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.
    No preview · Article · Jul 2015 · Journal of Behavior Therapy and Experimental Psychiatry
    • "TSBT naive children and adolescents appear to have varying capacity to suppress tics, without instruction, for prolonged periods in an environment that differentially reinforces tic suppression (Himle, Woods, Conelea, Bauer, & Rice, 2007; Specht et al., 2013; Verdellen et al., 2008). One study provided evidence to support the negative reinforcement hypothesis of tic maintenance and suggested that, for some youth, urge severity was low when children were allowed to tic freely and comparatively higher when tics were suppressed (Himle et al., 2007). Results of a subsequent study that examined urge ratings during and across sessions of ERP for tics indicated a contradictory pattern with no initial increase in urge severity when tics were suppressed (Verdellen et al., 2008). "
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    ABSTRACT: Tic-suppression-based treatments (TSBTs) represent a safe and effective treatment option for Chronic Tic Disorders (CTDs). Prior research has demonstrated that treatment naive youths with CTDs have the capacity to safely and effectively suppress tics for prolonged periods. It remains unclear how tic suppression is achieved. The current study principally examines how effective suppression is achieved and preliminary correlates of the ability to suppress tics. Twelve youths, ages 10 to 17 years, with moderate-to-marked CTDs participated in an alternating sequence of tic freely and reinforced tic suppression conditions during which urge intensity and tic frequency were frequently assessed. Probability of tics occurring was half as likely following high-intensity urges during tic suppression (31%) in contrast to low-intensity urges during tic freely conditions (60%). Age was not associated with ability to suppress. Intelligence indices were associated with or trended toward greater ability to suppress tics. Attention difficulties were not associated with ability to suppress but were associated with tic severity. In contrast to our "selective suppression" hypothesis, we found participants equally capable of suppressing their tics regardless of urge intensity during reinforced tic suppression. Tic suppression was achieved with an "across-the-board" effort to resist urges. Preliminary data suggest that ability to suppress may be associated with general cognitive variables rather than age, tic severity, urge severity, and attention. Treatment naive youths appear to possess a capacity for robust tic suppression. TSBTs may bolster these capacities and/or enable their broader implementation, resulting in symptom improvement.
    No preview · Article · Jun 2014 · Behavior Modification
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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.
    Full-text · Article · Apr 2014 · Behavior modification
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