TicTrainer software

What is it about?

This revised publication describes a simple online tool that is meant to help people with tics practice tic suppression. It's derived from exposure and response prevention (ERP), which is considered to be a first-line behavior therapy for Tourette syndrome (TS). We present a simple, working web platform (TicTrainer) that implements a strategy called reward-enhanced exposure and response prevention (RE–ERP). This strategy sacrifices most expert therapist components of ERP, focusing only on increasing the duration of time for which the user can suppress tics through automated differential reinforcement of tic-free periods (DRO). RE–ERP requires an external tic monitor, such as a parent, during training sessions. The user sees increasing digital rewards for longer and longer periods of successful tic suppression, similar to a video game score. A working instance of TicTrainer is available from https://tictrainer.com/

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Why is it important?

ERP is considered to be a first-line behavior therapy for Tourette syndrome (TS). However, ERP for tic disorders requires intentional tic suppression, which for some patients is difficult even for brief periods. Additionally, practical access to behavior therapy is difficult for many patients, especially those in rural areas. RE–ERP can be used together with a skilled behavior therapist, but it can also be used as is, without the typical focus on attention to the urge to tic. The main benefit of this trade-off, other than time and cost, is to test what part of ERP does the job. Thus TicTrainer is designed with future research in mind: it stores no personally identifiable health information, and it can be set up to blindly compare tics during typical (DRO) vs. placebo (noncontingent reward) conditions. RE–ERP does depend on a third party, like a parent or clinician, to detect tics. This distinguishes it from “BT-Coach,” a smart phone app designed by behavior therapy experts in the Netherlands in which the person with tics monitors himself / herself (https://www.bt-tics.com/bt-coach).