An effective behavioral treatment for Tourette’s Syndrome is Habit Reversal Therapy (HRT), which includes the ‘competing response’ procedure. While this helps many patients to control their tics, the underlying neurocognitive mechanisms are unknown. To provide neurobiological insights into the mechanisms, we will use functional neuroimaging in humans to test whether the competing response procedure shares similar neural mechanisms as so-called ‘stop-change’ behavior in a classic cognitive psychology task. Stop-change involves first stopping response1 and then initiating response2. Conveniently, the neural correlates of stop-change are quite well understood. We expect common activation in the right inferior frontal gyrus (rIFG), a critical node in the stopping network, for both stop change and the competing response. This would be consistent with prior studies showing rIFG activation during tic suppression, and would go further by linking this to the stopping of movement and also showing it occurs during the competing response procedure. In addition, we will use a state-of-the-art fMRI biofeedback method to test whether patients with TS can increase their control over the rIFG-stopping network while performing the competing response. We will provide real-time fMRI signal from the rIFG region of each patient, and investigate whether s/he can up-regulate that signal during the competing response routine. This will provide important technical insight, as well as proof-of-concept of the utility of real-time fMRI to optimize behavioral treatment. Yu-Chin Chiu, Ph.D., Adam R. Aron, Ph.D., Jennifer Friedman, M.D. & John Piacentini, Ph.D. University of California, San Diego, La Jolla, CA $75,000 2012 Grant Year Yu-Chin Chiu, Ph.D., Adam R. Aron, Ph.D., Jennifer Friedman, M.D. & John Piacentini, Ph.D. University of California, San Diego, La Jolla, CA Award: $75,000 Tourette Association of America Inc. – Research Grant Award 2012-2013