Understanding CBT for Tics: What You Need to Know
What is Tic Disorder?
Imagine feeling an urge to do something over and over, like blinking your eyes, shrugging your shoulders, or making a sound. You don’t really want to do it, but it feels like you have to. That’s what having a tic is like. Tics are sudden, repetitive movements or sounds that people can't easily control. They can be simple, like blinking, or more complex, like a series of movements or sounds.
Tic disorders, like Tourette syndrome, involve these tics happening frequently. Someone with Tourette syndrome has these symptoms that last for more than a year. While tics aren’t harmful by themselves, they can be frustrating and embarrassing.
What are Tics and Tourette's - How to Start Treatment CBIT (Source: OCD & Anxiety)
Prevalence of Tic Disorder
Tic disorders are more common than you might think. They tend to begin in childhood. Studies show that up to 1 in 5 children may experience tics at some point. But, most of these tics are temporary and often go away on their own. For about 1% of children, the tics persist and may lead to a diagnosis of a tic disorder, such as Tourette syndrome. Tics are more common in boys than in girls, with a ratio of about 3 to 4 boys for every girl. While tics often decrease in severity as children grow older, they can sometimes continue into adulthood. They are often associated with other conditions like OCD or ADHD.
Co-occurring Mental Health Conditions and Tics
Sometimes, tics don’t come alone. They can be part of a bigger picture that includes other mental health conditions. It’s important to recognize these connections because treating one can often help with the other.
OCD and Tics
Obsessive-Compulsive Disorder (OCD) is when someone has repetitive, unwanted thoughts (obsessions). They feel the need to perform certain actions (compulsions) to relieve the anxiety caused by these thoughts. Tics and OCD can sometimes overlap, making the person feel like they need to perform a tic to prevent something bad from happening.
Learn more about OCD and exposure and response prevention (ERP) therapy.
ADHD and Tics
Attention-Deficit/Hyperactivity Disorder (ADHD) involves problems with focus, hyperactivity, and impulsiveness. Kids, teens and adults with ADHD are more likely to have tics, too. The two conditions can feed off each other—when someone with ADHD gets stressed or overwhelmed, their tics might get worse.
Learn more about our services for ADHD.
Anxiety and Tics
Anxiety is a feeling of worry or fear that can be overwhelming at times. For people with tic disorders, anxiety can be a trigger, making tics more frequent or intense. This can create a cycle where tics cause more anxiety, which in turn makes the tics worse.
Learn more about CBT for anxiety.
What Causes Tic Disorder?
The exact cause of tic disorders isn’t fully understood. But, researchers believe it’s a mix of genetic and environmental factors.
Genetics play a big role—if you have a family member with tics, you’re more likely to develop them too.
There’s also evidence that changes in brain chemistry ( e.g. dopamine) can trigger tics.
Environmental factors can make tics worse or bring them out for the first time. Environmental factors may include things like stress or anxiety.
Infections and certain medications can trigger the onset of tics. While researchers continue to study the root causes, it’s clear that tic disorders are complex. It involves many factors working together.
Are There Treatments for Tics?
Yes, some treatments can help manage tics. One of the most effective options is cognitive behavioural therapy (CBT). CBT is a type of therapy that helps people understand and change their thought patterns and behaviours.
For tics, a specific form of CBT called Comprehensive Behavioural Intervention for Tics (CBIT) is often used. CBIT teaches you to become more aware of when your tics are about to happen. Then it helps you learn new ways to respond, reducing the frequency and intensity of the tics. It’s like retraining your brain to react differently to the urge to tic (Piacentini et al., 2010). This doesn’t mean your tics will disappear completely, but it can help you feel more in control.
CBT Treatment Components for Tics
When treating tics, the CBT therapist should use strategies with flexibility and collaboration. Numerous CBT interventions would be helpful and may include:
Assessment of tics and mental health including a functional evaluation of tics.
Psychoeducation to the client and family (if the client is a child or teen) on tics and CBT.
Thinking skills like thought records
Behavioural interventions like exposure, behavioural experiments, or relaxation skills.
Homework and goal setting
The CBT therapist should personalize the therapy plan based on the person’s symptoms, preferences, and more.
