The psychology of Tourette disorder: Revisiting the past and moving toward a cognitively-oriented future. (February 2019)

• Record Type: Journal Article
• Authors: Gagné, Jean-Philippe
• Is Part Of: Clinical psychology review. Volume 67(2019)
• Page Start: 11
• Page End: 21
• Publication Date: 2019-02
• Subjects: Tourette syndrome -- Tics -- Cognition -- Beliefs -- Discomfort -- Comprehensive integrated model; Clinical psychology -- Periodicals; Psychology, Pathological -- Periodicals; Psychotherapy -- Periodicals; Psychology, Clinical -- Periodicals; Electronic journals; 616.89
• DOI: 10.1016/j.cpr.2018.09.005
• Languages: English
• ISSNs: 0272-7358

Abstract

Abstract: Tourette syndrome is a neurodevelopmental disorder characterized by chronic tics (i.e., repetitive and stereotyped movements and vocalizations) and premonitory urges (i.e., aversive sensations preceding tics that are alleviated once a tic is performed). Research supports that dysfunctional neurobiological and psychological processes interact and contribute to the development and maintenance of tics. However, psychological theories of Tourette syndrome and accompanying research have mainly focused on the emotional states (e.g., anxiety and frustration) and behavioural principles (i.e., operant conditioning) that play a role in tic exacerbation. This selective review summarizes key discoveries pertaining to the emotional and behavioural aspects of Tourette syndrome but also proposes a more comprehensive, cognitively-oriented conceptualization of the disorder. Specifically, it is proposed that maladaptive beliefs about discomfort and about one's ability to cope with discomfort underlie negative appraisals of unpleasant sensory experiences in individuals with Tourette syndrome. It is further suggested that these beliefs lead individuals to perceive premonitory urges in a catastrophic manner and thereby enhance tic frequency. Concrete research avenues to empirically examine these hypotheses are outlined and clinical implications for the field of cognitive-behaviour therapy are discussed. Highlights: Chronic tics are influenced by both neurobiological and psychological processes. Research supports that emotional states and operant conditioning shape tics. Cognitive factors involved in Tourette syndrome are not well understood. Negative appraisals of aversive sensations may play a role in Tourette syndrome. It is proposed that negative beliefs about discomfort underlie such appraisals.