Neural correlates of behavior therapy for Tourette׳s disorder
Open accessAbstract
Tourette's disorder, also called Tourette syndrome (TS), is characterized by motor and vocal tics that can cause significant impairment in daily functioning. Tics are believed to be due to failed inhibition of both associative and motor cortico-striato-thalamo-cortical pathways. Comprehensive Behavioral Intervention for Tics (CBIT), which is an extension of Habit Reversal Therapy (HRT), teaches patients to become more aware of sensations that reliably precede tics (premonitory urges) and to initiate competing movements that inhibit the occurrence of tics. In this study, we used functional magnetic resonance imaging (fMRI) to investigate the neural changes associated with CBIT treatment in subjects with TS. Eight subjects with TS were matched with eight healthy controls in gender, education, age, and handedness. Subjects completed the Visuospatial Priming (VSP) task, a measure of response inhibition, during fMRI scanning before and after CBIT treatment (or waiting period for controls). For TS subjects, we found a significant decrease in striatal (putamen) activation from pre- to post-treatment. Change in VSP task-related activation from pre- to post-treatment in Brodmann's area 47 (the inferior frontal gyrus) was negatively correlated with changes in tic severity. CBIT may promote normalization of aberrant cortico-striato-thalamo-cortical associative and motor pathways in individuals with TS.
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Reduced putamen activity after habit-reversal training in Tourette syndrome suggests that this therapy works at least partly by normalizing atypically increased sensorimotor circuit activity associated with excessive habit formation.
“A neuroimaging study reported significantly reduced activity in the putamen following habit-reversal training in patients with TS, suggesting that this form of therapy works (at least in part) by normalizing atypically increased sensorimotor circuit activity associated with excessive habit formation [100].”
From Toward a neurocircuit-based taxonomy to guide treatment of obsessive-compulsive disorder (2021) · cites this paper as [100]
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“HRT has been found to be moderately effective in studies of trichotillomania (Rothbart et al., 2013; McGuire et al., 2014) and may also produce bene fi t in skin-picking disorder (Grant et al., 2012) and tic disorders such as Tourette ’ s syndrome (Deckersbach et al., 2014).”
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“Habit reversal training is an evidence-based (14) cognitive behavioral treatment that leads patient to be aware of the TS disease and it works on acceptance and self management of tics.”
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“In a randomized controlled trial comparing 10 sessions of CBIT versus psychoeducation and supportive therapy (PST) in 122 adults with CTD, PUTS scores did not signi fi cantly differ between treatment groups, though PUTS scores did signi fi cantly decrease over time across both groups (93).”
InfluentialTourette Syndrome and Tic Disorders
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“In patients with TS, involuntary movements compete with normal behavior, and reinforcing competitive actions can alleviate tic symptoms ( 17 ).”
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“utilized the same comprehensive behavioral intervention and functional magnetic resonance imaging to investigate the behavior treatment of Tourette’s syndrome with regard to neural change, found a significant decrease in the activation of striatal neurons of the basal ganglia from before to after the treatments [10].”
MethodTreatment options for tic disorders
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“premonitory urge (exposure with response prevention) [18].”
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Self-citationClinical Aspects of Premonitory Urges in Patients with Tourette’s Disorder
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Transcranial magnetic stimulation to probe the role of the supplementary motor area in tics
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“SMA shows strong resting state functional connectivity with deep brain stimulation sites most eective for treating tics (Fox et al., 2014) and with striatal regions thought to change with CBIT treatment (Deckersbach et al., 2014).”
Behavioural Therapy for tic disorders: a comprehensive review of the literature
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“Another study found that putamen activation during a visuospatial priming response inhibition decreased from CBIT baseline to endpoint [34].”
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“Neuroimaging findings suggest that behavioral interventions such HRT may enhance activity and functional connectivity in premotor and sen-sorimot or regions, possibly reflecting neuroplastic changes that facilitate awareness of premonitory urges and voluntary suppression of tics [30] .”
EEG power modulation in the sensorimotor regions is critical to motor tic suppression
Miyakoshi, M., Jurgiel, J., Dillon, A., Piacentini, J. C., Makeig, S., & Loo, S. K. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1580636 · Cited by 1 · see citing works
“…the inhibitory control exerted by frontal structures, such as the dorsolateral prefrontal cortex, inferior frontal gyrus, and supplementary motor area during voluntary movement and self-regulation, may be consistent with neural activity reported during tic inhibition and suppression (6, 84, 85).”
