The Case of "Hiro": Treating Tourette Syndrome by Comprehensive Behavioral Intervention for Tics (CBIT)

Abstract

Cognitive-behavioral therapy (CBT) with Comprehensive Behavioral Intervention for Tics (CBIT) is an efficacious treatment for Tourette Syndrome (TS), with a manualized version available for guiding practitioners through treatment. However, CBIT is still a fairly new treatment for TS and rigorous training in its application is sparse. Additionally, potential treatment considerations are not thoroughly described in the manual. This dissertation presents a systematic case study that specifically analyzes the use of the manual with 10-year-old "Hiro," a South Asian Indian boy with TS who also had attention deficit hyperactivity disorder (ADHD), which is a confounding factor in the treatment of TS. To do this meant applying flexibility and an "hypothesizing-then-testing" mentality. The creation of an individualized case formulation and an associated treatment plan for Hiro were very valuable components in his treatment. The case study chronicles Hiro's successful treatment and explores how and when adherence to the manual was effective as well as how and when greater flexibility was required. Furthermore, the case study explores factors in the clinician/client relationship and how that relationship can prove a powerful tool in treatment. Options for how to maintain treatment goals after termination are also examined.

On Protocols and Principles in the Case of Hiro

“…In reading this case, it is clear to me that Hiro's clinical endpoint is quite favorable and Dr. Lichtman's clinical approach soundly abides by tried-and-true principles of EBP. My main hunch is that a Principles First approach could have arrived at a similar clinical endpoint as the Protocol First approach demonstrated in this case (a fine example of multifinality, which Dr. Lichtman (2017) refers to in his introduction (p. 9). However, I do wonder if a Principles First approach might have made this therapy more efficient by reducing both the amount of therapy needed and the degree of frustration experienced by the child, family, and therapist.…”