The Impact of a Cognitive–Behavioral Therapy on Event-Related Potentials in Patients with Tic Disorders or Body-Focused Repetitive Behaviors

Abstract

ContextTic disorders (TD) are characterized by the presence of non-voluntary contractions of functionally related groups of skeletal muscles in one or multiple body parts. Patients with body-focused repetitive behaviors (BFRB) present frequent and repetitive behaviors, such as nail biting or hair pulling. TD and BFRB can be treated with a cognitive–behavioral therapy (CBT) that regulates the excessive amount of sensorimotor activation and muscular tension. Our CBT, which is called the cognitive–psychophysiological (CoPs) model, targets motor execution and inhibition, and it was reported to modify brain activity in TD. However, psychophysiological effects of therapy are still poorly understood in TD and BFRB patients. Our goals were to compare the event-related potentials (ERP) of TD and BFRB patients to control participants and to investigate the effects of the CoPs therapy on the P200, N200, and P300 components during a motor and a non-motor oddball task.MethodEvent-related potential components were compared in 26 TD patients, 27 BFRB patients, and 27 control participants. ERP were obtained from 63 EEG electrodes during two oddball tasks. In the non-motor task, participants had to count rare stimuli. In the motor task, participants had to respond with a left and right button press for rare and frequent stimuli, respectively. ERP measures were recorded before and after therapy in both patient groups.ResultsCoPs therapy improved symptoms similarly in both clinical groups. Before therapy, TD and BFRB patients had reduced P300 oddball effect during the non-motor task, in comparison with controls participants. An increase in the P300 oddball effect was observed posttherapy. This increase was distributed over the whole cortex in BFRB patients, but localized in the parietal area in TD patients.DiscussionThese results suggest a modification of neural processes following CoPs therapy in TD and BFRB patients. CoPs therapy seems to impact patients’ attentional processes and context updating capacities in working memory (i.e., P300 component). Our results are consistent with a possible role of the prefrontal cortex and corpus callosum in mediating interhemispheric interference in TD.

Abnormal perceptual sensitivity in body-focused repetitive behaviors

“…Termed cognitivepsychophysiological therapy, this technique targets rising tension and sensorimotor activation prior to symptom performance through a combination of interoceptive awareness training, behavioral restructuring of overactive styles of action, and cognitive restructuring of beliefs systems linked to tension [81]. Indeed, a recent study found that this treatment was associated with changes in event-related potentials during a motor inhibition task in sensorimotor and prefrontal areas [82], suggesting that this form of treatment affects sensory processing on a neural level.…”

Tragic Teenage Boy Presenting With Calluses Due to Dermatophagia

“…The clinical signs of dermatophagia included skin damage, bleeding, infection, calluses, and hangnails. Treatment consists of cognitive behavioral therapy and medical treatment including antidepressant drugs [9]. Here we have described a case of calluses on the hands associated with psychiatric comorbidity needs to be explained in light of the previous literature.…”

P300 Source Localization Contrasts in Body-Focused Repetitive Behaviors and Tic Disorders

“…Tic disorders (TD) and body-focused repetitive behaviors (BFRB) are two motor-related neuropsychiatric afflictions that can be difficult to distinguish in clinical settings because they often co-occur and because their symptoms can easily be confounded [ 1 , 2 ]. Indeed, large proportions of TD patients present comorbid disorders such as BFRB, but also depression, anxiety, and obsessive-compulsive disorder (OCD) [ 3 , 4 , 5 ].…”

“…By directly comparing non-comorbid and unmedicated TD and BFRB patients, psychophysiological markers would be more specific and allow more precise clinical differentiation. As treatments for both TD and BFRB are currently being developed [ 2 ], identifying specific methods to distinguish patients from both populations also has the potential to enhance treatment efficacy. Based on the previous ERP literature in TD and BFRB, we hypothesize that both patient groups will show reduced P300 amplitude compared to controls, and that TD should show more prominent P300 scalp topography over motor regions, while BFRB should activate a more widespread activation of the same component [ 2 , 51 , 52 , 53 ].…”