Chronic tic disorders (CTDs), including Tourette’s disorder and persistent motor or vocal tic disorder, are neurobiological conditions affecting an estimated 3 to 4 percent of children and adolescents. These disorders include the presence of motor and/or phonic tics, which can range in number, frequency, and severity. Although CTDs are typically treated through medications, the available medications have the potential of adverse side effects, do not result in long-term coping strategies, and may not be effective or preferable for all individuals. Habit reversal training (HRT), a behavioral intervention for tics, has been identified as a well-established treatment. The purpose of habit reversal is to build an individual’s awareness of his or her tics and disrupt tics through developing a competing behavioral response. One avenue or service delivery that has not yet been explored for individuals with CTDs is use of a parent-mediated approach to habit reversal. Parent-mediated interventions have been used successfully with children with challenging behavior and autism. They are based on a triadic model, in which a therapist works directly with a parent to teach the therapeutic techniques. Parents, in turn, work directly with their children while receiving feedback from the therapist. The current study investigated a parent-mediated habit reversal intervention for the treatment of chronic tic disorders in two children. A delayed multiple baseline design was used. Baseline data were collected for three sessions. Intervention was delivered over six sessions, during which time coaching was faded. Follow up data collection occurred one month after the end of treatment. Based on changes in parental fidelity of implementation from baseline to intervention, this study provides preliminary evidence for parents being trained as therapists and providing habit reversal training strategies to their children. This treatment was reported as acceptable by both parent participants and by one of the child participants. Treatment motivation remained high and stable throughout baseline, intervention, and follow up. Child motivation was more variable during baseline, intervention, and follow up. Tic severity was also variable and more research would be needed to determine the impact of treatment for tics. Limitations and implications for future research are provided.

The quality of life of children with Tourette Syndrome, a neurodevelopmental condition characterised by chronic tics, is impacted greatly by both the symptoms themselves and their social consequences. Habit Reversal Therapy, a behavioural therapy for tic management, has substantial empirical support in its individual form, but this approach has never been investigated in a group format. Group based delivery of Habit Reversal Therapy could increase access to therapy, improve the cost-effectiveness of treatments and potentially offer additional therapeutic benefits. This randomised controlled pilot study evaluated the feasibility and preliminary efficacy of Habit Reversal Therapy compared to psycho-educational groups for 33 children aged 9 to 13 years with Tourette Syndrome and Chronic Tic Disorders. Outcomes of the groups were evaluated in terms of reductions in tic severity and improvements in quality of life. Good attendance rates in both groups suggested feasibility and acceptability of the interventions. Improvements in tic severity and quality of life were found in both groups, although to a lesser extent compared to previous studies of individual behavioural therapy for tics. Motor tic severity showed greater improvements in the Habit Reversal Therapy group on the main outcome measure (Yale Global Tic Severity Scale) but not on a direct observational measure of tic frequency. Given the potential for such groups to provide additional treatment options for families, further research is warranted. Clinical implications and suggestions for improvements to the current design for a larger study are outlined as well as indications for wider reaching future research.

The temporomandibular disorders (TMD) diminish quality of life and can be costly for both individuals and the health care system. Stress from a variety of factors, including daily hassles and maladaptive thought patterns, has been commonly cited as a contributing factor in TMD. Support for this hypothesis comes from research demonstrating masseter muscle hyperactivity in response to experimental stressors, such as painful or frustrating stimuli. Many believe the link between stress and increased masseter muscle pain is parafunctional oral habits, including teeth clenching, grinding, and lip biting. Habit reversal has been used effectively to treat parafunctional oral behaviors and facial pain. Treatment entails teaching individuals to detect, interrupt, and reverse maladaptive oral behaviors. Positive results have been achieved in a group treatment format. Problems with prior research suggest that high attrition resulted from scheduling demands of the group treatment format. To address these problems, this study modified the habit reversal protocol used by Gramling, et al. (1996, 1999) into a minimal contact therapy (MCT) format. MCT has been applied effectively with many problem behaviors, including chronic headaches. Twenty individuals (10-treatment and 10-waitlist control) participated in the seven-lesson, manualized treatment. Participants completed a pre- and post-treatment assessment and an 18-month follow-up. Individuals met with the therapist one time and received weekly feedback via telephone or e-mail. Participants submitted homework and quizzes for each lesson. Those in the control condition spoke with the therapist on a weekly basis as an attention control. Treatment lasted a mean of about 20 weeks. Significant improvement in pain severity including mean pain levels, highest weekly pain levels, and number of pain free days was noted in the treatment group relative to controls. The number and frequency of maladaptive oral habits revealed a strong trend towards lower levels from pre- to post-treatment for individuals in the treatment condition relative to controls. Additional measures of pain symptomotology and personality functioning also revealed significant improvements in the treatment group. Results suggest that a standardized treatment for facial pain is well suited for adaptation to a MCT format. Minimal contact therapy is flexible and as effective as similar group treatments.

