As you may already know my son has Tourette Syndrome and we have been looking for a treatment that will reduce the amount of tics and reduce the intensity of the tics. The following is an overview of Tourette Syndrome and a description of some of the treatment options.
Just for a little background information, Tourette Syndrome (TS) is a neurological disorder. The first symptoms usually are involuntary (outside the patient’s control) movements (tics) of the face, arms, limbs or trunk. These tics are frequent, repetitive and rapid. Many persons report what are described as premonitory urges — the urge to perform a motor activity. There are also verbal tics. These verbal tics (vocalizations) usually occur with the movements. Associated conditions can include attentional problems (ADHD/ADD, impulsiveness (and oppositional defiant disorder), obsessional compulsive behavior, and learning disabilities. There is usually a family history of tics, Tourette Syndrome, ADHD, OCD. A diagnosis of Tourette Syndrome consists of the following criteria:
- Both multiple motor and one or more vocal tics have been present at some time during the illness, although not necessarily concurrently.
- The tics occur many times a day (usually in bouts) nearly every day or intermittently throughout a period of more than one year, and during this period there was never a tic-free period of more than three consecutive months.
- The disturbance causes marked distress or significant impairment in social, occupational or other
- important areas of functioning.
- The onset is before age 18 years.
- The disturbance is not due to the direct physiologic effects of a substance (e.g., stimulants) or a general medical condition (e.g., Huntington’s disease or postviral encephalitis).
There is no cure for Tourette Syndrome yet, but there are a number of different treatment options to help control TS symptoms. These treatment options include medications, hypnosis, Habit reversal training (HRT), massed negative practice, biofeedback, relaxation (such as exercise, yoga or meditation, deep breathing techniques), other behavioral approaches such as Cognitive Behavioral Therapy (CBT). Each of these options have their good points and bad points and work differently from person to person.
Medications are available to help control TS symptoms and include atypical neuroleptics, neuroleptics, anti-hyperactive drugs, and anti-depressants. Individuals react differently to the various medications, and frequently it takes some time until the right substance and dosage for each person are achieved. Almost all of the medications prescribed for TS treatment do not have a specific FDA indication for the disorder. The biggest issue with these medication are the side affects. Many people with TS would prefer to have their tics rather than dealing with the side effects of these drugs.
Trying to figure out what triggers the Tourette’s Syndrome tics is another way of treating the disorder without medication. By observing people with Tourette’s, one may be able to find something that triggers the tics, such as a certain phrase, sight or situation. Once the trigger or triggers have been found, they can be avoided. Of course, the key to this is identifying the trigger, which is not always easy.
One of the alternatives to the medications is hypnosis. Hypnosis is defined as a relaxed state of consciousness. This state allows people to be more open to suggestions. When the suggestions are related directly with their symptoms and anxiety, they are able to relax and make suggestions to reduce the Tourette Syndrome symptoms. It is also known that stressful situations can worsen the tics of Tourette Syndrome. After practicing the hypnosis methods people with Tourette Syndrome can make the suggestions a part of their normal life.
Other types of behavior therapy, such as meditation, deep breathing techniques and biofeedback have been shown to reduce stress, which increases how severe and how frequent the tics are.
Cognitive Behavioral Treatment
CBT is a type of behavior therapy used by mental health professionals to remove the negative thoughts and emotions connected to random or seemingly involuntary behaviors. CBT involves modifying thoughts and behaviors that contribute to symptoms, problems in functioning, and quality of life. It is one of the most research-supported forms of therapy and has been used effectively to address a wide range of psychological conditions. CBT can be tailored for young children or those who have additional psychological or developmental issues.
A well-recognized CBT method to treat tics is Habit Reversal Training (HRT) a group of techniques that include awareness training and learning to replace tics with competing movements.
Habit Reversal Training (HRT)
The most effective type of behavior therapy is Habit Reversal Training. This type of therapy makes people more aware of their old habits and allows them to develop counter-habits. The therapist performing the Habit Reversal Training helps her patient become aware of when a tic will occur, then helps him practice the counter-response to the tic signals his body gives. Most of the time, Habit Reversal Training is effective in naturally treating Tourette’s Syndrome.
Cognitive restructuring is another CBT method that is often used in treating TS.
This strategy, as the name implies, involves learning to modify the upsetting or rigid thinking that frequently accompanies TS. Since reducing body tension and overall reactivity is essential for those with tics, relaxation and stress management strategies are important for those with TS to learn as well. CBT strategies are also indicated to address family stress that is related to TS.
There are some factors that help determine whether an individual is a good candidate for CBT. One factor is motivational level. Another factor is being able to detect the thoughts, sensations, or feelings that occur right before a tic is a positive sign.
Hypnosis has also been recognized as a treatment for the symptoms of Tourette Syndrome. Hypnosis is a relaxed state of consciousness. This state allows people to be more open to suggestions. When the suggestions are related directly with their symptoms and anxiety, they are able to relax and make suggestions to reduce the Tourette Syndrome symptoms.
*Information provided from Tourette Syndrome Association