Ways to manage tics
Tourette Syndrome (TS) cannot be cured, and the aim of treatment is to reduce the symptoms and improve quality of life. Mild tics usually do not require treatment.
Treatment is considered if tics cause physical problems, such as pain, daily functioning (school, work, home) or social and emotional difficulties.
There are several approaches to reduce tics. The appropriate treatment for each individual needs to be assessed on an individual basis, and it may take some time to determine the most effective approach. When assessing the effectiveness of a treatment trial, it is important to use a sufficiently long observation period, as tics still wax and wane in frequency, severity and fluctuations will continue to occur with or without treatment.
Medications for co-occurring conditions
Co-occurring conditions can sometimes be more bothersome than the tics themselves. Such conditions, such as ADHD, often require medication, which can improve quality of life in patients with TS. It is therefore recommended to treat such conditions before initiating tic-reducing treatment. Treatment of these conditions can also result in a reduction of tics. It’s important to note that the specific treatment approach may vary depending on the individual’s unique circumstances and the severity of their symptoms. Consulting with healthcare professionals experienced in TS management can help determine the most appropriate treatment sequence and strategy for addressing co-occurring conditions and tic symptoms.
Behavioural Interventions
CBIT stands for Comprehensive Behavioural Intervention for Tics. It is a specialised form of therapy designed to help individuals with tic disorders, such as Tourette syndrome, manage and reduce their tics. CBIT is a non-medication approach that focuses on behavioural techniques and strategies.
The main components of CBIT include:
Awareness Training: Individuals learn to identify the premonitory sensations or urges that precede their tics. They develop increased awareness of their tics and the ability to recognise when a tic is about to occur.
Competing Response Training: Patients are taught to replace or modify their tics with alternative movements or behaviours that are physically incompatible with the tic. This technique helps reduce the intensity or frequency of tics.
Function-Based Interventions: CBIT incorporates strategies to address environmental triggers or internal factors that may influence tic expression. It helps individuals identify and manage situations or emotions that may exacerbate their tics.
Social Support: CBIT may involve support from family members, peers, or support groups to enhance coping skills and provide a supportive environment for individuals with tic disorders.
CBIT is typically conducted over a period of 8-10 sessions, with each session lasting around an hour. The therapy is customised to meet the individual’s specific needs and can be delivered by trained therapists or clinicians specialising in tic disorders.
It is important to note that CBIT is considered an evidence-based treatment for tics and has shown promising results in reducing tic severity and improving overall functioning in individuals with tic disorders.
Habit Reversal Training (HRT) is a type of behavioural therapy that is commonly used to treat tic disorders, including Tourette syndrome. It is based on the idea that tics are habitual behaviours that can be modified through the use of self-awareness, self-monitoring, and competing responses.
The goal of HRT is to help individuals with tic disorders recognise the urge to perform a tic, and then replace the tic with a different, less noticeable behaviour or response. For example, if an individual has a vocal tic of throat clearing, the competing response may be taking a deep breath or swallowing.
HRT typically involves several components, including:
- Awareness training: Individuals are taught to identify the sensations or feelings that occur before a tic, which can help them recognise the urge to perform the tic.
- Relaxation training: Relaxation techniques, such as deep breathing or progressive muscle relaxation, can help reduce overall stress and tension, which can sometimes exacerbate tics.
- Competing response training: Individuals learn to perform a competing response or behaviour that is incompatible with the tic, and to practice this response repeatedly until it becomes automatic.
- Social support: Family members and friends can be trained to provide positive feedback and reinforcement for the use of competing responses.
HRT is typically delivered by a trained therapist or healthcare professional, and may be used in conjunction with other treatments, such as medication or supportive therapy. HRT can be an effective treatment for tics, and may be particularly helpful for individuals who prefer non-pharmacological treatments or who experience side effects from medication.
CBIT (Comprehensive Behavioural Intervention for Tics) and HRT (Habit Reversal Training) are related but not exactly the same. HRT is a specific component or technique within the broader CBIT approach.
