Nonpharmacological treatment for Tourette syndrome

Providing psychoeducation to patients, parents, teachers and peers and exploring associated coping strategies is typically sufficient for most people with Tourette syndrome, unless tics are severe or debilitating.

Identify and address any specific environmental stresses or precipitants that may exacerbate the condition.

The most studied nonpharmacological intervention for Tourette syndrome is habit reversal training¹ . Patients usually experience an urge to tic called the ‘premonitory sensation’, which is often relieved by performing the tic. For most patients, this is an automatic and involuntary process. However, through awareness training, patients can become more aware of this urge and use competing responses to oppose the tic.

The Comprehensive Behavioural Intervention for Tics (CBIT) involves habit reversal training and psychosocial support. Randomised controlled trial evidence has demonstrated that Comprehensive Behavioural Intervention for Tics is effective in children and adults. Comprehensive Behavioural Intervention for Tics addresses tics sequentially.

There is preliminary evidence to suggest that exposure and response prevention (ERP) therapy may also be effective in the treatment of tics. This therapy encourages patients to fully experience urges to tic while actively suppressing tics during therapeutic sessions. Unlike Comprehensive Behavioural Intervention for Tics, exposure and response prevention focuses on all tics at the same time.

Adults who have severe, refractory tics that cause significant impairment in functioning may be treated with other therapies, including deep brain stimulation.