Tics


What are Tics?

Tics are sudden or brief movements (motor tics) or sounds (vocal tics, also known as vocalizations or phonic tics). They are often repetitive.  Motor tics can be simple, involving a single muscle group, or complex, involving sustained and/or coordinated movements. Vocal tics can also be brief or more sustained, sometimes with a few different vocalizations following one another.

Tics are ALWAYS absent during sleep.

Many children experience tics that last for a few weeks or a few months and often go away on their own. These patients do not have Tourette syndrome, which is characterized by multiple motor tics and vocalizations that last more than one year.

Cough Tic

Cough tic, also called habit cough, is a common vocal tic in children. The cough tic is commonly developed as an extension of some sort of respiratory infection and remains as a comforting behavior once the infection is gone.

Success Story: Medical Hypnosis for Cough Tic

15-year old Matt suffered from a recurrent coughing tic. After many unsuccessful medications and other treatments, Matt learned self-hypnosis from Dr. Jeffrey E. Lazarus in Palo Alto, CA. The video will show part of Matt’s first session with Dr. Lazarus, a follow up to how he uses self-hypnosis in his 4th session and a message from his mother.

Success Story: 15 Year Old Boy With Recurrent Cough Tic

Some Causes for Recurrent Cough Tics

Often, the patient develops the throat-clearing behavior as a result of post-nasal drip or cough associated with a respiratory infection, such as a common cold. Because the throat-clearing is comforting, the patient continues the behavior after the cold is gone. The patient forces a dry (unproductive) cough during the day, but the cough is absent while the child is asleep. Some parents report that the cough keeps the patient up at night, but on closer questioning, they realize that the cough is gone while the patient is actually asleep.

Many of the patients have tried medications that have not helped the condition. They have often undergone tests such as a chest x-ray and a sinus CT scan. They have seen sub-specialists including ear, nose and throat (ENT) doctors, allergists, and pulmonary (lung) specialists, and have been told that there is nothing wrong. In most cases it leaves the patient and their family in a worse state than before they began the medication and all of the testing.

There is Hope

When Dr. Lazarus sees patients with tics, with or without Tourette syndrome, as long as there is no significant anxiety, depression, or obsessive compulsive behavior, there is usually significant improvement after only 2 or 3 visits!

HYPNOSIS, HABIT REVERSAL (HR), and COMPREHENSIVE BEHAVIORAL INTERVENTION FOR TICS (CBIT)

As it happens, hypnosis and habit reversal are more alike than different.  Both are behavioral approaches. Both involve having patients be able to identify the premonitory urge before a tic occurs.  And, although in habit reversal the goal is to perform the “competing response,” in hypnosis, patients learn how to control and prevent the tic from happening.  With hypnosis, patients are taught how to actually get rid of the tics.

Dr. Lazarus usually teaches his patients medical hypnosis to control the tics at their first visit.  This is because he has found this approach to be much faster than habit reversal. At a subsequent visit, he then teaches habit reversal.

“Typically, my patients have significant improvement after only 1 to 3 visits.”

One of the main differences between using medical hypnosis compared to comprehensive behavioral intervention for tics (CBIT) with habit reversal, is a difference in style. CBIT with habit reversal includes using a “support person” to help the child patient. Typically, this is the parent.

Although experts using CBIT believe in using a support person, Dr. Lazarus is against this for a few reasons:

1. It can infantilize the child by giving him/her the message, “You can’t do this without our help.”

2. It can cause conflict if a parent or significant other “nags” the child or patient to “do your habit reversal” exercise.  What if the person says, “It’s time to do your habit reversal now,” and the patient says, “No,” or, “Maybe later?” This can lead to a power struggle and affect the outcome of the treatment.

3. The tics are, after all, the patient’s problem, not the parents.  Dr. Lazarus tells families, “We are all on TEAM Jane, or TEAM John, and, Jane/John is the only one who can take care of this problem. Just like any other skill that needs to be learned and practiced, such as learning how to play the piano or kick a soccer ball, you need an instructor, or a coach.  I will be your coach, Jane/John, and, just like soccer, the more you practice, the better you get at it. And the more you practice, the easier it gets. And the more you practice, the faster you get at it.”

4. It can give the patient the message, “You’re not good enough.”  Dr. Lazarus had one 10 year old with Tourette syndrome whose tics went from an average daily tic activity of 9 to 3 after only 3 visits, with no medication.  Yet, his mother complained, in front of the child by saying, “Yes, but he is still having tics!” How do you think the child felt about this, especially after he had done so well, after only 3 visits and without medication?  The child patient and Dr. Lazarus discussed this privately, and he felt ashamed, embarrassed, and angry at his mother. Fortunately, Dr. Lazarus was able to meet with his mother alone and educate her about this appropriately.

Also, CBIT practitioners believe in rewarding patients with tangible or monetary rewards to try and reinforce the program. Although the rewards are given for compliance with the program, Dr. Lazarus believes that tic control should be its own reward.  And, Dr. Lazarus is concerned that if the main reason the patient is doing the exercises is to get a present, the patient is not truly motivated to gain control over their tics in the first place.

Dr. Lazarus is highly trained in both medical hypnosis as well as CBIT.  And, habit reversal is often included as one of the hypnotic techniques he teaches.  His goal is to give patients several tools and then have them choose the ones that work best for them. 

Click to View

This hand-written letter from a 9 year old patient from out of state who was able to experience a breakthrough with their Tics.

“Dr. Lazarus is someone I will remember forever. Thank you Dr. Lazarus for all that you did for me!!!”

Dear Dr Lazarus Letter | Jeff Lazarus MD

Click to Watch

Here’s a news story about Tourette’s Syndrome and Tics on Channel 5 KPIX/CBS news story. We share how hypnosis works even when drugs fail.

Click to View

Here is a Tourette Syndrome Case Study: It describes how one child was able to control his cough Tic by using hypnosis.

Click to Read

Los Angeles Times Article (PDF)

Click to Read

JDBP Abstract (PDF): Non-pharmacological Treatment of Tics in Tourette Syndrome

Why Hypnosis for Tics?

The medications that are commonly used for tics often don’t work and have tremendous negative side effects.

These side effects include:

•    Sleepiness

•    Fainting

•    Slow heart rate

•    Weight gain

In addition, there is an insufficient number of randomized, double-blind trials comparing medication with a placebo. And, there have been no studies comparing behavioral and pharmacological approaches.1

It is also not known how these medications affect brain development.2

If you’re looking for significant improvements for yourself, a family member, or someone you know, schedule a visit with Dr. Lazarus. As long as there’s no anxiety, depression, or obsessive compulsive behavior, there can be a significant improvement after only 2 or 3 visits!

References:

1. Scahill, L. et al. April 2006. “Contemporary assessment and pharmacotherapy of Tourette syndrome.”. NeuroRx : the Journal of the American Society for Experimental NeuroTherapeutics 3 (2): 192–206.

2. Roessner, V, et al.  “European clinical guidelines for Tourette Syndrome and other tic disorders.” Eur Child Adolesc Psychiatry. 2011 April; 20(4): 153–154.