deletions | additions       diff --git a/Treatment.md b/Treatment.md  index c67e971..f5f9de1 100644  --- a/Treatment.md  +++ b/Treatment.md 
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A small uncontrolled open trial of mindfulness-based stress reduction was provided to 18 individuals who were at least 16 years old \citep{25149879}. Treatment consisted of 8 weekly 2-hour group classes and one four hour retreat. Participants were encouraged taught a tic-specific meditation exercise that involved noticing any urges to tic while maintaining a focus on one's breathing rather than trying to change or eliminate the urge to tic. Only one subject dropped out. Mean tic severity decreased by 20% and 10 subjects were rated as "much improved" or "very much improved" and thus considered treatment responders and these gains were maintained at a one month follow-up.  An open label trial of psychotherapy using a cognitive psychophysiological model of tic behavior \cite{26250742} conducted with 102 adults with 49 TS subjects and 36 subjects with chronic tic disorder completing treatment. The treatment consisted of 10 weeks of individual psychotherapy involved a variety of tasks including increasing awareness of tics, muscle discrimination, decreasing muscle tension and an overactive style of action, identifying low and high risk activities in terms of tic probability, highlighting the differences in behaviors, thoughts and feelings; decreasing perfectionistic beliefs linked to tension and relapse prevention. These psychotherapy tasks were chosen because of research suggesting that some TS subjects have perfectionist beliefs when they plan actions and this leads to an impulsive overactive style resulting in frustration, tension and tics. Large effect sizes were sen for both control groups compared to the waiting list control. 65% of the chronic tic disorder group and 74% of the TS group had reductions of more than 35% on the Tourette Syndrome Global Scale. At the end of treatment 78 of 85 completers were rated as mild or below regardless of the starting severity and the other 7 were considered to have moderate symptoms. Large effect sizes were seen whether they were simple or complex and similar results were seen for tic locations (i.e., eyes, face, head, neck and shoulder, trunk and abdomen, phonic). \citet{26022060} examined the effects of this psychotherapy approach on event-related potentials and lateralized readiness potentials (LRPs). EEGs were recorded for 20 TS subjects and 20 control subjects matched for age, sex and Raven Progressive Matrices score, while performing a stimulus-response compatibility inhibition task. During the NoGo condition, the TS group exhibited a delayed and overactivated frontal late positive component. The authors interpreted this result as evidence that this frontal activation may be an adaptive mechanism that allows patients to perform behaviorally similarly to the control subjects. TS subjects exhibited delayed stimulus-locked lateralized readiness potential onset latency. TS subjects also displayed larger response-locked LRP peak amplitudes which are associated with the execution of the motor program for the correct response. The authors suggest that the larger amplitudes may reflect overactivation of the pre-motor and motor cortex in TS patients. The larger sLRP amplitude was not normalized after psychotherapy. In contrast the sLRP onset and the rLRP peak were normalized after psychotherapy. Psychotherapy was provided for 124 children and adolescents who had OCD and had shown a partial response to a sertontin reuptake inhibitor \cite{26126872}. Tic status was evaluated using the YGTSS although tic duration could be less than a year. Tics were identified in 53% of the study participants and there were not significant differences from non-tic pariticipants in terms of age, six, family history, or OCD impairment or severity. Cognitive-behavioral therapy resulted in similar OCD symptom improvement in both groups.   In another study \cite{26091197} 12 children and adolescents, who had tics and were rated as non-responders after 14 weeks of cognitive-behavioral therapy, either received 16 weeks of sertraline treatment or 10 additional sessions of CBT. Internalizing disorders were more common in the non-tic patients and externalizing disorders were more common in the tic patients (50%) than in the non-tic patients (5.3%). The tic patients receiving sertraline showed more improvement as a result of receiving sertraline rather than CBT while the non-tic patients showed similar improvement whether they received sertraline or additional CBT. The authors suggested that the dopaminergic action of sertraline might have helped the OCD patients with tics.  | **Title** | **Comment** |