{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T17:06:58Z","timestamp":1790960818424,"version":"4.1.0"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,8,10]],"date-time":"2022-08-10T00:00:00Z","timestamp":1660089600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Individuals with Tourette Syndrome and Persistent Tic Disorders (collectively TS) often experience premonitory urges\u2014aversive physical sensations that precede tics and are temporarily relieved by tic expression. The relationship between tics and premonitory urges plays a key role in the neurobehavioral treatment model of TS, which underlies first-line treatments such as the Comprehensive Behavioral Intervention for Tics (CBIT). Despite the efficacy of CBIT and related behavioral therapies, less than 40% of adults with TS respond to these treatments. Further examination of the relationship between premonitory urges, tic severity, and tic impairment can provide new insights into therapeutic targets to optimize behavioral treatment outcomes. This study examined whether urge intolerance\u2014difficulty tolerating premonitory urges\u2014predicted tic severity and tic-related impairment among adults with TS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Participants were 80 adults with TS. Assessments characterized premonitory urge, distress tolerance, tic severity, and tic impairment. We used structural equation modeling (SEM) to examine the construct of urge intolerance\u2014comprised of premonitory urge ratings and distress tolerance ratings. We first evaluated a measurement model of urge intolerance through bifactor modeling, including tests of the incremental value of subfactors that reflect premonitory urge severity and distress tolerance within the model. We then evaluated a structural model where we predicted clinician-rated tic severity and tic impairment by the latent variable of urge intolerance established in our measurement model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Analyses supported a bifactor measurement model of urge intolerance among adults with TS. Consistent with theoretical models, higher levels of urge intolerance predicted greater levels of clinician-rated tic severity and tic impairment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This investigation supports the construct of urge intolerance among adults with TS and distinguishes it from subcomponents of urge severity and distress tolerance. Given its predictive relationship with tic severity and tic impairment, urge intolerance represents a promising treatment target to improve therapeutic outcomes in adults with TS.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyt.2022.929413","type":"journal-article","created":{"date-parts":[[2022,8,10]],"date-time":"2022-08-10T05:46:45Z","timestamp":1660110405000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":16,"title":["Urge intolerance predicts tic severity and impairment among adults with Tourette syndrome and chronic tic disorders"],"prefix":"10.3389","volume":"13","author":[{"given":"Kesley A.","family":"Ramsey","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro S.","family":"De Nadai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flint M.","family":"Espil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Ricketts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan T.","family":"Stiede","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Schild","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew W.","family":"Specht","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas W.","family":"Woods","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon","family":"Bennet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John T.","family":"Walkup","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanna","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Piacentini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph F.","family":"McGuire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,8,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1016\/j.jocrd.2014.06.002","article-title":"The prevalence of tic disorders and clinical characteristics in children","volume":"3","author":"Scahill","year":"2014","journal-title":"J Obsessive-Compuls Relat Disord."},{"key":"B2","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1002\/mds.26089","article-title":"Population prevalence of Tourette syndrome: a systematic review and meta-analysis","volume":"30","author":"Scharf","year":"2015","journal-title":"Mov Disord."},{"key":"B3","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1016\/j.jocrd.2014.03.004","article-title":"Clinical features of Tourette syndrome and tic disorders","volume":"3","author":"Leckman","year":"2014","journal-title":"J Obsessive-Compuls Relat Disord."