The aims of this project are: 1) to evaluate the effectiveness of an antidepressant on depressed patients receiving psychophysiological therapy for TM disorders, 2) to evaluate the effectiveness of a splint made at a patient's lowest level of non-specific electromyographic activity and psychophysiological therapy on patient response, 3) to develop and improve methods for making diurnal TM disorder patients aware of their behavior so as to improve psychophysiological therapy for these patients, 4) to develop a random beeper system to make patients aware of their diurnal parafuncitonal activity, and 5) to continue our long term follow-up of patients treated during the last two grant periods in order to evaluate the natural course of treatment effects for both successful and unsuccessfully treated patients. These studies will be completed on at least 175 patients with TM disorders. All will receive: 1) psychophysiological treatment for their pain, 2) psychological questionnaires and 3) various types of physiological and motivational material. All studies will have appropriate control groups in order to carefully evaluate the effectiveness of each intervention. Based upon results from our previous studies patients will be divided into groups based upon depression, nocturnal or diurnal parafunctional activity and, as necessary, other psychosocial factors. From our previous research we believe that the factors of depression and diurnal versus nocturnal parafunctional activity have a great effect on behavioral techniques. The experimental design will allow us to meet the aims of the project resulting in a better understanding of the effect of these factors on psychophysiological treatment as well as their relationship to TM disorders. It is obvious that the information gained in studying TM problems can be generalized to other health problems where behaviorial techniques are used.
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