A Better Treatment for Tics

Hannah Reese ’02

Hannah Reese ’02

Hannah Reese’s work is changing the way that clinicians treat people with anxiety and tic disorders. A clinical scientist, researcher, and an assistant professor of psychology at Bowdoin, Hannah has been pioneering a new mindfulness-based treatment for those with Tourette’s syndrome. Hannah explains that people with Tourette’s experience multiple motor and vocal tics, or sudden and recurrent twitches, motor movements, or sounds. Tics develop during childhood and persist for at least a year. About 25% of children have transient tics, Hannah says, but only 1% develop persistent tic disorders.

How did you become interested in researching Tourette’s and obsessive-compulsive disorder (OCD)?
I became interested in anxiety research while taking a seminar on shyness with Professor [Jonathan] Cheek from the Wellesley psychology department. His course inspired me to take a research position at Massachusetts General Hospital with some researchers whose work I had read for Prof. Cheek’s course. By chance, I was pulled into a project on Tourette’s syndrome at the OCD and Related Disorders program. I enjoyed doing clinical work for adults with Tourette’s, but  also found it frustrating because I saw that clinicians could do more to help. The experience motivated me to develop a mindfulness-based intervention for tics. I had been learning about mindfulness through my internship at Mass General Hospital, and could see how it connected to the work I was doing with folks with Tourette’s. These people often have what’s called a “premonitory urge” right before they tic. It’s very uncomfortable. People often report that they do the tic to get rid of the urge. Mindfulness interventions may help people learn to tolerate that urge and let it pass.

How has our understanding of Tourette’s syndrome changed since you entered the field?
People used to think of Tourette’s as a neurological disorder, so clinicians simply prescribed medication and did not appreciate the psychological components of tics. Now, psychologists have uncovered the ways in which people’s environment, emotions, and circumstances shape tics. My mentor Sabine Wilhelm [at Harvard Medical School, where Hannah earned her Ph.D. in clinical psychology] and her colleagues have pushed the psychological approach for treating tics—so much so, that in the last year, the American Academy of Neurology had declared that psychological approaches should be a first-line treatment, before medication, for people with tics.

Psychologists are starting to focus on helping those with tic disorders learn distress tolerance. People tend to think, “If something is going on in the brain, then we must intervene biologically.” But everything we do, and everything we learn, changes the brain. My research has found that psychotherapy helps to normalize the cortical-striatal-thalamic-cortical circuit in the brain that’s involved in planning, initiating, and inhibiting motor movements. These pathways often have abnormalities in people with Tourette’s. We don’t know exactly what parts of the therapeutic intervention create these biological changes, but an important takeaway from this research is that non-biological interventions can have biological effects.

Because of the pandemic, many people have continued or sought therapy through online services such as telehealth. Do you think COVID-19 has impacted the future of online therapy?
Absolutely! Even after the pandemic ends, I think a lot of clients will choose to do their therapy online, but this option won’t fully replace in person therapy. Some clinicians and clients will choose to be in person again, but I think many clinicians are figuring out that they can be as effective online as in person. Many clients are also realizing how much more convenient it is to see their therapist at the click of a button. For in-person therapy, patients must often budget time for travel, childcare, and work leave. Online therapy only consumes one hour of their week, so it disrupts the patient’s life less.

Insurance used to be a barrier to receiving online treatment. Companies were often reluctant to reimburse people for telehealth. Because of the pandemic, however, insurance companies have put many emergency telehealth coverage plans in place, and I think they’re in the process of extending those beyond the pandemic.

What do you think about “therapy apps”?
The psychotherapy seminar I teach discusses the questions of technology and mental health practices all semester! I think the therapy apps are interesting. I also think we have to be careful with the apps, because the technology has outpaced the evidence for them. Anybody can put anything up in an app store, and consumers have no protection. How does the average phone user know what therapy app will be helpful, and what might be dangerous? Some apps that have been demonstrated to have wrong, and potentially harmful, advice in them. We need a better regulatory framework to protect consumers from apps.

I also think researchers need to partner with industry more so that they can create well-functioning, pretty, easy-to-use, technologically savvy apps. But these apps should be based on strong, evidence-based psychotherapeutic principles and strategies.You don’t want to slow innovation, but you also don’t want to harm consumers.

Where is your future research headed?
My team just finished a small study comparing a mindfulness-based approach for tics to an education-based intervention in December. This summer, I hope to analyze that data and figure out what to research next depending on our findings. From working with participants, I know that some people benefited tremendously from the mindfulness-based approach; but not everybody, so I would like to understand why. I am currently at a decision point with my research. Should I try the mindfulness approach with children? Tics begin during childhood and, ideally, we would like to help people early. If the mindfulness intervention seems promising, do I focus on disseminating it to other clinics? What I find the most gratifying about my work is the back and forth between my research and clinical practice, which continually inform one another. I bring what I learn and research to the clinic, and my clinical experience influences the kind of research questions I ask.

How did your Wellesley education prepare you for a career as a research psychologist?
My Wellesley education has helped me understand how to ask the right questions. I still vividly remember taking my environmental psychology lab with Professor [Steven] Schiavo. Environmental psychology focuses on the ways in which people’s physical surroundings shape their behavior. In this class, I learned for the first time how to translate a research question into a method, to operationalize the concepts that I was curious about, and to study those concepts empirically. 

More broadly, the liberal arts education has encouraged me to think beyond my own discipline; to think about what it means to be human, and to consider the mind, brain, and behavior in a social, scientific and historical context.

What is your favorite Wellesley tradition?
Peppermint stick pie!

Interview by Kayla Fong ’21 and Polina Perelstein ’21 for a Calderwood Seminar they took last spring, Psychology in the Public Interest. Kayla majored in psychology and minored in Latin American Studies at Wellesley and is deciding between working and attending graduate school this upcoming fall. Polina majored in psychology and is currently working at a special education program for children with autism. Both are aspiring clinical psychologists.

Post a CommentView Full Policy

We ask that those who engage in Wellesley magazine's online community act with honesty, integrity, and respect. (Remember the honor code, alums?) We reserve the right to remove comments by impersonators or comments that are not civil and relevant to the subject at hand. By posting here, you are permitting Wellesley magazine to edit and republish your comment in all media. Please remember that all posts are public.

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.