HRT is a behavioural technique used in the treatment of tic disorders, including Tourette syndrome. It involves two main steps:
Awareness Training: Individuals learn to recognise the occurrence of their tics by increasing their awareness of the premonitory sensations or urges that precede the tics.
Competing Response Training: Once aware of the premonitory sensations, individuals are taught to engage in a competing response or a voluntary movement that is incompatible with the tic. By performing this alternative behaviour, they aim to reduce the occurrence or intensity of the tic.
CBIT, on the other hand, encompasses a comprehensive set of behavioural interventions beyond HRT. In addition to HRT, CBIT may include other components such as functional interventions, social support, and educational strategies. CBIT takes a more holistic approach by addressing environmental triggers, managing stressors, and providing a supportive framework for individuals with tic disorders.
In summary, HRT is a specific technique within CBIT, focusing on awareness training and competing response training, while CBIT is a broader intervention that incorporates HRT as one component among others.
What is the difference between Habit Reversal Training (HRT) and Exposure and Response Prevention (ERP) and which treatment is more effective with Tourette Syndrome?
Habit Reversal Training (HRT) and Exposure and Response Prevention (ERP) are both types of behavioural therapy that are used to treat a variety of conditions, including Tourette Syndrome. However, they differ in their focus and approach.
HRT is a therapy that focuses on identifying and modifying habits or behaviours, such as tics. It involves several components, including awareness training, relaxation training, and competing response training. The goal of HRT is to replace the unwanted habit or behaviour with a more adaptive and acceptable behaviour.
On the other hand, ERP is a therapy that focuses on reducing anxiety and distress by exposing an individual to anxiety-provoking situations or stimuli, and then preventing them from engaging in compulsive or ritualistic behaviours. The goal of ERP is to help individuals learn that they can tolerate anxiety and distress without resorting to maladaptive coping behaviours.
Both HRT and ERP have been shown to be effective treatments for Tourette Syndrome. However, the choice of treatment may depend on the specific symptoms and needs of the individual.
For example, HRT may be more appropriate for individuals whose primary symptom is tics, as it directly addresses the habit or behaviour that is causing distress. On the other hand, ERP may be more appropriate for individuals whose primary symptom is anxiety or obsessive-compulsive symptoms, as it directly addresses the underlying anxiety or distress.
Ultimately, the most effective treatment for Tourette Syndrome may depend on the individual’s specific symptoms, preferences, and goals, and may involve a combination of medication and behavioural therapy. It’s important to discuss the options with a healthcare professional who has experience in treating Tourette Syndrome.
Medication
There is no specific medication for TS. There is no known cure.
Finding a medication to help ease symptoms can be challenging and time consuming. Often it is trial and error, plus the side effects of the medication can worsen symptoms.
Deep Brain Stimulation (DBS)
Deep Brain Stimulation (DBS) is a surgical procedure that involves implanting electrodes into specific areas of the brain and using these electrodes to deliver electrical impulses that can regulate abnormal brain activity. DBS is sometimes considered as a treatment option for individuals with severe and debilitating Tourette syndrome who have not responded to other treatments, such as medication or behavioural therapy.
DBS is generally considered as a treatment option for Tourette syndrome in the following situations:
- Severe and debilitating symptoms: DBS may be considered when an individual experiences severe and disabling symptoms that significantly impact their quality of life, despite trying other treatments.
- Lack of response to other treatments: DBS may be considered when an individual has not responded to other treatments, such as medication or behavioural therapy.
- Specific tic location: DBS may be considered when an individual’s tics are localised to a specific brain region, such as the globus pallidus internus (GPi), which is a common target for DBS in Tourette syndrome.
DBS is a complex and invasive procedure that carries risks, including infection, bleeding, and neurological complications. It’s important to discuss the potential benefits and risks of DBS with a healthcare professional who has experience in performing the procedure, and to carefully consider whether it is an appropriate treatment option for an individual’s specific situation.