Specht Matt W, Nicotra Cassandra M, Kelly Laura M, Woods Douglas W, Ricketts Emily J, Perry-Parrish Carisa, Reynolds Elizabeth, Hankinson Jessica, Grados Marco A, Ostrander Rick S, Walkup John T
Johns Hopkins Hospital, Baltimore, MD, USA
Johns Hopkins Hospital, Baltimore, MD, USA.
Behav Modif. 2014 Mar;38(2):297-318. doi: 10.1177/0145445514537059. Epub 2014 Jun 12.
Tic-suppression-based treatments (TSBTs) represent a safe and effective treatment option for Chronic Tic Disorders (CTDs). Prior research has demonstrated that treatment naive youths with CTDs have the capacity to safely and effectively suppress tics for prolonged periods. It remains unclear how tic suppression is achieved. The current study principally examines how effective suppression is achieved and preliminary correlates of the ability to suppress tics. Twelve youths, ages 10 to 17 years, with moderate-to-marked CTDs participated in an alternating sequence of tic freely and reinforced tic suppression conditions during which urge intensity and tic frequency were frequently assessed. Probability of tics occurring was half as likely following high-intensity urges during tic suppression (31%) in contrast to low-intensity urges during tic freely conditions (60%). Age was not associated with ability to suppress. Intelligence indices were associated with or trended toward greater ability to suppress tics. Attention difficulties were not associated with ability to suppress but were associated with tic severity. In contrast to our "selective suppression" hypothesis, we found participants equally capable of suppressing their tics regardless of urge intensity during reinforced tic suppression. Tic suppression was achieved with an "across-the-board" effort to resist urges. Preliminary data suggest that ability to suppress may be associated with general cognitive variables rather than age, tic severity, urge severity, and attention. Treatment naive youths appear to possess a capacity for robust tic suppression. TSBTs may bolster these capacities and/or enable their broader implementation, resulting in symptom improvement.
基于抽动抑制的治疗方法（TSBTs）是慢性抽动障碍（CTDs）的一种安全有效的治疗选择。先前的研究表明，初治的CTD青少年有能力长时间安全有效地抑制抽动。目前尚不清楚抽动是如何被抑制的。本研究主要探讨如何实现有效的抑制以及抽动抑制能力的初步相关因素。12名年龄在10至17岁之间、患有中度至重度CTD的青少年参与了一个自由抽动和强化抽动抑制条件交替的序列，在此期间频繁评估冲动强度和抽动频率。与自由抽动条件下低强度冲动时相比，抽动抑制期间高强度冲动后抽动发生的概率降低了一半（31%对比60%）。年龄与抑制能力无关。智力指数与更大的抽动抑制能力相关或呈相关趋势。注意力困难与抑制能力无关，但与抽动严重程度相关。与我们的“选择性抑制”假设相反，我们发现参与者在强化抽动抑制期间，无论冲动强度如何，都同样有能力抑制他们的抽动。通过“全面”努力抵抗冲动来实现抽动抑制。初步数据表明，抑制能力可能与一般认知变量有关，而与年龄、抽动严重程度、冲动严重程度和注意力无关。初治的青少年似乎具备强大的抽动抑制能力。TSBTs可能会增强这些能力和/或使其更广泛地应用，从而改善症状。
