Mechanisms Underlying Behavior Therapy for Tourette’s Disorder

Purpose of Review: Behavior therapy is the recommended first-line treatment for Tourette’s disorder and other tic disorders (TD). Despite its therapeutic benefit, not all patients exhibit a positive treatment response. Understanding the mechanisms underlying behavior therapy for TD (i.e., how behavior therapy reduces symptoms) can help identify strategies to optimize treatment outcomes. This review examines evidence for three proposed mechanisms—habituation, associative learning, and cognitive control—across laboratory studies and clinical trials. Recent Findings: Evidence shows that mechanisms likely differ in youth and adults. The most promising evidence points to interactions between associative learning and cognitive control as mechanisms, with nuanced differences between youth and adults with TD. Habituation may also be a mechanism for adults with TD, but not for youth with TD. Summary: As multiple mechanisms are implicated and several promising ones remain unexamined, future mechanistic research is essential to identify approaches that could optimize behavior therapy outcomes.