Investigating Habituation to Premonitory Urges in Behavior Therapy for Tic Disorders
Open accessAbstract
Behavior therapy is effective for Persistent Tic Disorders (PTDs), but behavioral processes facilitating tic reduction are not well understood. One process, habituation, is thought to create tic reduction through decreases in premonitory urge severity. The current study tested whether premonitory urges decreased in youth with PTDs (N = 126) and adults with PTDs (N = 122) who participated in parallel randomized clinical trials comparing behavior therapy to psychoeducation and supportive therapy (PST). Trends in premonitory urges, tic severity, and treatment outcome were analyzed according to the predictions of a habituation model, whereby urge severity would be expected to decrease in those who responded to behavior therapy. Although adults who responded to behavior therapy showed a significant trend of declining premonitory urge severity across treatment, results failed to demonstrate that behavior therapy specifically caused changes in premonitory urge severity. In addition, reductions in premonitory urge severity in those who responded to behavior therapy were significant greater than those who did not respond to behavior therapy but no different than those who responded or did not respond to PST. Children with PTDs failed to show any significant changes in premonitory urges. Reductions in premonitory urge severity did not mediate the relationship between treatment and outcome in either adults or children. These results cast doubt on the notion that habituation is the therapeutic process underlying the effectiveness of behavior therapy, which has immediate implications for the psychoeducation and therapeutic rationale presented in clinical practice. Moreover, there may be important developmental changes in premonitory urges in PTDs, and alternative models of therapeutic change warrant investigation.
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Habit-reversal training is an effective behavioral therapy for tic symptoms in Tourette syndrome, targets sensory phenomena, and reduces premonitory urges and tic severity in adults with Tourette syndrome.
“Furthermore, habit-reversal training (Table 3), an effective behavioral therapy for tic symptoms used in TS, targets sensory phenomena and has been shown to reduce premonitory urges as well as tic symptom severity in adults with TS [98–99].”
From Toward a neurocircuit-based taxonomy to guide treatment of obsessive-compulsive disorder (2021) · cites this paper as [98]
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A Review of Cognitive and Behavioral Interventions for Tic Disorder
Kim, K. M., Bae, E. J., Lee, J., Park, T. W., & Lim, M. H. (2021) · Journal of korean Academy of Child and Adolescent Psychiatry · doi:10.5765/jkacap.200042 · Cited by 31 · see citing works
Correlates and Clinical Implications of Tic Suppressibility
Ueda, K., Kim, S., Greene, D. J., & BLACK, K. J. (2021) · Current Developmental Disorders Reports · doi:10.1007/s40474-021-00230-4 · Cited by 31 · see citing works
Predictors of therapeutic treatment outcome in adolescent chronic tic disorders
Nissen, J. B., Parner, E. T., & Thomsen, P. H. (2019) · BJPsych Open · doi:10.1192/bjo.2019.56 · Cited by 26 · see citing works
Developing the Premonitory Urges for Tic Disorders Scale–Revised (PUTS‐R)
Baumung, L., Müller‐Vahl, K., Dyke, K., Jackson, G. M., Jackson, S. R., Golm, D., Münchau, A. M., & Brandt, V. C. (2020) · Journal of Neuropsychology · doi:10.1111/jnp.12216 · Cited by 23 · see citing works
Cognitive control processes in behavior therapy for youth with Tourette’s disorder
Mcguire, J. F., Sturm, A., Ricketts, E. J., Montalbano, G. E., Chang, S. W., Loo, S. K., Woods, D. W., McCracken, J. T., & Piacentini, J. C. (2021) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.13470 · Cited by 23 · see citing works