Self-citationTourette syndrome research highlights from 2020
Hartmann, A., Atkinson-Clément, C., Depienne, C., & BLACK, K. J. (2022) · F1000Research · doi:10.12688/f1000research.75628.1 · Cited by 2 · see citing works
Recent advances in neuroimaging of Tourette syndrome
Cothros, N., & Martino, D. (2022) · International review of movement disorders · doi:10.1016/bs.irmvd.2022.02.001 · Cited by 2 · see citing works
Behavioral Therapy for Tourette Disorder: An Update
Himle, M. B., & Capriotti, M. R. (2016) · Current Behavioral Neuroscience Reports · doi:10.1007/s40473-016-0085-2 · Cited by 2 · 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
40. Tics et syndrome de gilles de la tourette
Delorme, R., Deniau, E., & Hartmann, A. (2012) · Time to knit · doi:10.1016/s0246-0378(17)79782-5
The neural correlates of tic inhibition
Abi‐Jaoude, E., & Sandor, P. (2022) · International review of movement disorders · doi:10.1016/bs.irmvd.2021.12.004
O’Connor, K. P., Lavoie, M. E., & Schoendorff, B. (2017) · Wiley eBooks · doi:10.1002/9781119167303.refs
Tic e sindrome di Gilles de la Tourette
Hartmann, A., Deniau, E., Czernecki, V., Negovanska, V., d’Harcourt, S., Depienne, C., Klein, Y., & Worbe, Y. (2018) · EMC - Neurologia · doi:10.1016/s1634-7072(18)89402-8
Alexander, J., & Woods, D. W. (2018) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780190634841.013.28
Self-citationNeuropsychological Assessment in Tourette Syndrome
Murphy, T. L., Czernecki, V., Tárnok, Z., & Stark, D. L. (2022) · Oxford University Press eBooks · doi:10.1093/med/9780197543214.003.0022
Behavioral 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
Ricketts, 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-citationTics et syndrome de Gilles de la Tourette
Hartmann, A., Bahadori, S., Bahout, M., Czernecki, V., Delorme, C., Depienne, C., Moulin, J., & Nilles, C. (2026) · Encyclopédie médico-chirurgicale. Neurologie · doi:10.1016/s0246-0378(25)50181-1
- Authors
- Deckersbach, T., Chou, T., Britton, J. C., Carlson, L. E., Reese, H. E., Siev, J., Scahill, L., Piacentini, J. C., Woods, D. W., Walkup, J. T., Peterson, A. L., Dougherty, D. D., & Wilhelm, S.
- Affiliations
- Harvard University (US)
- University of Miami (US)
- Nova Southeastern University (US)
- Emory University (US)
- University of California, Los Angeles (US)
- Texas A&M University (US)
- NewYork–Presbyterian Hospital (US)
- The University of Texas at San Antonio Health Science Center (US)
- Corresponding author
- Deckersbach, Thilo
- ORCID
- Venue
- Psychiatry Research: Neuroimaging
- Publisher
- Elsevier BV
- Published
- 2014-12
- Volume
- 224
- Issue
- 3
- Pages
- 269-274
- ISSN
- 0925-4927 (ISSN-L)
- PMC
- PMC4410879
- OpenAlex
- W1993772385
- Cited by
- 78
- References
- 36
- Citations by year
- 2026: 1 · 2025: 29 · 2024: 2 · 2023: 2 · 2022: 9 · 2021: 6 · 2020: 4 · 2019: 4 · 2018: 5 · 2017: 5 · 2016: 5 · 2015: 5 · 2012: 1
- FWCI
- 5.90
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychiatry Research Neuroimaging (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Bowdoin - Digital Commons (Bowdoin College) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Tourette Syndrome Association
- the Intramural Research Program of the National Institute of Mental Health (R00 MH091183)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Clinical Psychology › Stuttering Research and Treatment
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Keywords
- Tourette syndrome, Comprehensive Behavioral Intervention for Tics, habit reversal therapy, tics, response inhibition, premonitory urges, inferior frontal gyrus, tic severity
- MeSH terms
- Adult, Behavior Therapy, Frontal Lobe, Tourette Syndrome, Humans, Inhibition, Psychological, Magnetic Resonance Imaging, Male, Neural Pathways, Putamen, Treatment Outcome, Cerebrum, Young Adult
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