Managing Tic and Habit Disorders

A Cognitive Psychophysiological Treatment Approach with Acceptance Strategies

Kieron P. O'Connor, Marc E. Lavoie, Benjamin Schoendorff

• Publisher: Wiley-Blackwell
• Year: 2017
• Print ISBN: 9781119167273, 9781119167259
• eBook ISBN: 9781119167280
• Edition: 1
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

A pioneering guide for the management of tics and habit disorders

Managing Tic and Habit Disorders: A Cognitive Psychophysiological Approach with Acceptance Strategies is a complete client and therapist program for dealing with tics and habit disorders. Groundbreaking and evidence-based, it considers tics and habit disorders as part of the same spectrum and focuses on the personal processes that are activated prior to a tic and habit rather than the tic or habit itself. By drawing on acceptance and mindfulness strategies to achieve mental and physical flexibility in preparing action, individuals can release unnecessary tension, expend less effort and ultimately establish control over their tic or habit.

The authors explain how to identify the contexts of thoughts, feelings and activities that precede tic or habit onset, understand how self-talk and language can trigger tic onset, and move beyond unhelpful ways of dealing with emotions - particularly in taking thoughts about emotions literally. They also explore how individuals can plan action more smoothly by drawing on existing skills and strengths, and overcome shame by becoming less self-critical and more self-compassionate. They conclude with material on maintaining gains, developing new goals, and creating a more confident and controlled lifestyle.

Managing Tic and Habit Disorders is a thoughtful and timely guide for those suffering from this sometimes all-consuming disorder, and the professionals who set out to help them.

1
The Nature of Tics and Habits

Overview of the Nature of Tics and Habits

History

The first references to tics go back to medieval times. In the fifteenth century, two Dominican monks reported the case of a priest who could not help but grimace and emit vocalizations, whenever he was praying (Kramer and Sprenger, 1948). Later in 1825, Jean‐Marc Gaspard Itard described tics in a systematic way for the first time (Itard, 1825). The latter reports the case of a 26‐year‐old French noblewoman, the Marquise de Dampierre, who presented involuntary convulsive spasms and contortions at the level of the shoulders, neck, and face. Shortly afterwards, he also reported the presence of “spasms affecting the organs of voice and speech,” and notes the presence of strange screams and senseless words in the absence of a circumscribed mental disorder.

The Gilles de la Tourette syndrome is named after the French neurologist Georges Gilles de la Tourette, who, in 1885, described again the condition of the Marquise de Dampierre, now aged 86 years old, who continued to make abrupt movements and sounds also known as tics. The same year, Tourette described eight other patients with motor and vocal tics, some of whom had echo phenomena (a tendency to repeat things said to them) and coprolalia (utterances of obscene phrases) (Gilles de la Tourette, 1885) which was consistent with similar observations from American clinicians 1 year later (see Dana & Wilkin, 1886). In a doctoral dissertation published under the supervision of Tourette and Charcot, Jacques Catrou, documented 26 other cases (Catrou, 1890) with more details. The merit of Gilles de la Tourette's report, consisted not only in gathering remarkable clinical descriptions of the symptoms that were little documented, if ever, until then, but also in describing the fluctuating evolution of what become known as the Gilles de la Tourette Syndrome (Gilles de la Tourette, 1885).

Subsequently, there were few systematic investigations, clinical observations, or particular etiological developments during the first half of the twentieth century. Rather, during this period, a psychoanalytic explanation prevailed, with little or no notable empirical support (Ascher, 1948; Ferenczi, 1921; Mahler, 1944; Mahler, Luke, & Daltroff, 1945). In the 1960s an experimental drug treatment (i.e., haloperidol) surfaced for tics (Seignot, 1961). These results encouraged clinical trials in the United States, which further supported the beneficial effects of neuroleptics (Corbett, Mathews, Connell, & Shapiro, 1969; Shapiro 1970; Shapiro & Shapiro, 1968). These seminal investigations instigated the race to find an effective pharmacological treatment and, therefore, the search for a neurobiological etiology, relegating to the background, the psychoanalytic, and the behavioral approach as well (Shapiro & Shapiro, 1971 Shapiro, 1970; 1976).

Idea of a Tourette or Tic and Habit Spectrum

A majority of patients with Tourette's also face various concomitant problems (Freeman et al., 2000), which include obsessive‐compulsive disorder (OCD) or at least some obsessive‐compulsive symptoms, attention deficit hyperactivity disorder (ADHD), depression, and anxiety disorders.

