Working Mechanisms of Exposure and Response Prevention in the Treatment of Tourette Syndrome and Tic Disorders Revisited: No Evidence for Within-Session Habituation to Premonitory Urges

Overview

Journal J Clin Med

Specialty General Medicine

Date 2023 Nov 25

PMID 38002700

Authors

Jolande M T M van de Griendt

Nelleke M E van den Berg

Cara W J Verdellen

Danielle C Cath

Marc J P M Verbraak

Affiliations

Soon will be listed here.

Abstract

Background: Exposure and response prevention (ERP) has been shown to be an effective treatment for Tourette syndrome (TS) and chronic tic disorders (CTD). ERP is based on voluntary tic suppression in combination with prolonged exposure to premonitory urges preceding tics. A prevailing hypothesis of the working mechanism underlying ERP in tics is habituation to the premonitory urges as a result of prolonged exposure. However, results so far are equivocal. This study aims to further explore the relation between urges and ERP in tics, by investigating the course of premonitory urges during ERP sessions.

Methods: Using a data-driven approach, within-session habituation to premonitory urge intensity was investigated. In total, 29 TS patients rated urge intensity at seven timepoints during ten 1 h ERP sessions.

Results/conclusions: Latent growth modeling showed an increase in urge intensity during the first 15 min of each session followed by a plateau in the remaining 45 min of the session. This does not support the idea of within-session habituation to premonitory urges as a working mechanism of ERP. Other potential underlying working mechanisms are discussed and should be tested in future research.

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References

Kurlan R, Lichter D, Hewitt D . Sensory tics in Tourette's syndrome. Neurology. 1989; 39(5):731-4. DOI: 10.1212/wnl.39.5.731. View

Ganos C, Kahl U, Schunke O, Kuhn S, Haggard P, Gerloff C . Are premonitory urges a prerequisite of tic inhibition in Gilles de la Tourette syndrome?. J Neurol Neurosurg Psychiatry. 2012; 83(10):975-8. DOI: 10.1136/jnnp-2012-303033. View

Houghton D, Capriotti M, Scahill L, Wilhelm S, Peterson A, Walkup J . Investigating Habituation to Premonitory Urges in Behavior Therapy for Tic Disorders. Behav Ther. 2017; 48(6):834-846. PMC: 5679290. DOI: 10.1016/j.beth.2017.08.004. View

Reese H, Scahill L, Peterson A, Crowe K, Woods D, Piacentini J . The premonitory urge to tic: measurement, characteristics, and correlates in older adolescents and adults. Behav Ther. 2014; 45(2):177-86. PMC: 4445415. DOI: 10.1016/j.beth.2013.09.002. View

Pringsheim T, Okun M, Muller-Vahl K, Martino D, Jankovic J, Cavanna A . Practice guideline recommendations summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology. 2019; 92(19):896-906. PMC: 6537133. DOI: 10.1212/WNL.0000000000007466. View

Specht M, Woods D, Nicotra C, Kelly L, Ricketts E, Conelea C . Effects of tic suppression: ability to suppress, rebound, negative reinforcement, and habituation to the premonitory urge. Behav Res Ther. 2012; 51(1):24-30. DOI: 10.1016/j.brat.2012.09.009. View

OConnor K . A cognitive-behavioral/psychophysiological model of tic disorders. Behav Res Ther. 2002; 40(10):1113-42. DOI: 10.1016/s0005-7967(02)00048-7. View

Andren P, Aspvall K, Fernandez de la Cruz L, Wiktor P, Romano S, Andersson E . Therapist-guided and parent-guided internet-delivered behaviour therapy for paediatric Tourette's disorder: a pilot randomised controlled trial with long-term follow-up. BMJ Open. 2019; 9(2):e024685. PMC: 6398666. DOI: 10.1136/bmjopen-2018-024685. View

Leckman J, Riddle M, Hardin M, Ort S, Swartz K, Stevenson J . The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. J Am Acad Child Adolesc Psychiatry. 1989; 28(4):566-73. DOI: 10.1097/00004583-198907000-00015. View

10.

Sheehan D, Lecrubier Y, Sheehan K, Amorim P, Janavs J, Weiller E . The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1999; 59 Suppl 20:22-33;quiz 34-57. View

11.

Kwak C, Vuong K, Jankovic J . Premonitory sensory phenomenon in Tourette's syndrome. Mov Disord. 2003; 18(12):1530-3. DOI: 10.1002/mds.10618. View

12.

Verdellen C, Keijsers G, Cath D, Hoogduin C . Exposure with response prevention versus habit reversal in Tourettes's syndrome: a controlled study. Behav Res Ther. 2004; 42(5):501-11. DOI: 10.1016/S0005-7967(03)00154-2. View

13.

van de Griendt J, van Dijk M, Verdellen C, Verbraak M . The effect of shorter exposure versus prolonged exposure on treatment outcome in Tourette syndrome and chronic tic disorders - an open trial. Int J Psychiatry Clin Pract. 2018; 22(4):262-267. DOI: 10.1080/13651501.2017.1418892. View

14.

Verdellen C, Hoogduin C, Kato B, Keijsers G, Cath D, Hoijtink H . Habituation of premonitory sensations during exposure and response prevention treatment in Tourette's syndrome. Behav Modif. 2008; 32(2):215-27. DOI: 10.1177/0145445507309020. View

15.

Azrin N, Nunn R . Habit-reversal: a method of eliminating nervous habits and tics. Behav Res Ther. 1973; 11(4):619-28. DOI: 10.1016/0005-7967(73)90119-8. View

16.

Andren P, Holmsved M, Ringberg H, Wachtmeister V, Isomura K, Aspvall K . Therapist-Supported Internet-Delivered Exposure and Response Prevention for Children and Adolescents With Tourette Syndrome: A Randomized Clinical Trial. JAMA Netw Open. 2022; 5(8):e2225614. PMC: 9379743. DOI: 10.1001/jamanetworkopen.2022.25614. View

17.

Banaschewski T, Woerner W, Rothenberger A . Premonitory sensory phenomena and suppressibility of tics in Tourette syndrome: developmental aspects in children and adolescents. Dev Med Child Neurol. 2003; 45(10):700-3. DOI: 10.1017/s0012162203001294. View

18.

Wellen B, Ramanujam K, Lavelle M, Capriotti M, Butner J, Euler M . A Test of the Behavioral Model of Tic Disorders Using a Dynamical Systems Framework. Behav Ther. 2024; 55(3):513-527. DOI: 10.1016/j.beth.2023.08.010. View

19.

Woods D, Piacentini J, Himle M, Chang S . Premonitory Urge for Tics Scale (PUTS): initial psychometric results and examination of the premonitory urge phenomenon in youths with Tic disorders. J Dev Behav Pediatr. 2005; 26(6):397-403. DOI: 10.1097/00004703-200512000-00001. View

20.

Rachamim L, Zimmerman-Brenner S, Rachamim O, Mualem H, Zingboim N, Rotstein M . Internet-based guided self-help comprehensive behavioral intervention for tics (ICBIT) for youth with tic disorders: a feasibility and effectiveness study with 6 month-follow-up. Eur Child Adolesc Psychiatry. 2020; 31(2):275-287. PMC: 7683326. DOI: 10.1007/s00787-020-01686-2. View