Alışkanlığı tersine çevirme eğitiminin Tourette sendromundaki tiklerin tedavisinde uygulanması

Tikler ani, hızlı ve yineleyici motor veya vokal hareketlerdir. Bir zamanlar seyrek görüldüğü düşünülen tik bozuk- luklarının artık -Tourette bozukluğu da dahil olmak üzere- birçok çocuğu ve yetişkini etkilediği bilinmektedir. Tik bozukluklarının tedavisindeki temel yaklaşım ilaçtır. Bununla birlikte, davranışçı psikoterapi yaklaşımları tik bozuk- luklarının tedavisinde etkili bulunmuştur. Bu yazının amacı davranışçı psikoterapi tekniklerinden biri olan Alışkan- lığı Tersine Çevirme Eğitimiyle (ATÇE) ilgili olarak gerçekleştirilen randomize-kontrollü araştırma sonuçlarını değerlendirmek ve ATÇE‟nin temel uygulama bilgilerini aktarmaktır. Son yıllarda hem çocuk, hem de yetişkin örneklem gruplarıyla yapılan randomize-kontrollü araştırmalar, çocuklarda ve yetişkinlerde ATÇE‟nin kontrol grubuna göre önemli oranda etkili olduğunu göstermiştir. ATÇE‟nin etkili olmadığı hastalar için ise yeni davranışçı tekniklerin geliştirilmesi, ayrıca farmakoterapi ile davranışçı tedavilerin birlikte etkisi bu alandaki gelecek araştır- maların konusu olabilir.

Habit reversal training for the treatment of tics in Tourette syndrome

Tics are sudden, rapid and repetitive stereotyped movements or vocalizations. Once thought to be a rare disor- der, many children and adults are now known to suffer from tic disorders, including Tourette syndrome. Pharma- cological treatments have been the most commonly used treatment modality for tic disorders. More to the point behavioral psychotherapies have been shown to be effective. The present article aims to introduce one of the behavioral techniques, namely Habit Reversal Training (HRT) for the treatment of tic disorders including Tourette syndrome and evaluate the results of randomized-controlled studies. Results of the studies with large groups of children and adults demonstrated that HRT are effective compared to the control groups. Future studies are needed to develop new behavioral treatments for those patients who do not respond to HRT and also to examine the effects of combining behavioral treatments for tics with pharmacotherapy.

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