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.