Self-citationMatsuda, N., Nonaka, M., Kono, T., Fujio, M., Nobuyoshi, M., & Kano, Y. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00592 · Cited by 23 · see citing works
Review of habit reversal training for tic disorders
Liu, S., Li, Y., & Cui, Y. (2020) · Pediatric Investigation · doi:10.1002/ped4.12190 · Cited by 20 · see citing works
Andrén, P., Wachtmeister, V., Franzé, J., Speiner, C., de la Cruz, L. F., Andersson, E., de Schipper, E. J., Rautio, D., Silverberg-Mörse, M., Serlachius, E., et al. (2020) · Child Psychiatry & Human Development · doi:10.1007/s10578-020-01098-y · Cited by 20 · see citing works
Reese, H. E., Brown, W. A., Summers, B. J., Shin, J. Y., Wheeler, G. L., & Wilhelm, S. (2021) · Pilot and Feasibility Studies · doi:10.1186/s40814-021-00818-y · Cited by 19 · see citing works
Self-citationTourette syndrome research highlights from 2017
Hartmann, A., Worbe, Y., & BLACK, K. J. (2018) · F1000Research · doi:10.12688/f1000research.15558.1 · Cited by 18 · see citing works
Behavioral Interventions for Children and Adults with Tic Disorder
Woods, D. W., Himle, M. B., Stiede, J. T., & Pitts, B. X. (2023) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-080921-074307 · Cited by 20 · see citing works
Self-citationEdwards, K. R., Raines, J. M., Winnick, J. B., Sherman, M. F., Higginson, C. I., Navin, K. S., Conteh, F., Ricketts, E. J., & Specht, M. W. (2020) · Journal of Neural Transmission · doi:10.1007/s00702-020-02151-9 · Cited by 15 · see citing works
Sensory Gating in Neurodevelopmental Disorders: A Scoping Review
Schulz, S. E., Luszawski, M., Hannah, K. E., & Stevenson, R. A. (2023) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-023-01058-9 · Cited by 15 · see citing works
Hollis, C. P., Hall, C. L., Khan, K., Novere, M. L., Marston, L., Jones, R., Hunter, R. M., Brown, B. J., Sanderson, C., Andrén, P., et al. (2023) · Health Technology Assessment · doi:10.3310/cpms3211 · Cited by 15 · see citing works
Premonitory urge in tic disorders – a scoping review
Wohlgemuth, J. B., Watson, K. H., Gill, K. D., & Isaacs, D. A. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1504442 · Cited by 12 · see citing works
van de Griendt, J. M. T. M., van den Berg, N. M. E., Verdellen, C. W. J., Cath, D. C., & Verbraak, M. J. P. M. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12227087 · Cited by 11 · see citing works
Treatment of Tourette Syndrome With Attention Training Technique—A Case Series
Schaich, A., Brandt, V. C., Senft, A., Schiemenz, C., Klein, J. P., Faßbinder, E., Münchau, A. M., & Alvarez‐Fischer, D. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.519931 · Cited by 10 · see citing works
A Test of the Behavioral Model of Tic Disorders Using a Dynamical Systems Framework
Wellen, B. C. M., Ramanujam, K., Lavelle, M., Capriotti, M. R., Butner, J., Euler, M. J., & Himle, M. B. (2023) · Behavior Therapy · doi:10.1016/j.beth.2023.08.010 · Cited by 9 · see citing works
Self-citationMorand‐Beaulieu, S., Crowley, M. J., Grantz, H., Leckman, J. F., Scahill, L. D., & Sukhodolsky, D. G. (2022) · Clinical Neurophysiology · doi:10.1016/j.clinph.2022.07.500 · Cited by 8 · see citing works
Self-citationFriedrich, J., Rawish, T., Bluschke, A., Frings, C., Beste, C., & Münchau, A. M. (2023) · Biomedicines · doi:10.3390/biomedicines11061550 · Cited by 8 · see citing works
Lundström, L., Ivanova, E., Mataix‐Cols, D., Flygare, O., Cervin, M., Rück, C., & Andersson, E. (2024) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2024.100880 · Cited by 8 · see citing works
Advancements in the phenomenology, assessment, and treatment of Tourette syndrome
Ramsey, K. A., & Mcguire, J. F. (2023) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000922 · Cited by 7 · see citing works
Morand‐Beaulieu, S., Crowley, M. J., Grantz, H., Leckman, J. F., & Sukhodolsky, D. G. (2023) · Psychological Medicine · doi:10.1017/s0033291723001940 · Cited by 6 · see citing works
