Translational attention: From experiments in the lab to helping the symptoms of individuals with Tourette’s syndrome

Abstract

Over the past decade my colleagues and I have been able to demonstrate, using objective scientific paradigms, how topdown processes such as suggestion and expectation seem to override bottom-up effects in highly hypnotizable people. As appealing and as intriguing such demonstrations may be, however, these exemplars usually span a small set of circumscribed tasks, which are usually entrenched within the purview of experimental psychology. In his commentary, moreover, Kirsch (2011) emphasised the importance of including moderately suggestible participants in experiments involving hypnosis. In this paper we attempt to sketch out some preliminary data to support the potential generalizability of these findings to clinical situations. As a case in point, we focus on the neurodevelopmental motor disorder of Tourette’s Syndrome (TS), which is part of a spectrum of motor impairments, ranging from simple transient motor tics to chronic debilitating symptoms, and which affect 0.5–24% of school-aged children around the world (Freeman et al., 2000; Jankovic, 1997; Kurlan et al., 2001; Robertson, 2003; Shapiro, Shapiro, Young, & Feinberg, 1988; Singer & Walkup, 1991). Conveniently, tic severity in TS peaks around the age of 11–12 years of age – a time marked by heightened compliance with suggestion and susceptibility to hypnosis (see Kohen & Olness, 2011; Raz, 2012). Individuals with TS often have difficulty with executive functions, a term comprising a number of cognitive and behavioural constructs that include mental tracking, sustained attention, working memory, planning and organisation, goal-directedness, cognitive flexibility during problem-solving, impulse control, and self-regulation. Childhood motor disorders, including TS, are more widespread than is commonly acknowledged (Spessot & Peterson, 2006). The clinical hallmark of TS is the presence of motor or phonic tics: repetitive, stereotypedmotions or vocalisations (APA, 2000). Motor tics range from simple motions, such as blinking or shoulder-shrugging, to more complicated motions, such as jumping, and kicking (Jankovic, 2001). Phonic tics range from simple squeaking or grunting sounds to echoing and, more rarely, cursing (Freeman et al., 2000; Jankovic, 2001). In addition, many individuals with TS report sensations of mounting urges or psychological tension prior to ticking (Hallett, 2001; Leckman, 2002). TS is often co-morbid with attention-deficit hyperactivity disorder (ADHD), obsessive–compulsive disorder (OCD) or both (Robertson, 2003). The combination of TS with any co-morbidity increases the risk of problems such as anger management, self-injurious behaviour, and sleep disorders (Freeman et al., 2000). Thus, the management of TS is of critical concern to healthcare professionals. While pharmacological options exist for the treatment of TS (e.g., haloperidol, pimozide, or clonidine), general consensus posits that such therapies are suboptimal, and prominent researchers have lamented that ‘‘medication therapies for TS are, frankly, woefully inadequate’’ (Peterson & Cohen, 1998). Drug efficacy is inconsistent and unpredictable, and at best, offers only symptomatic relief (Phelps, 2008). Benefits often come at the expense of intolerable side-effects, including sedation, parkinsonism, tardive dyskinesia, cognitive dulling, dry mouth, fatigue, dizziness, weight gain, and metabolic problems (Swain, Scahill, Lombroso, King, & Leckman, 2007). TS specialists hence recognise the need for alternatives and therapeutic adjuncts (Phelps, 2008).