Research on components of habit reversal suggests that awareness training alone may be an effective and efficient intervention for reducing nervous habits. This study evaluated the effectiveness of awareness training for the reduction of three nervous habits that manifest in public speaking: filled pauses, tongue clicks, and inappropriate use of the word "like." Four university students delivered short speeches during baseline and assessment sessions. Awareness training consisted of response description and response detection. Awareness training resulted in meaningful reductions in target behaviors for all participants. Booster awareness training sessions were necessary for all participants to achieve further reductions in target behaviors. Generalization probes conducted in front of a small audience indicated that treatment effects generally maintained at low levels. Social validity scores indicated that the treatment was acceptable, and participants indicated not only decreased use of verbal fillers, but also improved overall public speaking ability post-treatment. Although awareness training was effective, it was not more efficient than simplified habit reversal.

ABSTRACT Public speaking is a challenge faced by people from all walks of life. Research in the area of public speaking has focused on examining techniques to reduce public speaking anxiety. Very little research, however, has focused on the acquisition of public speaking skills. While presenting speeches, many people engage in nervous habits that have the potential to decrease the effectiveness of the speech and their credibility as a speaker. This study evaluated the effectiveness of simplified habit reversal in reducing three of these nervous habits: filled pauses, tongue clicking, and inappropriate use of the word like. Following baseline, participants received simplified habit reversal training that consisted of awareness training and competing response training. During post-intervention assessments all 6 participants exhibited an immediate decrease in all three target behaviors.

Trichotillomania is defined as recurrent pulling of one’s hair that results in distress and negative effects on general functioning and quality of life. Estimates of trichotillomania lifetime prevalence generally range from approximately 1% to 3% and it is likely as common as disorders such as obsessive-compulsive disorder and agoraphobia. Yet, quality treatment for trichotillomania is often difficult to find as many mental health professionals are uninformed about the disorder and its treatment. Moreover, mental health services in general are inaccessible to many with estimates suggesting that 96.5 million people do not have access to adequate services. The use of telepsychology has been an effective method for disseminating treatment services for a variety of mental health conditions. However, no research has examined the effectiveness of telepsychology to treat trichotillomania. The current study reports the results of a randomized clinical trial of Acceptance and Commitment Therapy Enhanced Behavior Therapy for the treatment of trichotillomania delivered by way of telepsychology. The study compared an active treatment condition (n = 12) to a waitlist control condition (n = 10). Results showed significant reductions in hair pulling severity from pre- to post-treatment compared to the waitlist condition. Participants in the waitlist condition received the same treatment as participants in the treatment condition following the waitlist period. All participants were then combined to examine overall treatment effects from pre-treatment to a 12-week follow-up. The effect of treatment on hair pulling severity was still significant at follow-up, however the effect was not as strong as at post-treatment. Conversely, the effect on quality of life was maintained and even increased following post-treatment. Additional measures of psychological flexibility, perceived shame, and valued action also saw significant changes from pre-treatment to follow-up. The findings demonstrate that telepsychology is a viable option to disseminate treatment for trichotillomania. Implications, limitations, and future research directions are discussed.

<p>Among some researchers, there is an emerging conceptualization of chronic tic disorders (CTDs) as conditions that are partially rooted in avoidance of tic-related private experiences (i.e., painful or difficult thoughts and feelings) and internal sensations (i.e., premonitory urges to tic). The first specific aim of the present research was to investigate the possibility that experiential avoidance is related to tic severity and perceived quality of life in individuals with CTDs. The second aim was to determine whether the efficacy of Habit Reversal Training (HRT), the most prevalent and effective behavioral intervention for CTDs to date, might be enhanced by combining it with Acceptance and Commitment Therapy (ACT), an intervention that directly targets experiential avoidance. These aims were addressed by conducting two related studies. Study I, an online survey, included 239 adults (<italic>M</italic> = 37.6 years; <italic>SD</italic> = 13.8 years) who reported having been previously diagnosed with a CTD. Results showed that levels of premonitory urges, as well as both general and tic-specific experiential avoidance, were significantly positively related to tic severity. General and tic-specific experiential avoidance were also significantly negatively related to perceived quality of life. Psychometric analyses of two novel measures developed for Study I (i.e., the Yale Global Tic Severity Scale-Self-Report Version and the Acceptance and Action Questionnaire-Tic-Specific Version) demonstrated excellent internal consistency and convergent validity. Study II, a multi-site pilot investigation, involved 13 adolescents (<italic>M</italic> = 15.4 years; <italic>SD</italic> = 1.3 years) who were treated with either HRT alone or a novel HRT+ACT intervention. Results suggest that the HRT+ACT treatment is feasible, highly acceptable to both patients and parents, and as effective as HRT alone at reducing tic severity from pre-treatment through week 22 follow-up. Participants in both groups reported clinically significant post-treatment decreases in general and tic-specific experiential avoidance and improvements in overall functioning. Researchers concluded that experiential avoidance plays an important role in tic expression and overall functioning for individuals with CTDs. Results support additional development and testing of the promising HRT+ACT intervention, to evaluate its efficacy alone and in comparison to other relevant psychosocial and pharmacological interventions.</p> / Dissertation