prolonged Tic Suppression and Habituation to the Premonitory Urge

Grant Type
Grant Year
Institution Location
Institution Organization Name
Johns Hopkins Medical Institutions
Investigators Name
Specht, Matthew, PhD

Evidence supports the effectiveness of psychosocial treatments for Tourette Syndrome (TS) and tic disorders. Habit Reversal Training (HRT), a behavioral intervention, is the best researched psychosocial treatment for TS and tic disorders, and is now considered a well-established treatment for reducing tic symptoms. However, despite its proven effectiveness, practitioners seldom use it to reduce tic symptoms. For HRT to become more widely used it is essential that we better understand how it works. Many people with TS report feeling an unpleasant sensation right before a tic occurs. This feeling is often described as a “need” or “urge” to perform the tic. Until now it has been thought that performing the tic reduces the unpleasant sensation, and that suppressing the tic temporarily increases the urge. If this were the whole story, then purposely withholding tics would only increase the need to tic, and behavioral treatments to reduce symptoms would not be effective. However behavioral theory suggests that HRT works because it helps patients withhold the tic until the unpleasant urge or sensation that precedes the tic goes away on its own accord. The present study is designed to see what happens to the “urge” when tics are purposely withheld. Fifteen children and adolescents (aged 10-17) will be asked to complete a diagnostic evaluation. They will then be asked to go through a number of sessions in which they can either “tic freely” or “withhold tics” while at the same time providing urge ratings. Data from the two experimental situations will help us determine how the urge to tic reacts over time, both when tics are performed and when they are withheld. This research will help explain how behavioral treatments, such as HRT, decrease tic symptoms. Results will also lead to improved treatment recommendations, and will help to refine behavioral treatments for tic disorders in the future. Matthew W. Specht, Ph.D., John Walkup, M.D. Johns Hopkins Medical Institutions, Baltimore, MD Award: $53,228 Tourette Association of America Inc. – Research Grant Award 2008-2009