Other Treatment Options for Tics
When it comes to treating tics, it’s important to know that there’s no one-size-fits-all solution. The right approach depends on the severity of the tics and how much they impact daily life. Here’s an overview of some common treatment options:
Medication. For some people, especially those with more severe tics, medication may be necessary. Certain medications, like antipsychotics and alpha-adrenergic agonists, can help reduce tics. However, these medications often come with side effects. So they’re usually considered when tics are causing significant distress (Robertson, 2012).
Education and Support. Understanding tic disorders and educating those around you, like family, friends, and teachers. This can help reduce misunderstandings and improve support. At Virtual CBT Psychotherapy, you can book a parental consultation with a therapist to learn how to support your child. Support groups can also be helpful, providing a space to share experiences and tools for managing tics.
Habit Reversal Training (HRT). HRT is another behavioural approach that involves increasing awareness of tics. It also involves practicing behaviours that make it hard to perform the tic. You can often find this method as part of CBIT, but you can also use it on its own (Woods et al., 2008).
Lifestyle Changes. Managing stress, getting enough sleep, and regular exercise can all help in reducing the frequency and severity of tics. These changes won’t eliminate tics, but they can make them more manageable (Scahill et al., 2006).
Addressing Co-occurring Conditions. Since tics often co-occur with other mental health conditions, treating them can help reduce tics. For example, treating anxiety might lessen the triggers that worsen tics (Hirschtritt et al., 2015).
5 Tips for Parents with Kids Who Have Tics
Stay Calm and Supportive. Your child might feel self-conscious or frustrated about their tics. Reassure them that tics are not their fault and that they’re not alone. Stay patient and avoid drawing too much attention to the tics. It is best not to point them out to your child or teen. Instead, focus on pointing out their successes and achievements.
Create a Stress-Free Environment. Stress can make tics worse, so try to create a calm and predictable routine at home. Encourage relaxing activities like reading or drawing to help your child unwind.
Educate Yourself and Others. Learn as much as you can about tic disorders so you can explain it to your child, family members, and teachers. The more everyone understands, the more supportive they can be.
Encourage Breaks and Rest. Fatigue can trigger or worsen tics, so make sure your child gets plenty of rest. Encourage regular breaks during homework or other activities to help them relax.
Seek Professional Help. If your child’s tics are affecting their daily life, consider working with a therapist. You will want to find a therapist who specializes in Cognitive Behavioural Therapy (CBT) or Comprehensive Behavioural Intervention for Tics (CBIT). Early intervention can make a big difference. If your child also struggles with OCD, ADHD or anxiety, it will be important to find a therapist who also specializes in that. Book a free consultation with our clinic to learn how we can help.
Tic Treatment Options at Virtual CBT Psychotherapy
Psychological Assessments for children (as young as 8), teens and adults
Resources on Tourette’s
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Living with tics can be tough, especially when there are other mental health challenges involved. But you’re not alone, and there are ways to manage and reduce the impact of tics on your life. Working with a therapist who understands CBT and CBIT can make a big difference. Therapy can help you gain control over your tics and improve your well-being. Remember, getting help is a step towards making life a little easier and a lot more manageable.
At Virtual CBT, we have a variety of therapists to choose from. Book a free consultation and our Clinical Directors with match you with a CBT therapist.
ReferencesHirschtritt, M. E., Lee, P. C., Pauls, D. L., Dion, Y., Grados, M. A., Illmann, C., & Mathews, C. A. (2015). Lifetime prevalence, age of risk, and genetic relationships of comorbid psychiatric disorders in Tourette syndrome. JAMA Psychiatry, 72(4), 325-333.Piacentini, J., Woods, D. W., Scahill, L., Wilhelm, S., Peterson, A. L., Chang, S., & Walkup, J. T. (2010). Behavior therapy for children with Tourette disorder: A randomized controlled trial. JAMA, 303(19), 1929-1937.Robertson, M. M. (2012). The Gilles de la Tourette syndrome: The current status. Brain, 135(6), 1750-1776.Scahill, L., Sukhodolsky, D. G., Williams, S. K., & Leckman, J. F. (2006). Public health significance of tic disorders in children and adolescents. Advances in Neurology, 99, 240-248.Woods, D. W., Piacentini, J. C., Chang, S. W., Deckersbach, T., Ginsburg, G. S., Peterson, A. L., & Walkup, J. T. (2008). Managing Tourette syndrome: A behavioral intervention for children and adults. Oxford University Press.