Taking Charge of Your Health

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.

90 thoughts on “Treatment for Tics & Tourette’s (feat. Neuro Transmissions)

  1. For my skin picking I hid all mirrors, twizors and safty pins I keep my nails short. I use stim toys to hold and mindfulness.
    My tics/stimming are not Tourette or Autism. I just do them if Im at home or find a safe place if Im out. My dx's are Sczoaffective dis, ADHD, GAD, CAPD, dyslexia.

  2. This actually helped thank you. I have Motor tic disorder and I needed some video like this I enjoy this content. You earned a sub.

  3. Please help me. I dont know if this is a tic but i keep on plugging in wires and out and i just cant stop doing it please help me

  4. My daughter who has autism OCD and Seizure disorder has recently developed ticks – they are often loud screams, or grunts, she sweats and also has jerky neck movements, rolls up her eyes and have rapid eye shutting, is there a trick to control them and redirect it into less loud and manageable ones

  5. So this is what my condition called? Somehow i learn how to control it and somehow hide it to my friends. Like i can do it when i want to

  6. It's really cool to have both a Psychologist and a Neuroscientist giving input on the same stuff, to see how you approach the topic in slightly different ways

  7. This helps me a lot ! thank you so much !!! So here's a question from me , tourettes can be wax and wane will it be back after this kind of treatment?

  8. Hi im a 30 year old male and I have an eye tic, on the right side of my face. It just blinks or squints. I've had it on and off for years and the last 4 months it's come on really strong. I find it very embarrassing. It seems to be worse around people when I am alone it doesn't feel as bad but still can happen. Ive had some social anxiety in the past but lateley ive been fine and very confident excpet for when my eye tic came back, it really gets to me. Any opinions , suggestions, medications ive tired everything cutting down on caffieen , sleep, glasses (got eyes tested) and exorcised and its still there? Thanks

  9. Hi, Thank you for your video. I am 40 and I have a tic. I constantly rub my one hand fingers against each other. My left arm is usually more active doing this tic. I started doing this in 2016, and I just can't stop. My fingers are starting to hurt more and more, bones in my hand and my arms as well as my muscles.
    What can I do? I will try with flexing my fingers, since some of my fingers are always crossed or rubbing. HELP!

  10. Thank you for the great information. I have had a pretty severe eye tic developing over the past few months and I can already feel how the competing response you suggested is working. Which competing response would you suggest for someone who has the urge to clench the muscles in the pelvic floor? This has been a problem of mine for some time as it usually triggers a false urge to go to the bathroom, which interferes with my daily routine a lot.

  11. Brilliant! Congratulations on your success. Preschool age child showing first motor tic lasting 3-4 months then going away completely. How likely is this to be relatated to another mental health condition in the future and what can I do now to help prevent or better prepare? Thank you!!!

  12. This didn’t help me it just made everything worse. All I can think about now is my tics and how often they are and nothing has changed

  13. I am 40 years old with a history of polydrug use. I recently stopped doing drugs and developed anxiety and panic attacks and also ticks. I cleAred my throat constantly, doctors gave me ssris but it doesn't help much. The tick changed from throats clearing to nose sniifing face twitching. Do you have any recommendations? I'd be grateful

  14. this information is very enlightening, and not at all the overview that everyone gives. thank you for being thorough and giving other sources of info !

  15. Tics have been ruining my life for the last 3 years… I'm 26 and I'm going to try these! Wish me luck and thank you ?

  16. quite possible that phama rx can be just a great fit and can have a perfect result. psychostimulants are not contraindicated in some cases may be aggravated but others improved Therefore, this class of drugs should not be shunned but used on a case-to-case basis there is considerable semiologic overlap between tics and ADHD

  17. What is the therapy for headshaking? The movement is like you’re trying to flick a fringe on your forehead…

  18. I have physical tics. My oldest son has physical tics, my daughter has tics and might be Tourette's, my youngest son has been diagnosed with Tourette's and has the worst tics out of the lot of us.

    We also have ADD/ADHD. I'm a single father, you can imagine that the house is a bit crazy!

  19. Unfortunately my dad acts like theres something wrong with me. Gosh he needs to know how tics work. And is there a way to get rid of tics completely? My tics went away for about 1-2 yrs but it came back and I hate it.