},{"key":"B4","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1017\/S0012162200000839","article-title":"An international perspective on Tourette syndrome: selected findings from 3,500 individuals in 22 countries","volume":"42","author":"Freeman","year":"2000","journal-title":"Dev Med Child Neurol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1007\/s10882-010-9223-z","article-title":"Clinical characteristics of children and adolescents with a primary tic disorder","volume":"23","author":"Specht","year":"2011","journal-title":"J Dev Phys Disabil."},{"key":"B6","doi-asserted-by":"publisher","first-page":"100578","DOI":"10.1016\/j.jocrd.2020.100578","article-title":"The role of affect lability on tic severity and impairment in youth with Tourette's disorder","volume":"27","author":"Ramsey","year":"2020","journal-title":"J Obsessive-Compuls Relat Disord."},{"key":"B7","doi-asserted-by":"publisher","first-page":"744","DOI":"10.1002\/da.22357","article-title":"Suicidal thoughts and behaviors in children and adolescents with chronic tic disorders","volume":"32","author":"Storch","year":"2015","journal-title":"Depress Anxiety."},{"key":"B8","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1016\/j.jad.2016.04.027","article-title":"Suicidal ideation in youth with tic disorders","volume":"200","author":"Johnco","year":"2016","journal-title":"J Affect Disord."},{"key":"B9","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1007\/s10597-011-9465-y","article-title":"The impact of Tourette syndrome in adults: results from the Tourette syndrome impact survey","volume":"49","author":"Conelea","year":"2013","journal-title":"Community Ment Health J."},{"key":"B10","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1080\/15374410701279545","article-title":"Quality of life in youth with Tourette's syndrome and chronic tic disorder","volume":"36","author":"Storch","year":"2007","journal-title":"J Clin Child Adolesc Psychol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1516","DOI":"10.1002\/jclp.23323","article-title":"Sleep and chronotype in adults with persistent tic disorders","volume":"78","author":"Ricketts","year":"2022","journal-title":"J Clin Psychol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1007\/s10578-015-0544-0","article-title":"Clinical correlates and mediators of self-concept in youth with chronic tic disorders","volume":"47","author":"Hanks","year":"2016","journal-title":"Child Psychiatry Hum Dev."},{"key":"B13","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s10578-020-01111-4","article-title":"Academic, interpersonal, recreational, and family impairment in children with Tourette syndrome and attention-deficit\/hyperactivity disorder","volume":"53","author":"Ricketts","year":"2022","journal-title":"Child Psychiatry Hum Dev."},{"key":"B14","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1007\/s00787-016-0879-5","article-title":"An initial study of family accommodation in children and adolescents with chronic tic disorders","volume":"26","author":"Storch","year":"2017","journal-title":"Eur Child Adolesc Psychiatry."},{"key":"B15","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1007\/s10578-010-0211-4","article-title":"Exploring the impact of chronic tic disorders on youth: results from the Tourette syndrome impact survey","volume":"42","author":"Conelea","year":"2011","journal-title":"Child Psychiatry Hum Dev."},{"key":"B16","doi-asserted-by":"publisher","first-page":"896","DOI":"10.1212\/WNL.0000000000007466","article-title":"Practice guideline recommendations summary: treatment of tics in people with Tourette syndrome and chronic tic disorders","volume":"92","author":"Pringsheim","year":"2019","journal-title":"Neurology"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1341","DOI":"10.1016\/j.jaac.2013.09.015","article-title":"Practice parameter for the assessment and treatment of children and adolescents with tic disorders","volume":"52","author":"Murphy","year":"2013","journal-title":"J Am Acad Child Adolesc Psychiatry."},{"key":"B18","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1007\/s00787-021-01845-z","article-title":"European clinical guidelines for Tourette syndrome and other tic disorders-version 20 Part II: psychological interventions","volume":"31","author":"Andr\u00e9n","year":"2022","journal-title":"Eur Child Adolesc Psychiatry."