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Behavior therapy is a well-established and empirically supported treatment for tic disorders (TDs). However, concerns have been expressed about the negative effects of behavioral interventions, such as tic worsening, tic substitution, and excessive effort. This study explored perceived negative effects of tic management strategies in adults with TDs and predictors of these experiences. Participants ( N  = 72) completed semi-structured interviews 11 years after receiving behavior therapy or supportive therapy in a randomized clinical trial. We examined responses to interview questions about managing tics and predictors of reported negative effects. Most participants did not experience tic worsening (84%) or tic substitution (75%) from tic management strategies. The majority felt they could manage tics while participating in their environment (87%) and did not report life interference from tic management (77%). About half (45%) felt less present when managing tics. Treatment non-responders in the original trial were more likely to report negative effects of tic management strategies. No differences in reported negative consequences were found between those who received behavior therapy versus supportive therapy, suggesting that behavior therapy specifically does not lead to such adverse effects. These findings could reduce misconceptions about behavior therapy for TDs and enhance its acceptability and utilization., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Ms. Barber, Mr. Pitts, Mr. Stiede, and Dr. Compton declare that they have no conflicts of interest. Dr. Espil has received research support from the Foundation for OCD Research and honoraria from Springer Nature. Dr. Woods receives royalties from Guilford Press, Springer Press, and Oxford University Press and royalties for www.tichelper.com. Dr. Woods also receives speaking fees from the Tourette Association of America. Dr. Specht receives research support and speaking honoraria from the Tourette Association of America. Dr. Bennett receives royalties from UpToDate for an entry on child anxiety, and honoraria from the Tourette Association of America for CBIT training/talks and Lyra Health for speakers’ bureau. Dr. Walkup has served on advisory boards for the TLC Foundation for Body-Focused Repetitive Behaviors, Tourette Association of America, and the Anxiety and Depression Association of America. He has received speaking fees from the Tourette Association of America and AACAP. Dr. Walkup receives research funding from the Tourette Association of America and royalties from Oxford Press, Guilford Press, and Wolters Kluwer. Dr. Ricketts has received research funding from the National Institute of Mental Health (NIMH), Brain and Behavior Research Foundation, and the TLC Foundation for Body-Focused Repetitive Behaviors. She has received honoraria and research funding from the Tourette Association of America (TAA). She has received honoraria from the Centers for Disease Control and Prevention and Springer Nature. Dr. McGuire has received research support from the American Academy of Neurology, American Brain Foundation, American Psychological Foundation, Hilda and Preston Davis Foundation, Misophonia Research Fund, Tourette Association of America, and National Institute of Health. Dr. McGuire has received royalties from Elsevier and serves as a consultant for Signant Health, Syneos Health, and Luminopia. He has received editorial honoraria from Springer Nature and speakers’ bureau from the International OCD Foundation Pediatric Behavior Therapy Training Institute, and Tourette Association of America Scientific Advisory Board. Dr. Peterson reports receiving royalties from Oxford University Press for treatment manuals on tic disorders and receiving honoraria for CME presentations from the Tourette Association of America. Dr. Scahill has received research support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the US Department of Defense, and the Marcus Foundation. He has served as a consultant to Janssen Pharmaceuticals, Impel NeuroPharma and Cogstate. Dr. Scahill has received licensing fees from Roche, Yamo Pharmaceuticals, and Abbvie. He has received royalties from Guilford Press, Oxford University Press, and American Psychiatric Association Publishing. Dr. Wilhelm is a presenter for the Massachusetts General Hospital Psychiatry Academy in educational programs supported through independent medical education grants from pharmaceutical companies. She has received royalties from Guilford Publications, New Harbinger Publications, Springer, and Oxford University Press. Dr. Wilhelm has also received speaking honoraria from various academic institutions and foundations, including the International Obsessive Compulsive Disorder Foundation, the Tourette Association of America, and the Centers for Disease Control and Prevention. In addition, she received honoraria for her role on the Scientific Advisory Board for One-Mind (PsyberGuide), Koa Health, Inc., and Noom, Inc. Dr. Wilhelm has received research and salary support from Koa Health, Inc. Dr. Piacentini receives research support from NIMH, Patient-Centered Outcomes Research Institute (PCORI) and the TLC Foundation for BFRBs, advisor fees and equity from Lumate Health; publication royalties from Guilford Press, Oxford University Press, and Elsevier; and travel/speaking honoraria from the Tourette Association of America and International OCD Foundation.

Tic-suppression-based treatments (TSBTs) represent a safe and effective treatment option for Chronic Tic Disorders (CTDs). Prior research has demonstrated that treatment naive youths with CTDs have the capacity to safely and effectively suppress tics for prolonged periods. It remains unclear how tic suppression is achieved. The current study principally examines how effective suppression is achieved and preliminary correlates of the ability to suppress tics. Twelve youths, ages 10 to 17 years, with moderate-to-marked CTDs participated in an alternating sequence of tic freely and reinforced tic suppression conditions during which urge intensity and tic frequency were frequently assessed. Probability of tics occurring was half as likely following high-intensity urges during tic suppression (31%) in contrast to low-intensity urges during tic freely conditions (60%). Age was not associated with ability to suppress. Intelligence indices were associated with or trended toward greater ability to suppress tics. Attention difficulties were not associated with ability to suppress but were associated with tic severity. In contrast to our "selective suppression" hypothesis, we found participants equally capable of suppressing their tics regardless of urge intensity during reinforced tic suppression. Tic suppression was achieved with an "across-the-board" effort to resist urges. Preliminary data suggest that ability to suppress may be associated with general cognitive variables rather than age, tic severity, urge severity, and attention. Treatment naive youths appear to possess a capacity for robust tic suppression. TSBTs may bolster these capacities and/or enable their broader implementation, resulting in symptom improvement., (© The Author(s) 2014.)