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<p>Among some researchers, there is an emerging conceptualization of chronic tic disorders (CTDs) as conditions that are partially rooted in avoidance of tic-related private experiences (i.e., painful or difficult thoughts and feelings) and internal sensations (i.e., premonitory urges to tic). The first specific aim of the present research was to investigate the possibility that experiential avoidance is related to tic severity and perceived quality of life in individuals with CTDs. The second aim was to determine whether the efficacy of Habit Reversal Training (HRT), the most prevalent and effective behavioral intervention for CTDs to date, might be enhanced by combining it with Acceptance and Commitment Therapy (ACT), an intervention that directly targets experiential avoidance. These aims were addressed by conducting two related studies. Study I, an online survey, included 239 adults (<italic>M</italic> = 37.6 years; <italic>SD</italic> = 13.8 years) who reported having been previously diagnosed with a CTD. Results showed that levels of premonitory urges, as well as both general and tic-specific experiential avoidance, were significantly positively related to tic severity. General and tic-specific experiential avoidance were also significantly negatively related to perceived quality of life. Psychometric analyses of two novel measures developed for Study I (i.e., the Yale Global Tic Severity Scale-Self-Report Version and the Acceptance and Action Questionnaire-Tic-Specific Version) demonstrated excellent internal consistency and convergent validity. Study II, a multi-site pilot investigation, involved 13 adolescents (<italic>M</italic> = 15.4 years; <italic>SD</italic> = 1.3 years) who were treated with either HRT alone or a novel HRT+ACT intervention. Results suggest that the HRT+ACT treatment is feasible, highly acceptable to both patients and parents, and as effective as HRT alone at reducing tic severity from pre-treatment through week 22 follow-up. Participants in both groups reported clinically significant post-treatment decreases in general and tic-specific experiential avoidance and improvements in overall functioning. Researchers concluded that experiential avoidance plays an important role in tic expression and overall functioning for individuals with CTDs. Results support additional development and testing of the promising HRT+ACT intervention, to evaluate its efficacy alone and in comparison to other relevant psychosocial and pharmacological interventions.</p> / Dissertation

Metakognition ermöglicht Einblicke in eigene kognitive Prozesse und beeinflusst menschliches Verhalten in mehreren Bereichen. Die Debatte, ob Metakognition sich domänenallgemein oder domänenspezifisch auswirkt, bleibt unentschieden, wobei die meisten Studien auf sensorische Informationsverarbeitung und Gedächtniseffekte fokussieren. Diese Dissertation unterstreicht die Notwendigkeit, weitere Domänen zu untersuchen, um diese Frage zu klären, und tut dies, indem sie Metakognition im motorischen Bereich erforscht. Diese Arbeit umfasst vier empirische Studien. Studie 1 untersuchte die zugrundeliegenden Strukturen in metakognitiven Domänen und fand keine Beweise, die eine Unterscheidung zwischen intern oder extern generierter Information unterstützen. Studie 2 konzentrierte sich auf motorische Metakognition und verglich die Introspektion direkter und indirekter Bewegungsparameter. Obwohl beide Bewegungsparameter gleichermaßen introspektierbar sind, weisen fehlende Korrelationen zwischen verschiedenen Bewegungsparametern innerhalb einer Domäne auf die Rolle von nicht-domänenspezifischen Merkmalen in der Metakognition hin. In einem datengesteuerten Ansatz zeigte Studie 3, wie die Introspektion verschiedener Aspekte der Bewegung mit motorischer Kontrolle und Metakognition verknüpft ist. In Studie 4 wurde getestet, ob metakognitive Defizite die Vorgefühle bei Tourette-Störung untermauern. Es fanden sich keine Belege für Beeinträchtigungen in taktiler oder visueller Metakognition, was die Rolle der Metakognition in der Pathophysiologie der Störung in Frage stellt. Insgesamt betont die Arbeit die Notwendigkeit, domänenbezogene und aufgabenspezifische Merkmale zu entflechten und Faktoren zu identifizieren, die Allgemeinheit und Spezifität beeinflussen. Sie trägt zum Verständnis der motorischen Metakognition bei, indem sie experimentelle und analytische Ansätze vorantreibt und gleichzeitig Einblicke in die Architektur höherer kognitiver Funktionen und das Bewusstsein bietet. / Metacognition, the ability to introspect into one's cognitive processes, can guide human behaviour across various domains. The debate whether metacognition operates in a more domain-general or a domain-specific fashion remains inconclusive, with most studies focused on sensory and memory domains. This thesis argues that to resolve this question, it is necessary to broaden the scope of domains, and it does so by exploring metacognition in the motor domain. This thesis comprises four empirical studies. Study 1 examined the underlying structures in metacognitive domains, finding no evidence to support a distinction between internally or externally generated information. Study 2 focused on motor metacognition, comparing the monitoring of direct and indirect movement parameters. While both movement parameters can be equally well monitored, the absence of correlations within the same domain but across different monitored parameters highlights the role of non-domain features on metacognition. In a data-driven approach, Study 3 revealed how monitoring different aspects of movement is linked with motor control and metacognitive judgments. Study 4 tested whether metacognitive deficits underpin premonitory urges in Tourette's disorder. No evidence of metacognitive impairment was found in the tactile or visual domains, challenging metacognition's role in the disorder's pathophysiology. Overall, the thesis emphasises the need to disentangle domain-related and task-specific features, advocating for identifying factors that influence generality and specificity. It contributes to the understanding of motor metacognition by advancing experimental and analytical approaches, while providing insights into the architecture of higher cognitive functions and conscious processing.