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In the case of tics, these components are intended to increase tic awareness, develop a competing response to the tic, and build treatment motivation and compliance.<ref name=HRT/> HRT is based on the presence of a premonitory urge, or sensation occurring before a tic.<ref name=LombrosoScahill>{{cite journal|author=Lombroso PJ, Scahill L|url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17937978|title=Tourette syndrome and obsessive–compulsive disorder|journal=Brain Dev|date=April 2008|volume=30|issue=4|pages=231–7|pmid=17937978}}</ref> HRT involves replacing a tic with a competing response—a more comfortable or acceptable movement or sound—when a patient feels a premonitory urge building.<ref name=LombrosoScahill/>
In the case of tics, these components are intended to increase tic awareness, develop a competing response to the tic, and build treatment motivation and compliance.<ref name=HRT/> HRT is based on the presence of a premonitory urge, or sensation occurring before a tic.<ref name=LombrosoScahill>{{cite journal|author=Lombroso PJ, Scahill L|url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17937978|title=Tourette syndrome and obsessive–compulsive disorder|journal=Brain Dev|date=April 2008|volume=30|issue=4|pages=231–7|pmid=17937978}}</ref> HRT involves replacing a tic with a competing response—a more comfortable or acceptable movement or sound—when a patient feels a premonitory urge building.<ref name=LombrosoScahill/>


Controlled trials have demonstrated that HRT is an acceptable, tolerable, effective and durable treatment for tics,<ref name=HRT/> to the extent that it is a more effective means of treating [[Tourette syndrome]] (TS) than medication; in the original study on the application of HRT to those with TS, it was found in the three subjects used in the study that tics were reduced by 64–99%,<ref name=Azrin2>{{cite journal|author=Azrin NH, Peterson AL|title=Habit Reversal for the Treatment of Tourette Syndrome|journal=Behav Res Ther |date= 1988|volume=26|issue=4|pages=347–351|pmid=3214400}}</ref><ref name=Azrin3>{{cite journal|author=Azrin NH, Peterson AL|title= Treatment of Tourette Syndrome by habit reversal: A waiting-list control group comparison|journal=Behav Ther |date= 1990|volume=21|issue=3|pages=305–318}}</ref> which is higher than the 25-80% reduction noted in pharmacological studies.<ref name=Marsh>Marsh, TL (2007). ''Children With Tourette Syndrome : A Parent's Guide'' (2nd ed.). US: Woodbine House.</ref> HRT reduces the severity of vocal tics, and results in enduring improvement of tics when compared with supportive therapy.<ref name=SingerBehavior>{{cite journal|author=Singer HS|title=Tourette's syndrome: from behaviour to biology|journal=Lancet Neurol|date=March 2005|volume=4|issue=3|pages=149–59|pmid=15721825}}</ref>
Controlled trials have demonstrated that HRT is an acceptable, tolerable, effective and durable treatment for tics,<ref name=HRT/> to the extent that it is a more effective means of treating [[Tourette syndrome]] (TS) than medication.{{cn}}{{dubious}} In the original study on the application of HRT to those with TS, it was found in the three subjects used in the study that tics were reduced by 64–99%,<ref name=Azrin2>{{cite journal|author=Azrin NH, Peterson AL|title=Habit Reversal for the Treatment of Tourette Syndrome|journal=Behav Res Ther |date= 1988|volume=26|issue=4|pages=347–351|pmid=3214400}}</ref><ref name=Azrin3>{{cite journal|author=Azrin NH, Peterson AL|title= Treatment of Tourette Syndrome by habit reversal: A waiting-list control group comparison|journal=Behav Ther |date= 1990|volume=21|issue=3|pages=305–318}}</ref> which is higher than the usual 50% reduction noted in pharmacological studies.{{dubious}}{{MEDRS}}<ref name=Azrin2/> HRT reduces the severity of vocal tics, and results in enduring improvement of tics when compared with supportive therapy.<ref name=SingerBehavior>{{cite journal|author=Singer HS|title=Tourette's syndrome: from behaviour to biology|journal=Lancet Neurol|date=March 2005|volume=4|issue=3|pages=149–59|pmid=15721825}}</ref>