Cadeddu, R., Braccagni, G., Branca, C., van Luik, E. R., Pittenger, C., Thomsen, M. S., & Bortolato, M. (2024) · British Journal of Pharmacology · doi:10.1111/bph.16392 · Cited by 5 · see citing works
Clinical Aspects of Premonitory Urges in Patients with Tourette’s Disorder
Nam, S. H., Park, J., & Park, T. W. (2019) · Journal of korean Academy of Child and Adolescent Psychiatry · doi:10.5765/jkacap.180025 · Cited by 5 · see citing works
Che, G., Ren, W., Mcguire, J. F., Li, P., Zhao, Z., Tian, J., Zhang, J., & Zhang, Y. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1224825 · Cited by 5 · see citing works
Behavioural Therapy for tic disorders: a comprehensive review of the literature
Morand‐Beaulieu, S., Szejko, N., Fletcher, J., & Pringsheim, T. M. (2024) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2024.2405740 · Cited by 2 · see citing works
Yu, L., Li, Y., Wang, X., & Cui, Y. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1530911 · Cited by 2 · see citing works
Phenomenology of Tics and Sensory Urges
Leckman, J. F., Bloch, M. H., Sukhodolsky, D. G., Artukoglu, B. B., Scahill, L. D., & King, R. A. (2022) · Oxford University Press eBooks · doi:10.1093/med/9780197543214.003.0002 · Cited by 1 · see citing works
Self-citationReese, H. E., Brown, W. A., Wallenberger, Y. H., Ramsey, K. A., Browning, L. E., Rooks, J. D., Gould, N. F., Leoutsakos, J., Mendelson, T., Chang, A. H., et al. (2026) · Contemporary Clinical Trials · doi:10.1016/j.cct.2026.108224 · Cited by 1 · see citing works
Behavioral interventions for tic disorders
Himle, M. B., Marklin, M., & Wellen, B. C. M. (2026) · Handbook of clinical neurology · doi:10.1016/b978-0-443-13554-5.00030-4 · Cited by 1 · see citing works
Die Bedeutung des Vorgefühls bei Tic-Störungen
Schütteler, C., & Gerlach, A. L. (2022) · Zeitschrift für Klinische Psychologie und Psychotherapie · doi:10.1026/1616-3443/a000677 · Cited by 1 · see citing works
Behavioral predictors of sexual proclivity in a sexual offender
Ruben, D. H. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-819805-6.00003-8
Montalbano, G. E., Yang, J. W., Nurmi, E. L., & Ricketts, E. J. (2021) · Comprehensive Clinical Psychology · doi:10.1016/b978-0-12-818697-8.00042-x
Tic disorders and trichotillomania
Miltenberger, R. G., Stiede, J. T., Woods, D. W., & Himle, M. B. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-805469-7.00008-5
Self-citationBehavioral and Cognitive–Behavioral Therapy for Tourette Disorder
Mcguire, J. F., Capriotti, M. R., Woods, D. W., & Piacentini, J. C. (2022) · Oxford University Press eBooks · doi:10.1093/med/9780197543214.003.0025
Self-citationWoods, D. W., Piacentini, J. C., Peterson, A. L., Scahill, L. D., & Walkup, J. T. (2025) · doi:10.1093/med-psych/9780199363346.001.0001
Self-citationWoods, D. W., Piacentini, J. C., Peterson, A. L., Scahill, L. D., & Walkup, J. T. (2025) · doi:10.1093/med-psych/9780199363346.002.0005
Self-citationWoods, D. W., Piacentini, J. C., Peterson, A. L., Scahill, L. D., & Walkup, J. T. (2025) · doi:10.1093/med-psych/9780199363346.002.0004
Self-citationIntroductory Information for Therapists
Woods, D. W., Piacentini, J. C., Peterson, A. L., Scahill, L. D., & Walkup, J. T. (2025) · doi:10.1093/med-psych/9780199363346.003.0001
Self-citationBehavioral Model of Tic Disorders and Mechanisms of Change
Woods, D. W., Piacentini, J. C., Peterson, A. L., Scahill, L. D., & Walkup, J. T. (2025) · doi:10.1093/med-psych/9780199363346.003.0003
Self-citationWoods, D. W., Piacentini, J. C., Peterson, A. L., Scahill, L. D., & Walkup, J. T. (2025) · doi:10.1093/med-psych/9780199363346.003.0002
Self-citationWoods, D. W., Piacentini, J. C., Peterson, A. L., Scahill, L. D., & Walkup, J. T. (2025) · doi:10.1093/med-psych/9780199363346.005.0001
Self-citationWoods, D. W., Piacentini, J. C., Peterson, A. L., Scahill, L. D., & Walkup, J. T. (2025) · doi:10.1093/med-psych/9780199363346.003.0006
