title: Effects of tic suppression: ability to suppress, rebound, negative reinforcement, and habituation to the premonitory urge.
abstract: The comprehensive behavioral intervention for tics (CBIT) represents a safe, effective non-pharmacological treatment for Tourette's disorder that remains underutilized as a treatment option. Contributing factors include the perceived negative consequences of tic suppression and the lack of a means through which suppression results in symptom improvement. Participants (n = 12) included youth ages 10-17 years with moderate-to-marked tic severity and noticeable premonitory urges who met Tourette's or chronic tic disorder criteria. Tic frequency and urge rating data were collected during an alternating sequence of tic freely or reinforced tic suppression periods. Even without specific instructions regarding how to suppress tics, youth experienced a significant, robust (72%), stable reduction in tic frequency under extended periods (40 min) of contingently reinforced tic suppression in contrast to periods of time when tics were ignored. Following periods of prolonged suppression, tic frequency returned to pre-suppression levels. Urge ratings did not show the expected increase during the initial periods of tic suppression, nor a subsequent decline in urge ratings during prolonged, effective tic suppression. Results suggest that environments conducive to tic suppression result in reduced tic frequency without adverse consequences. Additionally, premonitory urges, underrepresented in the literature, may represent an important enduring etiological consideration in the development and maintenance of tic disorders.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Bloomberg Children's Center, Johns Hopkins Hospital, Baltimore, MD 21283, USA. mspecht1@jhmi.edu
authors.forename: Matt W
authors.initials: MW
authors.lastname: Specht
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Woods
authors.forename: Cassandra M
authors.initials: CM
authors.lastname: Nicotra
authors.forename: Laura M
authors.initials: LM
authors.lastname: Kelly
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Ricketts
authors.forename: Christine A
authors.initials: CA
authors.lastname: Conelea
authors.forename: Marco A
authors.initials: MA
authors.lastname: Grados
authors.forename: Rick S
authors.initials: RS
authors.lastname: Ostrander
authors.forename: John T
authors.initials: JT
authors.lastname: Walkup
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D001521:Behavior Therapy / Q000379:methods*; D002648:Child; D005260:Female; D006185:Habituation, Psychophysiologic; D006801:Humans; D007266:Inhibition, Psychological; D008297:Male; D012008:Recurrence; D012054:Reinforcement, Psychology; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D020323:Tics / Q000503:physiopathology / Q000517:prevention & control* / Q000523:psychology; D005879:Tourette Syndrome / Q000503:physiopathology / Q000517:prevention & control* / Q000523:psychology; D016896:Treatment Outcome