  20. I have a blinking tic and i cant stop closing my eyes when eating. Another tic i have is even more uncomfortable. Its evening out pressure in my ears that isnt even there… i often also cant stop yawning…

  21. I wonder if behavior therapy like; CBIT ( Comprehensive Behavioral Intervention Therapy) or HRT ( Habit Reversal Training ) can be a viable treatment for compulsive eating or eating disorders ?

  22. Hello Again! 4 almost 5 year old showing second motor tic eye rolling / looking up hard blinking and occasionally tightening one side of his face. The last tic sniffing left after a few months. What are the competing responses to his new tic and should we consider therapy for this considering it’s his second tic? What does this indicate for his future if anything? Otherwise happy healthy typical child. Your opinion is SO appreciated!

  23. I have a tick that is a weirs noise i make from my throat.. Kind of like a hicup mixed with a dog barking.. I hate it, its like having almost permanent hiccups that never go away.. Will be trying this.

  24. I have a horrible tic habit, I keep blinking 10000ect times a day. I need a cbt, I had tics over after over from a young age from Little noises I'll make to neck twitching, to lots more. Usually it goes after I find something to keep me busy. But I'm such a loner person it's harder not that I'm 25 & have to deal with these things. I just wanna be normal I need help. Please help me stop excessively blinking, I hold my eyes close for a few seconds & keep blinking. People look at me like a special person. I hate this

  25. Thanks guys, oof! Really. I needed quick help with the tic and found your nice video. I didn't research my tic much, I just kinds live with it for like 7 years maybe..

  26. i didnt even know i had a tic untill people started telling me i keep sticking my tongue out a little like im licking something off my lips. today my husband said im also strating to twitch my lips. i hate this because thats what my mom does and it annoyed the hell out of me when growing up. the problem is that i dont even notice doing it.. so no clue how to stop it… so annoying!! please help 🙁

  27. I struggled with chewing the sleeves of my clothes, though I no longer do that I began biting my cheeks. The last couple years I've done it less, I dont really know what causes it. I'll keep the opposite behavior thing in mind next time I catch myself! Thank you

  28. Had them since I was 7 I am now 24 I use to get treated for them as a child but stopped during my teenage years because I didn't want to be on meds so much plus they showed me how to control them…but recently they been so severe i find stress to be a huge trigger for me

  29. Wow! Thank you so much!
    I do have tourette syndrome, I lift my eyebrows repeatedly and move my head along with it, it’s been quite embarassinf many times.
    These exercises will help me hopefully, I tried holding the top of my head for a minute or so, and the urge lessened.

  30. I have a vocal tic and while I was put on tons of medication as a child for it nothing really helped. I didn’t cope with it at all, I was badly bullied growing up and it just made me more aware of it. But since I’ve seen your videos and deep breathing helps as you say I’m going to give it a try. I’m almost 26 and I’ve been dealing with it since I was a child and I’m just done with it and I want it to stop.

  31. Yea this doesn't help me either.
    I have a tics since I was like 7 years old. Now I am 30. My tics underwent changes trough the years. They were more intense and decreased. Recently I had so intense tics that made me research more about them. So I searched in the internet and I came across this . The more I read this the more depressed I became. It was like a death sentence to me. It sais: "Tourette Syndrome is an inherited, neurological condition, the key features of which are tics, involuntary and uncontrollable sounds and movements. TS is a complex condition and a large amount of people with the condition will also experience co-occurring features and conditions."
    -Whaat? It is inherited genetic disease. Not escape then, I was thinking. Then I started to observe my behavior in relationship with the environment around me. The more stressed I was the more tics I was doing. Moreover I dont have my tics since I was born. They appeared in my childhood. And my childhood was full of stressful events. Sick parents,family fights etc.
    Now I thing my tics are not a genetic disease, but coping mechanism to stress, boredom, anxiety and other discomfort in my body. There are other researches pointing out, that tics are just behavior disorder like ADHD, Addiction, Depression, Opositionality, Conduct and other disorders have the same origin – childhood trauma. And the trauma manifests itself in these disorders.
    I would recommend people with tics or tourettes to search more alternative methods. I very much appreciate the Gabor Mate an Peter Levine work. They have a understanding of the problem that fits my gut feeling about it. Here some videos I recommend:

  32. I have facial tics mostly eyes. Weird thing is. I can stop them if i forced it. But sometimes i am not aware. Also when forcing on stopping tics, new tics comes out.

