral interventions for TS. A team of investigators from Massachusetts General Hospital/Harvard Medical School; Yale University; University of Texas Health Science Center at San Antonio; University of California, Los Angeles; the University of Wisconsin-Milwaukee; Johns Hopkins Medical Institutions; and the Tourette Syndrome Association tested the effectiveness of a Comprehensive Behavioral Intervention for Tics (CBIT), a therapy based on habit reversal training that includes two concepts: Tic-awareness training, which teaches how to recognize early signs that a tic is about to occur, and Competing-response training, which teaches how to engage in a voluntary behavior that is physically incompatible with the impending tic. For example, a person feeling an urge to jerk his or her shoulder may be taught to tense arm muscles while pushing the elbow against the torso (a competing response). This combination of awareness training and competing response training is intended to disrupt the cycle of premonitory urge and performance of the tic. The researchers randomized 122 adults at three research centers to either CBIT or a control treatment that included supportive therapy and education about TS. Each group received eight sessions over a 10-week period. Those who responded to therapy were assessed three months and six months after the end of the study period to determine if the therapy’s benefits persisted. Results of the Study Overall, 38 percent of patients receiving CBIT showed significant symptom improvement compared to 6 percent receiving the control treatment. The results complement the earlier CBIT study in children, which found that 52 percent of the children who received CBIT showed significant symptom improvement compared to 18.5 percent receiving the control treatment.

About 62.5 percent of those who responded to CBIT in the trial returned for follow-up assessments at three and six months. About 80 percent of the returning participants continued to show a positive response to CBIT, indicating the treatment has enduring benefits for a significant group. In comparison, about 50 percent of those who responded to the control treatment returned for post-treatment assessment, and only about 25 percent of those continued to show benefits after six months. Significance Given the limited medication options for treating TS and the adverse effects associated with the antipsychotic medications, CBIT provides an alternative treatment to manage tics in children and adults. However, the positive response among adults was lower than among the children. The researchers suggest that people with tics that persist into adulthood may have a more chronic form of the disorder that is more difficult to treat. What’s Next Future research focused on CBIT may uncover the role of behavioral learning in reducing the involuntary movements and tics associated with TS. In the meantime, the researchers are working with the Tourette Syndrome Association and the Centers for Disease Control and Prevention to disseminate this intervention by offering training workshops to clinicians around the country social worker ceus Reference Wilhelm S, Peterson AL, Piacentini J, Woods DW, Deckersbach T, Sukhodolsky DG, Chang S, Liu H, Dziura J, Walkup JT, Scahill L. Randomized trial of behavior therapy for adults with Tourette syndrome. Archives of General Psychiatry. 2012 August.