Effects of tic suppression: Ability to suppress, rebound, negative reinforcement, and habituation to the premonitory urge

Matt W. Specht, Douglas W. Woods, Cassandra M. Nicotra, Laura M. Kelly, Emily J. Ricketts, Christine A. Conelea, Marco A. Grados, Rick S. Ostrander, John T. Walkup

Research output: Contribution to journalArticlepeer-review

77 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)24-30
Number of pages7
JournalBehaviour Research and Therapy
Issue number1
StatePublished - Jan 2013

Bibliographical note

Funding Information:
This research was supported by a grant from the Tourette's Syndrome Association . This association had no involvement in designing and conducting the study, analyzing and interpreting the data, or writing this report.

Funding Information:
Doug Woods has received book royalties from Guilford Press, Oxford University Press, Springer Press, and New Harbinger Publications. Dr. Woods has received grants from the Tourette Syndrome Association, Trichotillomania Learning Center and the National Institutes of Health . Dr. Woods has received speaking honoraria from a partnership program between the Tourette Syndrome Association and Centers for Disease Control.


  • Extinction learning
  • Habituation
  • Rebound
  • Tic suppression
  • Tourette's
  • Urge


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