Investigating the effects of tic suppression on premonitory urge ratings in children and adolescents with Tourette's syndrome

Tics represent a complex class of behaviors that have a neurobiological origin and are influenced by factors both internal and external to the individual. One factor that has gained recent attention is the premonitory urge. Contemporary behavioral models suggest that some tics are preceded by aversive somatic urges that increase in severity when tics are suppressed and are attenuated by performance of the tic. It has been proposed that the removal of premonitory urges may strengthen or maintain tics via negative reinforcement. This investigation is the first to empirically evaluate the effect of tic suppression on the premonitory urge phenomenon. Five children and adolescents, ages 8–17 years, participated in the study. Using an ABAB reversal design, tic frequency and subjective premonitory urge ratings were recorded under conditions of free-to-tic baseline (BL) and reinforced tic suppression (differential reinforcement of zero-rate behavior). Results show that four of the five children demonstrated reliable suppression. Of the four children who achieved suppression, three demonstrated a pattern in which subjective urge ratings were higher during suppression than during BL. Results provide preliminary support for the negative reinforcement view of tic function for some children.     

Role of thought-related beliefs and coping strategies in the escalation of intrusive thoughts: an analog to obsessive-compulsive disorder

Cognitive-behavioral models of obsessive-compulsive disorder (OCD) assume that obsessions have their origin in normal intrusive thoughts. These models propose that certain beliefs, such as thought-action fusion (TAF) beliefs, combined with the use of ineffective coping strategies, such as thought suppression, lead to the development of OCD. The purpose of the current study was to examine the relationship between these variables in a non-clinical sample in addition to exploring the effects of an alternative, acceptance-based coping strategy. This study explored the relationship between TAF beliefs, thought suppression, and OC-consistent symptoms via mediational analyses. Results showed that thought suppression mediated the relationship between TAF beliefs and OC-consistent symptoms. This study also experimentally examined the effects of various coping strategies (suppression, acceptance, or monitor-only) on the frequency of a distressing intrusion and appraisal ratings (e.g., anxiety, guilt, responsibility) after a TAF induction. Spontaneous suppression in the monitor-only group made comparisons of the experimental data difficult. However, analyses provided preliminary evidence suggesting that thought suppression is related to more intrusions, higher levels of anxiety, and negative appraisals, whereas an acceptance-based approach may be a useful alternative. Additional findings, limitations of the current study, and directions for future research are discussed.     

Confidence intervals for gamma-family measures of ordinal association

This research focused on confidence intervals (CIs) for 10 measures of monotonic association between ordinal variables. Standard errors (SEs) were also reviewed because more than 1 formula was available per index. For 5 indices, an element of the formula used to compute an SE is given that is apparently new. CIs computed with different SEs were compared in simulations with small samples (N = 25, 50, 75, or 100) for variables with 4 or 5 categories. With N > 25, many CIs performed well. Performance was best for consistent CIs due to N. Cliff and colleagues (N. Cliff, 1996; N. Cliff & V. Charlin, 1991; J. D. Long & N. Cliff, 1997). CIs for Spearman's rank correlation were also examined: Parameter coverage was erratic and sometimes egregiously underestimated.     

Development and Initial Validation of an Abbreviated Spider Phobia Questionnaire Using Item Response Theory

An abbreviated Spider Phobia Questionnaire (SPQ) was developed using methods based in item response theory. Fifteen of the 31 SPQ items that demonstrated good to excellent discrimination along the spider fear continuum were retained in Study 1 that consisted of 1,555 nonclinical and clinical participants. The SPQ-15 demonstrated good internal consistency and correlated highly with the full SPQ. Structural equation modeling revealed that the SPQ-15 demonstrated excellent convergent validity, with strong associations with small animal disgust and other phobic symptoms. Supportive evidence was also found for divergent validity in relation to panic-related symptoms. The SPQ-15 was uniquely predictive of avoidance behavior and fear and disgust responding towards spiders in nonclinical, analogue, and treatment-seeking samples in Studies 2, 3, and 4. Lastly, in Study 5, the SPQ-15 was sensitive to the effects of exposure-based treatment. These findings suggest that the SPQ-15 has considerable strengths, including decreased assessment and scoring time while retaining high reliability, validity, and sensitivity.     

Evaluation and elimination of an avoidance response in a child who stutters: A case study

In this case study, efforts to treat stuttering in a 6-year-old male with cerebral palsy were complicated by frequent replies of “I don't know” that allowed the child to avoid more extensive answers to conversational questions. Following a program of extinction plus differential reinforcement of alternative behavior (DRA), the response “I don't know” was decreased while both speech rate and stuttering increased. Simplified habit reversal (SHR) techniques (controlled breathing) were then applied and resulted in a reduction of stuttering and maintenance of low rates of avoidance. A reversal to baseline resulted in initially high levels of avoidance and low levels of stuttering, with these trends reversing as baseline continued. The SHR treatment for stuttering was then reimplemented and stuttering rates again decreased while avoidance rates remained low, Implications are discussed.     

Specificity of learning in reality-orientation sessions: a single-case study

A single-case study of retraining of verbal orientation in a 68-year-old patient with Korsa-koff's psychosis is described. In order to test the specificity of learning three different lists of verbalorientation items were taught in separate phases of a multiple-baseline design. Learning did occur mainly in the appropriate phases, with little generalization across phases being apparent. The results support the presence of a relearning component in the Reality-Orientation approach. In addition they emphasize that it is desirable for treatment programmes to focus on particular target areas of functioning.     

Fixed-ratio escape and avoidance-escape from naloxone in morphine-dependent monkeys: effects of naloxone dose and morphine pretreatment.

Lever pressing by rhesus monkeys was maintained by morphine injections during four equally spaced sessions each day. During other periods, lever pressing was maintained by timeout from a continuous naloxone infusion (escape), or by timeout from a stimulus that preceded naloxone injections, or termination of the injections (avoidance-escape). As naloxone dose increased in the escape procedure, response rate increased to a maximum and then decreased. In the avoidance-escape procedure, response rate generally increased as naloxone dose increased, but the changes in rate were small compared to the excape procedure. Substitution of saline for naloxone in the escape procedure led to a very low response rates within three sessions. In the avoidance-escape procedure, rate decrements produced by saline substitution appeared to be related to the behavioral history of the monkey. Previous escape experience led to more rapid decreases in responding when saline was introduced, whereas responding was maintained for 15 sessions in a monkey without prior escape conditioning. Morphine pretreatment produced comparable, dose-dependent decreases in response rates in both procedures. The rate-decreasing effects of morphine were exacerbated when no naloxone was delivered in the escape procedure.     

Group shift to caution at the race track

Group and individual riskiness were compared on $2 “win” best at the race track. Using the standard pretest-posttest risk-shift design, group discussion to unanimous decision was found to produce a cautious shift in group bets.