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

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.

Tourette syndrome research highlights from 2023

“…A proposed working mechanism of BT is within-session habituation to aversive sensations preceding tic occurrence (i.e., premonitory urges). In a Dutch study by van de Griendt and colleagues (van de Griendt et al 2023), 29 participants with TS (7-59 years) rated premonitory urge intensity at multiple timepoints during 10 in-person ERP sessions. Results showed an increased urge intensity during the first 15 minutes of each session, which then levelled out during the remaining 45 minutes of the session.…”