Current Diagnostic Criteria of Tics and Habits

Nosology of the Gilles de la Tourette syndrome and tic disorders

Tic disorder and Tourette's syndrome are currently classified in the Diagnostic and Statistical Manual of Mental Disorders Version 5 (DSM‐5) (APA, 2013) with motor disorders listed in the neurodevelopmental disorder category. A tic is defined as a sudden, rapid, recurrent, non‐rhythmic motor movement or vocalization. Tics can be present in the form of simple or complex multiple motor or vocal tics. The complex tics are contractions of a group of skeletal muscles, resulting in complex and repetitive movements, such as hopping, contact with certain objects or people, grimacing, abdominal spasms, tapping, movements or extension of the arms or legs, shoulder movements in sequence, copropraxia (unintentionally performing sexual gestures), or echokinesia (imitation of a gesture). Simple tics are defined as non‐voluntary repetitive contractions of functionally related groups of skeletal muscles in one or more parts of the body including blinking, cheek twitches, and head jerks among others. Vocal tics can also take the form of simple (e.g., coughing, sniffing, clearing throat) or complex tics, such as coprolalia (using profanity and obscene words) or palilalia (involuntary repetition of syllables, words, or phrases).

Tic disorders are grouped into three main classifications in the DSM‐5: Tourette's disorder (307.23), persistent chronic motor or vocal tic disorder (307.22), and provisional tic disorder (307.21).

The criteria for Tourette's disorder are (a) the presence of both multiple motor and one or more vocal tics at some time during the illness, although not necessarily concurrently; (b) tics that may wax and wane in frequency, but have persisted for more than 1 year since first onset; (c) onset is before age 18 years; and (d) a disturbance that is not attributable to the physiological effects of a substance or another medical condition (e.g., Huntington's disease, post‐viral encephalitis). For the persistent chronic motor or vocal tic disorder, single or multiple motor or vocal tics have been present during the illness, but not both motor and vocal. The other criteria are similar to those for Tourette's disorder.

In provisional tic disorder single or multiple motor and/or vocal tics are present, and tics have been present for less than 1 year since first tic onset. Criteria have never been met for Tourette's disorder or persistent (chronic) motor or vocal tic disorder (see examples in Table 1.1).

Table 1.1 Examples of simple and complex tics

Parts of body	Involuntary repetitive movements
Mental	Playing a tune or phrase over and over in your head, mentally counting numbers for no apparent reason. Following contours with the eyes or in the mind
Head	Head tics to the side, front, or back. Tapping or hitting the head
Face	Nose wrinkling, ear flapping, cheek contracting, forehead and temple tension, raising eyebrows, licking or biting lips, protruding tongue
Eyes	Winking, excessive blinking, eyelid tremor, squinting, straining eye muscles, staring, rolling eyes, opening eyes excessively
Mouth	Lip movement, chewing, teeth grinding, tongue ducking, parsing, pouting, forcing tongue against palate, biting tongue, biting finger nails
Vocal/phonic	Coughing, burping, throat clearing, humming, making noises, swallowing, repeating phrases or tunes, sniffing, laughing, breathing, swearing
Shoulders	Movement shrug up and down or forwards or backwards or on one side
Abdomen	Tensing stomach or abdomen into a knot, expanding the abdomen
Torso	Tensing, twisting, or gyrating movement involving legs, arms, or trunk. Maintaining a fixed posture
Hands	Rubbing fingers together, waggling or clinching fingers or cracking fingers or knuckles, scratching, twiddling, doodling, tapping, fidgeting, stroking (earlobes, chin, etc.), playing with objects, clenching/unclenching the fist.
Legs	Moving legs repetitively up and down or towards and away from each other, bending legs, kicking movements

Note: Cognitive or mental tics are controversial, but involve mental repetitions of words/phrases/tunes/maneuvers that are mostly not visible but respond in the same way to the program. Often they can be substituted for motor tics, which become equally uncontrollable and distressing. They have a situational profile and are accompanied by specific motor actions, eye movements, postures, behavior, and similar processes preceding onset. It is important to distinguish mental tics from obsessions, which are anxiogenic. Mental tics are frequently playful and stimulating at the beginning, but can later become invasive but are unrelated to a dominant fear. Similarly, sensory tics generally involve some tension associated with the sensation, such as tingling, burning, or itching, and may be independent phenomena or a precursor or consequence of behavior to follow.

Habit disorders and body focused repetitive behavior (BFRB)

Another concomitant clinical problem often associated with tic disorder is body focused ...

Table of contents

• Cover
• Title Page
• Table of Contents
• List of Tables and Figures
• About the Authors
• Acknowledgments
• About the Companion Website
• Introduction
• 1 The Nature of Tics and Habits
• 2 Evaluation and Assessment
• 3 Motivation and Preparation for Change
• 4 Developing Awareness
• 5 Identifying At‐Risk Contexts
• 6 Reducing Tension
• 7 Increasing Flexibility
• 8 Addressing Styles of Planning Action
• 9 Experiential Avoidance, Cognitive Fusion, and the Matrix
• 10 Emotional Regulation and Overcoming the Habit–Shame Loop
• 11 Achieving Goals and Maintaining Gains
• References
• Author Index
• Subject Index
• End User License Agreement