Treatment for Tics & Tourette’s (feat. Neuro Transmissions)

I’m here with my friend Alie Caldwell, neuroscience
researcher and host of Neuro Transmissions, a YouTube channel all about neuroscience. Hi every body! What brings you to The Psych Show, Alie? I’ve want to pick your brain about something. On Neuro Transmissions, we’ve covered the
neuroscience of Tourette’s syndrome – how these sudden and repetitive movements have
their roots in the basal ganglia, dopamine’s impact on movement signals, and how the media
exaggerates what the disorder is really like. We discussed why medications work, but I wanted
to talk to you about how therapy can help. What’s funny about that is for a long time,
people questioned whether  therapy should even matter for Tourette’s. Since talking about a tic can lead you to
experience a tic, suppressing a tic sometimes lead to more tics, and as there are effective
medications, many researchers didn’t see the point of therapy for Tourette’s. Right, but medications can have major side
effects. I know weight gain is pretty common and some
people can have a difficult time with thinking and focusing. Parents especially get worried about starting
their kids on these types of drugs. That’s why psychologists developed CBIT
– the comprehensive behavioral intervention for Tics. It’s an 8 session treatment usually done
over 10 weeks that uses behavioral therapy, habit reversal, and emotional regulation to
help people become much more aware of how their tics work and what they can do to ride
out their urges to tic. How does it work? Remember the Battle of Helm’s Deep from
Lord of the Rings: The Two Towers? Yeah of course! Humans and Elves come together to fight the
Uruk-hai, it’s pretty epic. I agree it’s one of my favorite battles. Remember that one Uruk-hai who snuck a bomb
through this small gap in the fortress? Yeah, it totally changed the course of
the battle. That’s pretty much how tics occur. So basically,  a tic is a neural signal that
would normally be blocked, like the invading Uruk-hai. But for people who have Tourette’s, the
neural signals find an opening out of the basal ganglia – like the vulnerable spot in
Helm’s Deep – and change swhat you do and the sounds you make.. Exactly! What CBIT can do is strengthen your defenses
against these rogue neural signals. It’s as if we fortified that whole section
of the fortress at the very first sign of trouble. It doesn’t eliminate your tics, but it does
help you to manage them. I can show you how it works if you’re interested. Well I’m a scientist so I love experiments, let’s give it a try! The first thing we have to do is awareness
training, which helps you to become SUPER aware of everything that leads you to experience
a tic. Well I don’t have any tics. That’s okay, we can simulate it. I want you to keep your eyes open and avoid
the urge to blink. I haven’t done this since elementary school
but okay, Tell me what you’re experiencing right now. My eyes feel very wide and they’re kinda dry. It’s almost sore on the front. I really want to blink. Where in your face are you feeling it? In my eyes. On the surface of my eyes. It’s really starting to get hard to not blink now. Okay it’s feeling like a throbbing urge? What does it feel like? It’s starting to water… Oh I just blinked! You just blinked! And you blinked right again. How does it feel right now? Good, it feels a lot better. I feel like I want to blink a lot. Everything you just experienced is similar
to a tic. The strong urge to engage in a movement, the relief you experienced when you blinked.. How you kept blinking afterwards All that stuff that led up to it, that’s what we call a premonitory urge. Think of them as the signs that an Uruk-hai
is about to break through your fortress. The whole first half of this treatment is
about getting you intimately aware of every detail of a premonitory urge. I’ve never been so aware of the sensations
related to eye blinking. It’s really interesting how something that’s
so natural and automatic for me can suddenly feel so overwhelming when I’m trying not to do it. That’s why just suppressing tics doesn’t
work. You need a stronger defense against those
neural signals. That’s where competing responses come in. This is the part where we fortify our defenses? Exactly! There are three rules to developing a competing
response: 1) When you’re doing it you can’t tic, or it’s much harder to tic, 2) it’s
less noticeable than the tic, 3) and you can do it for a minute or until the urge to tic
goes away. What would be a competing response for eye
blinking? Slow, controlled closing and opening of the
eyes. So if I have eye blinking tics, I’d learn
about the warning signs like how my eyes felt kinda dry and itchy and then at the first sign of trouble I’d start controlled blinking? Yup, and then you’d continue doing your
competing response for a minute or until the urge disappears, whatever takes longer. What are some other common competing responses? A lot of vocal tics respond well to deep breathing. For neck rolling tics, I’ll have people
tense their neck muscles and hold their chin slightly down. For facial grimacing tics, gently pursing
your lips together can help. Nose scrunching tics are a little complicated,
but pulling your nose down, keeping your lips shut, and deep breathing can help. IF the tic involves stretching your arm out,
you can pull your arms in against your chest. It sounds like competing responses use the
opposite muscles that are involved in the tic. Totally. If the tic involves pushing out, the competing
response is about pulling in. If the tic is about breathing in, the competing
response should involve exhaling. What’s cool about this treatment is it sounds
like you’re building habits, taking advantage of neuronal plasticity – the brain’s ability
to form and strengthen new neuronal connections – to strengthen neural pathways that really
do fortify against rogue signals in the basal ganglia. That’s why I love treating tics. My patients are literally rewiring their brains. AND it gives me an excuse to talk about
Lord of the Rings. Once patients master this part of the treatment,
we’ll also teach them new skills to manage emotions that can cause tics, change their
environment to make it less likely to produce tics, and also teach parents to ignore tics
and encourage competing responses. How effective is CBIT? About half of the people who get CBIT get
better, which makes it about as effective as medications. It doesn’t work as well for people who have
multiple diagnoses like Tourettes AND ADHD. Sometimes it’s better to get those other
problems treated first and then trying CBIT. If you’d like to learn more about this treatment,
we’ve got a lot of resources in the description below. Have you ever experienced a tic? An itch you couldn’t stop scratching? Or maybe skin-picking, hair-pulling, or nail-biting? How’d you cope with them? Let us know in the comments below! Special thanks to Alie Caldwell for joining
me on this episode! Be sure to subscribe to her channel, Neuro
Transmissions because I know you’re going to love her videos as much as I do. Alie will teach you about how the brian works,
take you behind the scenes of her labtorary research, and even show you the science behind
Jedi Mind Tricks. You will give this video a thumbs up and share
it on social media. I don’t think it works like that Hmmmm… To see another video that Ali and I made
together, click here to learn all about why we’re so afraid of clowns.

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