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Tourettes Action Funded Research 2019
The impact of interoceptive awareness and attentional control on tics, anxiety and quality of life in young people with Tourette Syndrome/Chronic Tic Disorders (TS/CTD)
Dr Tammy Hedderly, Evelina London Children’s Hospital, Guys and St Thomas’ NHS Foundation Trust
Award: 3551
Study Duration: Paused due to Covid, restarted late 2024 - ongoing
Aims of the study
There is growing interest in how perceptions of internal body sensations (e.g. heartbeat, muscles), called interoception, may contribute to psychiatric symptoms (e.g. anxiety, mood). In children and adults with Tourette Syndrome/Chronic Tic Disorders (TS/CTD) lower ability to accurately perceive internal body sensations has been shown to be related to increased tics and anxiety and lower quality of life. Research also suggests that reduced attention to internal body sensations may be helpful to manage tics. This suggests that higher awareness of body sensations in TS/CTD may influence tic expression, whilst the ability to control attention and shift it away from internal sensations may be important for tic management. These aspects of interoception have not yet been explored in TS/CTD.
To inform future psychological therapies, this study will explore interoceptive accuracy, awareness and attentional control in young people with TS/CTD compared to controls, aged 11-17 years. The study will use experimental tasks and questionnaires. Exploring the role of interoception in TS/CTD is of importance to understand the factors that contribute to tics and comorbid psychiatric symptoms. A better understanding of these factors would help to inform the development of psychological treatments for young people with TS/CTD.
Study results will be published once data has been collected and processed
Improving tics and quality of life in children with Tourette’s syndrome (TS): A pilot investigation into an HRT workshop with TS mentor co-facilitation
Dr Tamsin Owen, Evelina London Children’s Hospital, Guys and St Thomas’ NHS Foundation Trust
Award: £1,175
Study Duration: Paused due to Covid, restarted late 2024 - ongoing
Aims of the study
Background: Group Habit Reversal Therapy (HRT) and Exposure Response Prevention (ERP) are both therapies that can help children manage their tics. Children tell us that one of the best things about such groups is meeting other people with tics. However, going to these groups on a weekly basis can also get in the way of everyday life. We would like to look at (a) whether a shorter HRT group would be as helpful as the longer course of sessions (b) whether it is helpful for these groups to also be led by a peer mentor (an older person who also has tics and has had the same therapy in the past).
Method: Ten children with Chronic Tic Disorder or TS will take part in three HRT workshops that are co-designed and led by peer mentors that also have TS. Another parent workshop will run alongside this. The children and parents will be given questionnaires before the workshop, and 3 and 6 months after the workshop. Children and parents will also be given an interview to see what they thought of the workshop.
Results: We will look at the results of the questionnaires to see if there is any improvement in tics, mood and quality of life after taking part in the workshops. We also plan to look in detail at the feedback given in the interviews to see how helpful the children found the workshop and any improvements they suggest.
Discussion: We hope to find out whether having shorter HRT therapy and also including peer mentors in the workshops will be useful in managing tics and improving quality of life and hope to use these findings to further develop tic treatments for children.
Study results will be published once data has been collected and processed
Developing novel brain imaging approaches to investigate the neural basis of premonitory urges in Tourette Syndrome
Prof Penny Gowland, Professor of Physics, University of Nottingham, UK
Award: £16,500
Study Duration: 2019 - ongoing
Aims of the study
Most individuals with Tourette syndrome (TS) report that their tics are preceded by ‘premonitory urges’ [PU] - uncomfortable bodily sensations that are experienced as a strong urge for motor discharge. Unfortunately, PU are particularly difficult to investigate using conventional brain imaging approaches, as they are spontaneous events that are not manifest as directly observable behaviour. PU are particularly important because individuals who experience PU often report that these experiences are more bothersome than their tics and that they would not exhibit tics if they did not experience PU. For this reason, it has been proposed that PU should be considered as the driving force behind the occurrence of tics, and it is timely and important to investigate the functional anatomy and pathophysiology of PU. To quantify brain activity associated with spontaneous events requires a model-free approach in which the timing of events is not known in advance. We propose to utilise a novel functional magnetic resonance imaging (fMRI) approach, developed at the University of Nottingham and that is termed ‘Sparse Paradigm Free Mapping’ (SPFM), for this purpose. We aim to demonstrate that by using this approach, we can reliably obtain fMRI measurements associated with premonitory sensory phenomena in TS that are not in themselves directly observable as overt behaviour. To achieve this objective we will validate the SPFM approach by investigating the functional anatomy of several common urge phenomena, including PU in TS, and demonstrate that PU can be reliably measured in TS without the necessity for overt tic expression.