  33. I’ve been fighting tics over 10 years. I spread that feel to my whole body so its like my body keep vibrating. When i stop doing that, that feel focus on one spot. For instance i have head shaking tic, when that feel comes i tighten my legs. I practised that a lot. I remove 1 major tic and i created a minor tic which less visual. 😉

  34. I have a new tic that is getting out of control. raising my eyebrows high. Not sure how to reverse this (besides closing eyes)

  35. I have about 6 tics now. But some of them last for a few weeks, months or years and then disappear. Sometimes they come back, or new ones take their place. It's so weird and irritating and hard to control them when around people… -.-

  36. I watched this video a while back when I had an eye tic that was pretty bad, and was able to eventually stop with this method. What would you recommended for throat clicking? I constantly tighten up my throat and it causes a lot of muscle pain

  37. I have tics. I have one where I blink a lot though it is more like a hard blink/ grimace. Another one is a head nodding tic which is more like a twitch. This tic in particular stresses me out because I dont want people to notice and Im scared that they will ask me why I keep twitching when I cant control it. Thank you for the video.

  38. I've just seen this now, and it was kinda helpful for me. I have tics and it makes me breathe less than usual and it's really irritating and really hard to deal with. It happens to me almost everytime, everyday. My girlfriend is helping in a way she don't know, when I'm with people that's I'm not that comfortable with, my tics doesn't occur that much or sometimes I don't really have the urge to do it. And deep breathing helped too, I wish I had the resources to consult to a specialist for my tics. I did went to a psych but it didn't help that much, the medications she gave me, which are antipsychotics just made me really sleepy and made my whole body become numb. It started from mannerisms when I was still in grade school and now it's getting worse. And one of the thoughts that came to me is that my gaming addiction caused me this. Just wanted to share my story and hoping that someone could help me. I live in the Philippines.

  39. Sirmy tic problem is not stop sir realy I'm so tried is problm sir help me I'm not normal my tic is motor tic help me sir how can handle it my nack are paining

  40. Dear Dr Ali, Greetings. My sweetheart son age 7 has TS since One year now. Can you please guide me how can I get this therapy in India, New Delhi so that I could try this for my son. I will be ever ever Grateful to you if you help please. [email protected]

  41. I cope with my tics by waiting until no one's looking and then ticcing like crazy. Lol. In other words, I have no real coping mechanism. ???

  42. My 6 yr old sticks her tongue out obsessively. She can hardly get through a sentence without sticking her tongue out. People assume shes being rude. Its embarrassing but I dont want to draw attention to it. Any suggestions??

  43. I really appreciate this vid, thank you. It's been really stressful watching this develop in my 5 year old over the past 2 years to the point that I lost a job over it. We still haven't come to terms with it and find it depressing every new wave of tics that pops up at random intervals. I will give this a try and see if it helps. Also, could this have started from a head injury? He jumped on a ball and hit the back of his head on concrete and apart from some tears and temporary swelling he was right back at that ball again. He did have a brain scan and Docs said all was fine but from the info we been given over the years about his condition I just can't trust Doctors at my local Hospital much anymore. His tics started after a bout of what appeared to be chicken pox but a recent blood test revealed no sign of chicken pox in him; this has been such an emotional up and down journey so far and still going!

  44. I looked this video up because my tics are getting bad. I’m treated with meds for OCD and ADHD. But my tics are major. When they wane they are nearly nonexistent, but when they wax… look out! I could be having screaming fits on the floor or be in a wheelchair for a week+.

  45. I thank you very much. Since I am not only suffering from Tourette, but also from Autism and compulsive disorder, this is extremely helplful since it does actually also teach the emotions to change.

  46. My neck cracks and pops when I tic (in my neck for years) and it first started on a school bus being hyper and shaking my head as a kid purposely trying to get dizzy with a friend. From then on, I acquired tics in my neck.

  47. I have a problem i always experience Tics syndrome when i have Anxiety attach,please help me i think am losing it

  48. Well this was great and very informative thank you for sharing. She is so right there is a burning sensation when you try to keep your eyes open and those exercise really helped I'm going to try it for a week and I'll come back and share to see if it made a change

  49. You're still repressing it. I mean, I'll try this but this may make me want to do it more. I'm looking for an out right cure. This is torture…

  50. This is better than my mom’s methods. She used to beat me when i had my tics which made me think about them more often and have more tics but this really helps

  51. tics make easy things difficult. i can’t even execute workouts properly? or hold a serious conversation properly

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