A Test of the Behavioral Model of Tic Disorders Using a Dynamical Systems Framework

Brianna C.M. Wellen, Krishnapriya Ramanujam, Mark Lavelle, Matthew R. Capriotti, Jonathan Butner, Matthew J. Euler, Michael B. Himle

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Tic disorders are a class of neurodevelopmental disorders characterized by involuntary motor and/or vocal tics. It has been hypothesized that tics function to reduce aversive premonitory urges (i.e., negative reinforcement) and that suppression-based behavioral interventions such as habit reversal training (HRT) and exposure and response prevention (ERP) disrupt this process and facilitate urge reduction through habituation. However, previous findings regarding the negative reinforcement hypothesis and the effect of suppression on the urge-tic relationship have been inconsistent. The present study applied a dynamical systems framework and within-subject time-series autoregressive models to examine the temporal dynamics of urges and tics and assess whether their relationship changes over time. Eleven adults with tic disorders provided continuous urge ratings during separate conditions in which they were instructed to tic freely or to suppress tics. During the free-to-tic conditions, there was considerable heterogeneity across participants in whether and how the urge-tic relationship followed a pattern consistent with the automatic negative reinforcement hypothesis. Further, little evidence for within-session habituation was seen; tic suppression did not result in a reduction in premonitory urges for most participants. Analysis of broader urge change metrics did show significant disruption to the urge pattern during suppression, which has implications for the current biobehavioral model of tics.

Original languageEnglish (US)
Pages (from-to)513-527
Number of pages15
JournalBehavior Therapy
Volume55
Issue number3
DOIs
StatePublished - May 2024
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2023 Association for Behavioral and Cognitive Therapies

Keywords

  • behavior therapy
  • habituation
  • negative reinforcement
  • systems theory
  • tics
  • Tourette syndrome

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

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