|Translational Behavior Analytic Research in Tourette Syndrome: From Bedside to Bench and Back|
|Monday, May 28, 2012|
|2:00 PM–3:20 PM |
|4C-4 (Convention Center)|
|Area: CBM; Domain: Applied Research|
|Chair: Douglas W. Woods (University of Wisconsin, Milwaukee)|
|Discussant: R. Gregory Nunn (San Diego City Schools)|
Behavior analysts have long been the primary engineers behind the development of effective, nonmedicinal interventions for chronic tic disorders (e.g., Tourette syndrome; TS). Recent efforts have brought these treatments into the mainstream of clinical psychology and medicine in the form of Comprehensive Behavioral Intervention for Tics (CBIT), a "new-and-improved" version of Azrin and Nunn's (1973) Habit Reversal Training that is amenable and accessible to practice settings and practitioners outside of behavior analysis. However, this rapid expansion has been met by both familiar and unique criticisms and concerns about the use of behavior analytic interventions. We will discuss these recent advances in behavior analytic treatments for TS, research aimed at addressing empirical questions central to concerns of nonbehavior analysts, and basic research findings with potentially important implications for future refinement of existing treatments. Bringing these "bedside" questions and clinical phenomena into the laboratory for controlled evaluation has helped to allay concerns about behavioral interventions for TS, generated interesting questions for future basic research, and provided a foundation for efforts to further improve the efficacy of behavioral interventions for tic disorders. The lessons learned thus far from these endeavors can inform translational research efforts with other clinically relevant phenomena, in the service of bringing our powerful technologies to the masses while staying true to our philosophical roots.
|Keyword(s): tic disorders, translational research, treatment dissemination|
Comprehensive Behavioral Intervention for Tics: A New and Improved Habit Reversal-Based Intervention
|DOUGLAS W. WOODS (University of Wisconsin, Milwaukee)|
For decades, behavior analysts have developed and implemented efficacious interventions for Chronic Tic Disorders (CTDs) such as Tourette syndrome. Beginning in the 1970s, Azrin and Nunn (1973) showed that Habit Reversal Training (HRT) could quickly produce drastic reductions in tic frequency. Azrin and his colleagues published numerous replications showing HRTs efficacy and superiority to other non-pharmacological interventions, but HRT remained largely unknown to mainstream practitioners and the general public. Fortunately, this trend is changing at last. The past decade has seen the development of Comprehensive Behavioral Intervention for Tics (CBIT), an HRT-based treatment protocol that also includes functional analysis/intervention, relaxation training, and psychoeducation components. Large-scale, randomized controlled trials have demonstrated CBITs efficacy in decreasing tics in both children and adults, using research methodology palatable to non-behavior analysts, resulting in a drastic increase in the visibility and availability of behavior analytic interventions for tics. These successes are hugely encouraging, but much work remains to be done to disseminate CBIT to front-line practitioners (e.g. neurologists, pediatricians), and to refine the existing CBIT protocol to further improve outcomes. These endeavors can be aided by the continuation of the translational, programmatic research that has produced successes in this area to date.
DRO-Maintained Tic Suppression During Engagement in Stressful and Unstressful Tasks
|BRYAN BRANDT (University of South Florida), Christine A. Conelea (Brown University), Douglas W. Woods (University of Wisconsin, Milwaukee)|
Some have doubted that tic-suppressing skills can be successfully used in attention-demanding, stressful environments. We conducted evaluated these claims using a laboratory paradigm. In Study 1,children with CTDs were exposed to alternating periods of baseline (BL), DRO (DRO), and DRO with distraction produced by a requirement to engage concurrently in an attention-demanding task on which no contingencies were placed (DRO+DIS). Both DRO and DRO+ DIS reduced tics below BL levels and did so to a similar extent. Performance on the CPT was comparable during DRO+DIS and pre- and post- experimental administrations of the task. Study 2 exposed children with CTDs to alternating periods of BL, BL with stress (i.e. with a concurrent requirement to solve math problems that had increased self-reported stress levels during pre-experimental assessment (BL+STR), DRO, and DRO plus stress, (DRO+STR). Tic frequencies were comparable during BL and BL+STR conditions. However, tic frequencies were higher in DRO+STR than in DRO conditions. Results suggest tic suppression is unaffected by concurrent engagement in attention-demanding tasks (and vice versa), and that widely reported stress-induced tic exacerbations are mediated by a decrease in the efficacy of environmental factors maintaining tic suppression, as opposed to direct exacerbation of tics per se.
Temporal Dynamics of Urge-to-Tic Ratings and Escape-Maintained Responding During DRO-Maintained Tic Suppression
|MATTHEW CAPRIOTTI (University of Wisconsin, Milwaukee), Bryan Brandt (University of South Florida), Douglas W. Woods (University of Wisconsin, Milwaukee)|
Tics associated with Tourette Syndrome (TS) are maintained in part by a negative reinforcement cycle in which ticcing produces escape from aversive somatosensory experiences known as premonitory urges. Behavioral interventions for TS are believed to produce short-term and long-term habituation to premonitory urges, and these processes are thought to be responsible for their efficacy. However, little controlled research has evaluated these phenomena directly. We exposed children with TS to periods of free-to-tic baseline (BL), DRO, and MULT DRO EXT (MULT) with subject-initiated component transitions. Subjects rated their urge strength every 30 seconds during BL and DRO. Overall, ratings were higher during DRO conditions than BL conditions. Urge ratings were stable within and across BL conditions. In contrast, a pattern of initial increases and subsequent decreases was seen within DRO conditions. Latency to transition to the EXT component during MULT conditions corresponded to the magnitude of the decrease in self-reported urge strength in previous DRO conditions, and to a validated pencil-and-paper measure of urge severity. Results suggest that habituation to premonitory urges accompanies prolonged DRO-maintained tic suppression. Further, latency to transition to the EXT component of the MULT schedule used herein may be a useful empirical proxy for premonitory urge strength.