Self-citationComorbidity Management: It’s Not Just Tics
Lewin, A. B. (2025) · doi:10.1093/med-psych/9780199363346.003.0017
Bootes, K. R., Blount, T. H., Kudryk, K., & Himle, M. B. (2025) · doi:10.1093/med-psych/9780199363346.003.0015
Occupational Therapy, Tourette Disorder, and CBIT
Rowe, J., & Martin, H. S. (2025) · doi:10.1093/med-psych/9780199363346.003.0013
Assessment of Tourette Disorder
Woods, D. W., Piacentini, J. C., Peterson, A. L., Scahill, L. D., & Walkup, J. T. (2025) · doi:10.1093/med-psych/9780199363346.003.0004
Self-citationWoods, D. W., Piacentini, J. C., Peterson, A. L., Scahill, L. D., & Walkup, J. T. (2025) · doi:10.1093/med-psych/9780199363346.003.0007
Self-citationFunctional Assessment and Function-Based Intervention
Woods, D. W., Piacentini, J. C., Peterson, A. L., Scahill, L. D., & Walkup, J. T. (2025) · doi:10.1093/med-psych/9780199363346.003.0005
Self-citationWoods, D. W., Piacentini, J. C., Peterson, A. L., Scahill, L. D., & Walkup, J. T. (2025) · doi:10.1093/med-psych/9780199363346.003.0010
Self-citationSessions 7 and 8 and Booster Sessions
Woods, D. W., Piacentini, J. C., Peterson, A. L., Scahill, L. D., & Walkup, J. T. (2025) · doi:10.1093/med-psych/9780199363346.003.0011
Self-citationMcguire, J. F. (2025) · doi:10.1093/med-psych/9780199363346.003.0014
Woods, D. W., Piacentini, J. C., Peterson, A. L., Scahill, L. D., & Walkup, J. T. (2025) · doi:10.1093/med-psych/9780199363346.003.0009
Self-citationWoods, D. W., Piacentini, J. C., Peterson, A. L., Scahill, L. D., & Walkup, J. T. (2025) · doi:10.1093/med-psych/9780199363346.003.0008
Self-citationWoods, D. W., Piacentini, J. C., Peterson, A. L., Scahill, L. D., & Walkup, J. T. (2025) · doi:10.1093/med-psych/9780199363346.002.0009
Self-citationAdapting CBIT for Younger Children
Bennett, S. M., & Capriotti, M. R. (2025) · doi:10.1093/med-psych/9780199363346.003.0012
Self-citationRicketts, E. J., Dougherty, A. C. T., Gonzalez, A., & Chang, S. W. (2025) · doi:10.1093/med-psych/9780199363346.003.0016
Behavior therapy for childhood tic disorders
Barber, K. E., Pitts, B. X., Houghton, D. C., & Woods, D. W. (2025) · Elsevier eBooks · doi:10.1016/b978-0-443-22365-5.00006-8
Self-citation
- Authors
- Houghton, D. C., Capriotti, M. R., Scahill, L. D., Wilhelm, S., Peterson, A. L., Walkup, J. T., Piacentini, J., & Woods, D. W.
- Affiliations
- Texas A&M University (US)
- University of California, San Francisco (US)
- Emory University (US)
- Harvard University (US)
- The University of Texas at San Antonio Health Science Center (US)
- Cornell University (US)
- University of California, Los Angeles (US)
- Marquette University (US)
- Corresponding author
- Houghton, David C.
- ORCID
- Venue
- Behavior Therapy
- Publisher
- Elsevier BV
- Published
- 2017-11
- Volume
- 48
- Issue
- 6
- Pages
- 834-846
- ISSN
- 0005-7894 (ISSN-L)
- PMC
- PMC5679290
- OpenAlex
- W2742459374
- Cited by
- 67
- References
- 83
- Citations by year
- 2026: 2 · 2025: 26 · 2024: 4 · 2023: 10 · 2022: 4 · 2021: 7 · 2020: 7 · 2019: 3 · 2018: 4
- FWCI
- 4.74
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Behavior Therapy (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- e-Publications@Marquette (Marquette University) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Yale University
- National Institute of Mental Health (R01MH069875, R01MH069874, R01MH069877, R01MH070802)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Clinical Psychology › Stuttering Research and Treatment
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Keywords
- premonitory urges, habituation, tic reduction, treatment response, therapeutic process, children and adults
- MeSH terms
- Adolescent, Adult, Behavior Therapy, Child, Female, Habituation, Psychophysiologic, Humans, Male, Models, Psychological, Tic Disorders, Treatment Outcome
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