Tic talk, Tic talk: time is wasting

Think brain problems can only be approached with drugs, surgery, or despair? Good news: the brain can be healed in the same way it develops: through learning. This will surprise those whose brains explode when they hear me say "parents don't cause eating disorders" and lose consciousness before they hear the second part: "parents and treatment providers can change the environment to help fix brain problems."

The NIMH's big brain, Thomas Insel, describes it well in his latest blog post about interventions for Tourette's. In a post that also mentions the "flowering" of behavioral treatments for other brain issues -- including anorexia -- he also describes a behavioral technique for tics in Tourette's, a disorder that is "one of the most neurological of the neuropsychiatric syndromes."

The news of effective behavioral techniques for mental illness is the kind of progress all of us desire. Drug treatments, while often life-saving, are still blunt instruments for a delicate task. Finding ways to help a brain re-train and strengthen alternate functions is something this particular organ is designed to do.

But psychotherapy isn't risk-free nor is it always intuitive. It takes skills to apply, and thoughtful use of the evidence and theory - not just good intentions and attractive myths. The answer to the question below, Dr. Insel, is "yes. and NOW. and how can we help you make it happen?"

As the success of behavioral interventions becomes more widespread, we will need to address an “inconvenient truth.” For medications, we have a well-developed pathway for regulating use. A prescription for an antidepressant medication yields the same treatment, no matter who prescribes it. By contrast, we don’t have the same regulatory process for behavioral treatments. There is no federal agency that oversees the quality or effective dose of psychotherapy. And there is no easy way to assure that the behavioral intervention provided in practice is the same as the behavioral intervention tested in a research study. With the increasing evidence of the value of behavioral interventions, is this the time to develop a rigorous process for qualifying their use and ensuring their uniform dissemination?


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