HRT is not yet proven or widely accepted, but large-scale trials are ongoing and should provide better information about its efficacy in treating TS.<ref name=Swain>{{cite journal|author=Swain JE, Scahill L, Lombroso PJ, King RA, Leckman JF|title=Tourette syndrome and tic disorders: a decade of progress|journal=J Am Acad Child Adolesc Psychiatry|date=August 2007|volume=46|issue=8|pages=947–68|pmid=17667475}} </ref> Studies through 2006 are "characterized by a number of design limitations, including relatively small sample sizes, limited characterization of study participants, limited data on children and adolescents, lack of attention to the assessment of treatment integrity and adherence, and limited attention to the identification of potential clinical and neurocognitive mechanisms and predictors of treatment response".<ref name=HRT/> Additional controlled studies of HRT are needed to address whether HRT, medication, or a combination of both is most effective, but in the interim, "HRT either alone or in combination with medication should be considered as a viable treatment" for [[tic disorder]]s.<ref name=HRT/>
HRT is not yet proven or widely accepted, but large-scale trials are ongoing and should provide better information about its efficacy in treating TS.<ref name=Swain>{{cite journal|author=Swain JE, Scahill L, Lombroso PJ, King RA, Leckman JF|title=Tourette syndrome and tic disorders: a decade of progress|journal=J Am Acad Child Adolesc Psychiatry|date=August 2007|volume=46|issue=8|pages=947–68|pmid=17667475}} </ref> Studies through 2006 are "characterized by a number of design limitations, including relatively small sample sizes, limited characterization of study participants, limited data on children and adolescents, lack of attention to the assessment of treatment integrity and adherence, and limited attention to the identification of potential clinical and neurocognitive mechanisms and predictors of treatment response".<ref name=HRT/> Additional controlled studies of HRT are needed to address whether HRT, medication, or a combination of both is most effective, but in the interim, "HRT either alone or in combination with medication should be considered as a viable treatment" for [[tic disorder]]s.<ref name=HRT/>

Revision as of 13:39, 24 November 2009

Habit reversal training (HRT) is a "multicomponent behavioral treatment package originally developed to address a wide variety of repetitive behavior disorders".[1]

Behavioral disorders treated with HRT include tics, trichotillomania, nail biting, thumb sucking, and skin picking.[2] It consists of five components:[1]

  1. awareness training,
  2. competing response training,
  3. contingency management,
  4. relaxation training, and
  5. generalization training.

For tic disorders

In the case of tics, these components are intended to increase tic awareness, develop a competing response to the tic, and build treatment motivation and compliance.[1] HRT is based on the presence of a premonitory urge, or sensation occurring before a tic.[3] HRT involves replacing a tic with a competing response—a more comfortable or acceptable movement or sound—when a patient feels a premonitory urge building.[3]

Controlled trials have demonstrated that HRT is an acceptable, tolerable, effective and durable treatment for tics,[1] to the extent that it is a more effective means of treating Tourette syndrome (TS) than medication.[citation needed][dubious – discuss] In the original study on the application of HRT to those with TS, it was found in the three subjects used in the study that tics were reduced by 64–99%,[4][5] which is higher than the usual 50% reduction noted in pharmacological studies.[dubious – discuss][unreliable medical source?][4] HRT reduces the severity of vocal tics, and results in enduring improvement of tics when compared with supportive therapy.[6]

HRT is not yet proven or widely accepted, but large-scale trials are ongoing and should provide better information about its efficacy in treating TS.[7] Studies through 2006 are "characterized by a number of design limitations, including relatively small sample sizes, limited characterization of study participants, limited data on children and adolescents, lack of attention to the assessment of treatment integrity and adherence, and limited attention to the identification of potential clinical and neurocognitive mechanisms and predictors of treatment response".[1] Additional controlled studies of HRT are needed to address whether HRT, medication, or a combination of both is most effective, but in the interim, "HRT either alone or in combination with medication should be considered as a viable treatment" for tic disorders.[1]

References and notes

  1. ^ a b c d e f Piacentini JC, Chang SW (2006). "Behavioral treatments for tic suppression: habit reversal training". Advances in neurology. 99: 227–33. PMID 16536370.
  2. ^ Azrin NH, Nunn RG (November 1973). "Habit-reversal: a method of eliminating nervous habits and tics". Behav Res Ther. 11 (4): 619–28. PMID 4777653. As reported in Piacentini JC, Chang SW. PMID 16536370
  3. ^ a b Lombroso PJ, Scahill L (April 2008). "Tourette syndrome and obsessive–compulsive disorder". Brain Dev. 30 (4): 231–7. PMID 17937978.
  4. ^ a b Azrin NH, Peterson AL (1988). "Habit Reversal for the Treatment of Tourette Syndrome". Behav Res Ther. 26 (4): 347–351. PMID 3214400.
  5. ^ Azrin NH, Peterson AL (1990). "Treatment of Tourette Syndrome by habit reversal: A waiting-list control group comparison". Behav Ther. 21 (3): 305–318.
  6. ^ Singer HS (March 2005). "Tourette's syndrome: from behaviour to biology". Lancet Neurol. 4 (3): 149–59. PMID 15721825.
  7. ^ Swain JE, Scahill L, Lombroso PJ, King RA, Leckman JF (August 2007). "Tourette syndrome and tic disorders: a decade of progress". J Am Acad Child Adolesc Psychiatry. 46 (8): 947–68. PMID 17667475.{{cite journal}}: CS1 maint: multiple names: authors list (link)
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