},{"key":"B19","doi-asserted-by":"publisher","first-page":"858","DOI":"10.1177\/0883073810397046","article-title":"Behavior therapy for tics in children: acute and long-term effects on psychiatric and psychosocial functioning","volume":"26","author":"Woods","year":"2011","journal-title":"J Child Neurol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"2114","DOI":"10.1038\/s41386-020-0762-4","article-title":"Optimizing behavior therapy for youth with Tourette's disorder","volume":"45","author":"McGuire","year":"2020","journal-title":"Neuropsychopharmacology"},{"key":"B21","doi-asserted-by":"publisher","first-page":"764","DOI":"10.1016\/j.jaac.2021.08.022","article-title":"Long-term outcomes of behavior therapy for youth with Tourette disorder","volume":"61","author":"Espil","year":"2022","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"B22","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1001\/archgenpsychiatry.2011.1528","article-title":"Randomized trial of behavior therapy for adults with Tourette's disorder","volume":"69","author":"Wilhelm","year":"2012","journal-title":"Arch Gen Psychiatry."},{"key":"B23","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1007\/s40474-015-0063-5","article-title":"Behavior therapy for tic disorders: an evidenced-based review and new directions for treatment research","volume":"2","author":"McGuire","year":"2015","journal-title":"Curr Dev Disord Rep."},{"key":"B24","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1093\/med-psych\/9780190052775.003.0012","article-title":"Tourette's Disorder","volume-title":"Complexities in Obsessive Compulsive and Related Disorders: Advances in Conceptualization and Treatment.","author":"Ramsey","year":"2021"},{"key":"B25","volume-title":"Managing Tourette Syndrome: A Behavioral Intervention for Children and Adults (Therapist Guide)","author":"Woods","year":"2008"},{"key":"B26","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1007\/s40474-021-00225-1","article-title":"Mechanisms underlying behavior therapy for tourette's disorder","volume":"8","author":"Essoe","year":"2021","journal-title":"Curr Dev Disord Rep"},{"key":"B27","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1176\/ajp.150.1.98","article-title":"Premonitory urges in Tourette's syndrome","volume":"150","author":"Leckman","year":"1993","journal-title":"Am J Psychiatry."},{"key":"B28","doi-asserted-by":"publisher","first-page":"761","DOI":"10.1007\/s10578-020-01085-3","article-title":"Urge intolerance and impairment among youth with Tourette's and chronic tic disorders","volume":"52","author":"Ramsey","year":"2021","journal-title":"Child Psychiatry Hum Dev."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1929","DOI":"10.1001\/jama.2010.607","article-title":"Behavior therapy for children with Tourette disorder: a randomized controlled trial","volume":"303","author":"Piacentini","year":"2010","journal-title":"JAMA"},{"key":"B30","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1097\/00004583-198907000-00015","article-title":"The yale global tic severity scale: initial testing of a clinician-rated scale of tic severity","volume":"28","author":"Leckman","year":"1989","journal-title":"J Am Acad Child Adolesc Psychiatry."},{"key":"B31","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1037\/1040-3590.17.4.486","article-title":"Reliability and validity of the Yale global tic severity scale","volume":"17","author":"Storch","year":"2005","journal-title":"Psychol Assess."},{"key":"B32","doi-asserted-by":"publisher","first-page":"e1711","DOI":"10.1212\/WNL.0000000000005474","article-title":"A multicenter examination and strategic revisions of the Yale global tic severity scale","volume":"90","author":"McGuire","year":"2018","journal-title":"Neurology"},{"key":"B33","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1097\/00004703-200512000-00001","article-title":"Premonitory urge for tics scale (PUTS): initial psychometric results and examination of the premonitory urge phenomenon in youths with tic disorders","volume":"26","author":"Woods","year":"2005","journal-title":"J Dev Behav Pediatr."},{"key":"B34","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1016\/j.beth.2013.09.002","article-title":"The premonitory urge to tic: measurement, characteristics, and correlates in older adolescents and adults","volume":"45","author":"Reese","year":"2014","journal-title":"Behav Ther."},{"key":"B35","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1016\/j.jpsychires.2016.09.007","article-title":"The premonitory urge revisited: an individualized premonitory urge for tics scale","volume":"83","author":"McGuire","year":"2016","journal-title":"J Psychiatr Res."},{"key":"B36","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1007\/s11031-005-7955-3","article-title":"The distress tolerance scale: development and validation of a self-report measure","volume":"29","author":"Simons","year":"2005","journal-title":"Motiv Emot."