Investigating the effects of tic suppression on premonitory urge ratings in children and adolescents with Tourette's syndrome

University of Wisconsin-Milwaukee, USA.
Behaviour Research and Therapy (Impact Factor: 3.85). 01/2008; 45(12):2964-76. DOI: 10.1016/j.brat.2007.08.007
Source: PubMed


Tics represent a complex class of behaviors that have a neurobiological origin and are influenced by factors both internal and external to the individual. One factor that has gained recent attention is the premonitory urge. Contemporary behavioral models suggest that some tics are preceded by aversive somatic urges that increase in severity when tics are suppressed and are attenuated by performance of the tic. It has been proposed that the removal of premonitory urges may strengthen or maintain tics via negative reinforcement. This investigation is the first to empirically evaluate the effect of tic suppression on the premonitory urge phenomenon. Five children and adolescents, ages 8-17years, participated in the study. Using an ABAB reversal design, tic frequency and subjective premonitory urge ratings were recorded under conditions of free-to-tic baseline (BL) and reinforced tic suppression (differential reinforcement of zero-rate behavior). Results show that four of the five children demonstrated reliable suppression. Of the four children who achieved suppression, three demonstrated a pattern in which subjective urge ratings were higher during suppression than during BL. Results provide preliminary support for the negative reinforcement view of tic function for some children.

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Available from: Michael B Himle, Dec 08, 2014
    • "We began by examining the possibility that data aggregation (i.e., comparing mean urge ratings ) obscured meaningful patterns of change in urge ratings across tic freely and tic suppression periods. This possibility was based on a review of previous studies in which some participants evidenced patterns of changing urge ratings that appeared consistent with the urge reduction model, with more ambiguous patterns for others (Capriotti, Brandt, Ricketts, Espil, & Woods, 2012; Himle et al., 2007). The primary aim of the current study was to examine individual participant urge ratings. "
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    ABSTRACT: Premonitory urges are central to emerging behavioral models of chronic tic disorders (CTD). Urge reduction has been proposed as a behavioral explanation for tic maintenance and exacerbation as well as the efficacy of behavioral treatments. Prior investigations have produced inconsistent findings despite common methodologies. The current study evaluated the possibility that data aggregation obscures distinct and meaningful patterns of change in urge ratings when tics are freely expressed versus suppressed. Participants (n = 12) included children with moderate-to-marked tic severity and noticeable premonitory urges. Tic frequencies and urge ratings were obtained at 15 s and 10-s intervals, respectively, across an alternating sequence of 10-min tic freely and 40-min tic suppression conditions. Patterns were established using a two step approach. Five distinct patterns of urge rating change emerged, suggesting data aggregation may obscure meaningful patterns in the urge-tic relationship when tics are completed versus suppressed. Eligibility criteria may have unintentionally excluded younger affected children and included older participants with more severe tic disorders than commonly seen. Additional research with less stringent eligibility criteria and a larger sample size will help validate the results. The relationship between urges and tics is much more complex than previously theorized. Investigations that rely on global assessments of urge and tic severity and/or assume uniformity when aggregating participant data may obscure meaningful differences in the urge-tic relationship. Future investigations should examine the possibility that individual differences and/or developmental considerations modulate the functional urge-tic relationship. Copyright © 2015. Published by Elsevier Ltd.
    Journal of Behavior Therapy and Experimental Psychiatry 07/2015; 50:162-170. DOI:10.1016/j.jbtep.2015.07.004 · 2.23 Impact Factor
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    • "Himle and colleagues (2007) collected ratings of urge strength every 10 s during experimental conditions, whereas two of the three other studies relied on retrospective reports collected at the end of each 5 to 10 min experimental condition. In addition, the authors of two of these studies (Conelea et al., 2011; Woods et al., 2009) reported that their data were trending toward a replication of the Himle et al. (2007) study and suspected the failure to replicate may have been due to low statistical power. On the whole, experimental evidence may be regarded as partially consistent with the negative reinforcement hypothesis, with the need for further, wellpowered replications to provide clarification. "
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    ABSTRACT: Tourette syndrome (TS) is marked by the chronic presence of motor and vocal tics that are usually accompanied by aversive sensory experiences called "premonitory urges." Phenomenological accounts suggest that these urges occur before tics and diminish following their occurrence. This has led some to suggest that tics are negatively reinforced by removal of premonitory urges. This hypothesis has proven difficult to test experimentally, however, due in part to challenges in measuring premonitory urge strength. We tested predictions of the negative reinforcement conceptualization of premonitory urges using novel experimental tactics within the context of the "tic detector" paradigm. We compared tic rates and ratings of premonitory urge strength exhibited by youth with TS or chronic tic disorder under free-to-tic baseline (BL), reinforced tic suppression (RTS), and reinforced tic suppression with escape (RTS + E) conditions. Results were consistent with previous research and hypotheses of the present study. Participants rated the strength of their premonitory urges as higher during RTS conditions than during BL conditions. Within RTS + E conditions, tic rates were higher during escape portions when the contingency supporting tic suppression was inactive than during components where the contingency was active, and ratings of urge strength were higher at the onset of break periods than at the offset. All participants engaged in some level of escape from reinforced suppression during the course of the experiment. Results of this study support the notion that tics may be negatively reinforced by removal of aversive premonitory urges. Future directions for basic and clinical research are discussed.
    Behavior modification 04/2014; 38(2). DOI:10.1177/0145445514531015 · 2.23 Impact Factor
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    • "This process could be the sign of transition from simple sensory perceptions to fully fledged consciousness.31,32 Thus, a refined degree of self-consciousness could help patients recognize their subjective symptoms and thereby improve their ability to suppress them, as is shown in behavioral techniques such as exposure and response prevention and habit-reversal therapy, which can be effective strategies for regulating tics.33–36 The significance and function of PUs is not known. "
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    ABSTRACT: Tourette syndrome (TS) is a neuropsychiatric disorder characterized by the chronic presence of multiple motor tics and at least one vocal/phonic tic since childhood. Tics typically change and vary in both intensity and severity over time, with remission and exacerbation common. In the vast majority of patients, tic expression is characteristically accompanied by discomforting bodily sensations, known as sensory phenomena or premonitory urges. We reviewed the existing literature on premonitory urges associated with the sense of voluntariness of action in TS. Although the wish to move is perceived by the patient as involuntary, the decision to release the tic is often perceived by the patient as a voluntary capitulation to the subjective urge. Most patients with TS can exert a degree of control over the urge and constantly try to inhibit the movement. Based on these features, it has been suggested that tics performed in response to an urge to move should be classified as 'unvoluntary', as opposed to voluntary or involuntary acts. However, recent experimental data suggest that the brain areas involved in the generation of the wish to act show considerable overlap between healthy subjects and patients with TS. The simultaneous presence of both voluntary and involuntary aspects in the expression of tic symptoms by patients with TS is consistent with the hypothesis that tics can have the same neurophysiologic substrate as voluntary acts, even though they are misperceived as being involuntary. This reinforces the view of TS as a hyperkinetic movement disorder primarily affecting the conscious experience of action.
    09/2013; 3.
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