Tourette Syndrome


What is Tourette Syndrome?

Tourette syndrome (TS) is a complex neurobehavioral disorder characterized by multiple motor tics, as well as vocalizations, which wax and wane. The motor tics involve specific muscle groups and can change from one part of the body to another. The vocalizations, or phonic tics, may involve grunting, sniffing, coughing, snorting, throat-clearing or other sounds.

The tics occur many times a day, nearly every day, or intermittently for more than a year. Many people believe that these tics and vocalizations are involuntary. However, many patients are able to suppress their tics, especially when they are concentrating intently on something.

Patients with Tourette syndrome may have other associated conditions, including anxiety, obsessive compulsive behavior, learning problems, ADD, and ADHD.  It is important to realize that although hypnosis can be quite helpful in controlling the tics, these other conditions need to be addressed separately.

There is Hope

When Dr. Lazarus sees patients with tics, with or without Tourette syndrome being present, he is confident he can help as long as there is no significant anxiety, depression, or obsessive compulsive behaviors. You will more than likely see a significant improvement after only 2 or 3 visits!

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

Hypnosis and habit reversal are more alike than different.  Both of these processes are behavioral approaches. They involve patients being able to identify the premonitory urge before a tic occurs.  Habit reversal’s goal is to perform a “competing response,” where hypnosis teaches patients how to control and prevent the tic from happening in the first place.  Hypnosis is more beneficial because patients are taught how to actually get rid of the tics. It’s treating the underlying cause rather than the symptoms.

Dr. Lazarus usually teaches his patients medical hypnosis to control the tics at their first visit.  This approach works much faster than habit reversal, and it provides a much better foundation for the patient gaining control over the tics. 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 the style. CBIT with habit reversal includes using a “support person” to help the child patient. Typically, this is the parent.

Some experts believe using a support person with CBIT will help. However, Dr. Lazarus is against this for a number of 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.

CBIT practitioners believe in rewarding patients with tangible or monetary rewards to try and reinforce that program. Dr. Lazarus believes that tic control should be its own reward.  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.  If something doesn’t work for a patient why would we keep using it in the first place?

What One Mother Had to Say About Dr. Lazarus

Dr. Lazarus met with us about childhood tics that our daughter is experiencing. We went into depth about history and possible treatment. It is clear to me that Dr. Lazarus is incredibly knowledgeable in the area of tics/Tourette’s/anxiety. My husband and I found the consultation to be useful and informative.

After the 2.5 hour consultation, Dr. Lazarus suggested that it wasn’t the right time to bring in our daughter for a variety of factors (age, the fact that she is not bothered by the tics herself, etc) and that we would call back when these factors change. Dr. Lazarus did not try to sell us anything when it could have been easy for him to do so.

As parents, we are always desperate to help our children and I believe many professionals out there take advantage of this and prescribe treatments that may or may not be necessary or helpful. When he suggested a home plan for my husband to try, we were thankful and surprised at the same time. As parents, we look to professionals to help us help our children so it was refreshing to have a professional make this recommendation. It built trust between us and Dr. Lazarus and we will definitely come back when the tics start to bother our daughter.

Cleveland WKYC-TV, NBC, Channel 3

Cleveland WKYC-TV, NBC, Channel 3’s Health News with Monica Robbins, aired a story about one of Dr. Lazarus’ patients, a boy with Tourette Syndrome who had been asked to leave school for a week because his cough tic was so disruptive to the class. As Monica Robins, the health news anchor, reports, the child was able to control the cough tic after meeting two or three times with Dr. Lazarus. Five years later, he is still doing well. When a tic occurs, he is able to control it using the techniques that he learned from Dr. Lazarus.

Cleveland WJW, Fox, Channel 8

That’s Life with Robin Swoboda,

WJW/Fox8 News in Cleveland, Ohio, features an interview with Jeffrey Lazarus, MD on February 21, 2007.

Tourette Syndrome Case Study

View case study of how one child was able to control his cough tic

Contact Dr. Lazarus if you would like him to speak to your physician’s or special interest group.

Publications on Hypnosis for Tics and Tourette Syndrome

JDBP Abstract : Nonpharmacological Treatment of Tics in Tourette Syndrome (PDF)

07/12/10: Self-Hypnosis Training May Help Children With Tourette Syndrome, Study Finds, by Jeannine Stein, Los Angeles Times (PDF)

05/17/07: Pediatrician Sees Results In Hypnosis, by Sue Reid, Chagrin Valley Times (PDF)