},{"key":"B37","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1037\/t18597-000","article-title":"The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10","volume":"59","author":"Sheehan","year":"1998","journal-title":"J Clin Psychiatry."},{"key":"B38","volume-title":"Mplus User's Guide","author":"Muth\u00e9n","year":"1998"},{"key":"B39","doi-asserted-by":"crossref","DOI":"10.1002\/9781119422730","volume-title":"Structural Equation Modeling: Applications Using Mplus","author":"Wang","year":"2019"},{"key":"B40","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1080\/00273171.2012.715555","article-title":"The rediscovery of bifactor measurement models","volume":"47","author":"Reise","year":"2012","journal-title":"Multivar Behav Res."},{"key":"B41","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1111\/j.1467-6494.2011.00739.x","article-title":"Modeling general and specific variance in multifaceted constructs: a comparison of the bifactor model to other approaches","volume":"80","author":"Chen","year":"2012","journal-title":"J Pers."},{"key":"B42","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1007\/s11336-009-9135-y","article-title":"Ensuring positiveness of the scaled difference chi-square test statistic","volume":"75","author":"Satorra","year":"2010","journal-title":"Psychometrika"},{"key":"B43","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/10705519909540118","article-title":"Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives","volume":"6","author":"Hu","year":"1999","journal-title":"Struct Equ Model Multidiscip J."},{"key":"B44","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/j.jpsychires.2020.12.040","article-title":"Defining tic severity and tic impairment in Tourette disorder","volume":"133","author":"McGuire","year":"2021","journal-title":"J Psychiatr Res."},{"key":"B45","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/j.jocrd.2016.06.001","article-title":"Acceptance of premonitory urges and tics","volume":"10","author":"Gev","year":"2016","journal-title":"J Obsessive-Compuls Relat Disord."},{"key":"B46","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1016\/j.jpsychores.2014.08.001","article-title":"Mindfulness-based stress reduction for tourette syndrome and chronic tic disorder: a pilot study","volume":"78","author":"Reese","year":"2015","journal-title":"J Psychosom Res."},{"key":"B47","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1186\/s40814-021-00818-y","article-title":"Feasibility and acceptability of an online mindfulness-based group intervention for adults with tic disorders","volume":"7","author":"Reese","year":"2021","journal-title":"Pilot Feasibility Stud."},{"key":"B48","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1176\/appi.psychotherapy.2015.69.2.97","article-title":"The course and evolution of dialectical behavior therapy","volume":"69","author":"Linehan","year":"2015","journal-title":"Am J Psychother."},{"key":"B49","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1037\/per0000368","article-title":"The independent roles of mindfulness and distress tolerance in treatment outcomes in dialectical behavior therapy skills training","volume":"11","author":"Zeifman","year":"2020","journal-title":"Personal Disord."},{"key":"B50","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1080\/87568225.2017.1294469","article-title":"Distress tolerance skills for college students: a pilot investigation of a brief DBT group skills training program","volume":"31","author":"Muhomba","year":"2017","journal-title":"J Coll Stud Psychother."},{"key":"B51","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1155\/2013\/732038","article-title":"Health-related quality of life in gilles de la Tourette syndrome: a decade of research","volume":"27","author":"Cavanna","year":"2013","journal-title":"Behav Neurol."},{"key":"B52","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1016\/j.jpsychires.2013.12.009","article-title":"A meta-analysis of behavior therapy for Tourette syndrome","volume":"50","author":"McGuire","year":"2014","journal-title":"J Psychiatr Res."}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2022.929413\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,10]],"date-time":"2022-08-10T05:46:54Z","timestamp":1660110414000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2022.929413\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,10]]},"references-count":52,"alternative-id":["10.3389\/fpsyt.2022.929413"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2022.929413","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,10]]},"article-number":"929413"}}