Effects of Tic Suppression and Urge Monitoring on Premonitory Urges and Tic Frequency in Tourette Syndrome.

Objectives: Behavioral interventions for Tourette syndrome (TS) involve tic suppression and attention to premonitory urges. However, some patients believe that focusing on tic symptoms or urges may worsen symptoms, and that suppressing tics may exacerbate urges. Using a single experimental dataset with real-time urge monitoring, this study addressed two analytical aims. Aim 1 examined whether tic suppression worsens the intensity, frequency, and persistence of premonitory urges. Aim 2 examined whether sustained attention to urges increases tic frequency or worsens subjective urges. Methods: Ten adult men with TS and frequent tic symptoms (mean age=28.3 years, standard deviation=9.1 years) completed four 5-min conditions twice: rest, suppression, urge-reporting, and suppression+urge-reporting. In the urge-reporting conditions, participants used a handheld monitor to continuously report urges. The sessions were video-recorded, and tic frequency was coded. For Aim 1, the mean urge intensity, frequency of threshold-crossing urge episodes, and post-threshold persistence patterns were compared between the urge-reporting and suppression+urge-reporting conditions. For Aim 2, tic frequency and subjective states were compared between the conditions with and without urge-reporting. Results: At the group level, tic suppression was not associated with consistent worsening of mean urge intensity, frequency of threshold-crossing urge episodes, or post-threshold persistence patterns. This overall pattern did not clearly differ by obsessive-compulsive symptoms, although participants with these symptoms showed larger and more persistent urge responses in the descriptive plots. Sustained urge-reporting was not associated with a consistent group-level increase in tic frequency; instead, marked individual variability was observed. Subjective urge intensity and fatigue were higher after suppression+urge-reporting condition than after suppression condition. Conclusion: Under short-term laboratory conditions, tic suppression was not associated with a consistent group-level worsening pattern in premonitory urge indices, and real-time urge reporting was not associated with a consistent group-level increase in tic frequency. However, individual variability was substantial; this variability may be partly related to obsessive-compulsive symptoms.