An Empirical Examination of Symptom Substitution Associated with Behavior Therapy for Tourette's Disorder

Authors

Alan L. Peterson, University of Texas at San AntonioFollow
Joseph F. McGuire, University of California, Los AngelesFollow
Sabine Wilhelm, Harvard Medical School
John Piacentini, University of California, Los AngelesFollow
Douglas W. Woods, Marquette UniversityFollow
John T. Walkup, Weill Cornell Medical CollegeFollow
John P. Hatch, University of Texas at San Antonio
Robert Villarreal, University of Texas at San Antonio
Lawrence Scahill, Emory University

Document Type

Article

Language

eng

Format of Original

13 p.

Publication Date

1-2016

Publisher

Elsevier

Source Publication

Behavior Therapy

Source ISSN

0005-7894

Abstract

Over the past six decades, behavior therapy has been a major contributor to the development of evidence-based psychotherapy treatments. However, a long-standing concern with behavior therapy among many nonbehavioral clinicians has been the potential risk for symptom substitution. Few studies have been conducted to evaluate symptom substitution in response to behavioral treatments, largely due to measurement and definitional challenges associated with treated psychiatric symptoms. Given the overt motor and vocal tics associated with Tourette’s disorder, it presents an excellent opportunity to empirically evaluate the potential risk for symptom substitution associated with behavior therapy. The present study examined the possible presence of symptom substitution using four methods: (a) the onset of new tic symptoms, (b) the occurrence of adverse events, (c) change in tic medications, and (d) worsening of co-occurring psychiatric symptoms. Two hundred twenty-eight participants with Tourette’s disorder or persistent motor or vocal tic disorders were randomly assigned to receive behavioral therapy or supportive therapy for tics. Both therapies consisted of eight sessions over 10 weeks. Results indicated that participants treated with behavior therapy were not more likely to have an onset of new tic symptoms, experience adverse events, increase tic medications, or have an exacerbation in co-occurring psychiatric symptoms relative to participants treated with supportive therapy. Further analysis suggested that the emergence of new tics was attributed with the normal waxing and waning nature of Tourette’s disorder. Findings provide empirical support to counter the long-standing concern of symptom substitution in response to behavior therapy for individuals with Tourette's disorder.

Comments

Accepted version. Behavior Therapy, Vol. 47, No. 1 (January 2016): 29-41. DOI. © 2015 Elsevier Ltd. Used with permission.

Douglas W. Woods was affiliated with Texas A&M University at time of publication.

Recommended Citation

Peterson, Alan L.; McGuire, Joseph F.; Wilhelm, Sabine; Piacentini, John; Woods, Douglas W.; Walkup, John T.; Hatch, John P.; Villarreal, Robert; and Scahill, Lawrence, "An Empirical Examination of Symptom Substitution Associated with Behavior Therapy for Tourette's Disorder" (2016). Psychology Faculty Research and Publications. 244.
https://epublications.marquette.edu/psych_fac/244