Homework adherence predicts therapeutic improvement from behavior therapy in Tourette's disorder.
Homework adherence predicts therapeutic improvement from behavior therapy in Tourette's disorder.
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DOI：
10.1016/j.brat.2021.103844
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发表时间：
2021-05
影响因子：
4.1
通讯作者：
McGuire JF
中科院分区：
文献类型：
--
作者：
Essoe JK;Ricketts EJ;Ramsey KA;Piacentini J;Woods DW;Peterson AL;Scahill L;Wilhelm S;Walkup JT;McGuire JF
行为疗法是抽动秽语症 (TD) 的一线干预措施，其中一个关键组成部分是在治疗就诊期间练习治疗技能（即家庭作业）。本研究探讨了 TD 行为治疗期间家庭作业依从性与治疗结果之间的关系，并探讨了治疗期间家庭作业依从性的基线预测因素。参与者包括 119 名 TD 患者（70 名青少年，49 名成人），他们在临床试验中接受了行为治疗。在对抽动严重程度和临床特征进行基线评估后，参与者接受了 8 次行为治疗。治疗师在每次治疗期间记录家庭作业的遵守情况。治疗后，由不了解治疗情况的独立评估人员重新评估抽动的严重程度。整体家庭作业的坚持程度越高，可以预测参与者抽动严重程度的减轻和治疗反应。早期遵守家庭作业可预测青少年治疗的改善，而较晚遵守家庭作业则可预测成人的治疗改善。青少年遵守家庭作业的基线预测因素包括较低的多动/冲动和照顾者压力。与此同时，在成年人中，家庭作业依从性增加的基线预测因素包括年龄较小、多动/冲动程度较低、强迫症严重程度、愤怒和与工作相关的残疾程度较高。家庭作业的坚持是行为治疗的一个组成部分，并且与治疗的改善相关。提高家庭作业依从性的策略可以优化行为治疗的效果并改善治疗结果。
Behavior therapy is a first-line intervention for Tourette’s Disorder (TD), and a key component is the practice of therapeutic skills between treatment visits (i.e., homework). This study examined the relationship between homework adherence during behavior therapy for TD and therapeutic outcomes, and explored baseline predictors of homework adherence during treatment. Participants included 119 individuals with TD (70 youth, 49 adults) who received behavior therapy in a clinical trial. After a baseline assessment of tic severity and clinical characteristics, participants received 8 sessions of behavior therapy. Therapists recorded homework adherence at each therapy session. After treatment, tic severity was re-assessed by independent evaluators masked to treatment condition. Greater overall homework adherence predicted tic severity reductions and treatment response across participants. Early homework adherence predicted therapeutic improvement in youth, whereas late adherence predicted improvement in adults. Baseline predictors of greater homework adherence in youth included lower hyperactivity/impulsivity and caregiver strain. Meanwhile in adults, baseline predictors of increased homework adherence included younger age, lower hyperactivity/impulsivity, obsessive-compulsive severity, anger, and greater work-related disability. Homework adherence is an integral component of behavior therapy and linked to therapeutic improvement. Strategies that improve homework adherence may optimize the efficacy of behavioral treatments and improve treatment outcomes.
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