People with tics often think that little can be done to help them, but that isn't what science tells us.
While this may be true for a small portion of people with tics, for whom treatment wasn't very effective or for whom treatment options are limited, research suggests that treatment does help the majority of people with tics to show a clinically significant reduction in their tics. What does clinically significant mean? It means a noticeable difference in mental health or overall quality of life.
In our previous blog post, Tics & Tic Disorders - The Basics, we explored some common FAQx about tics. A quick refresher: Tics are involuntary or semivoluntary movements and noises that are sudden, brief, fast, typically repetitive and meaningless. They wax and wane over time in number and type of tic, their severity, and where on the body they are located. Tics are usually not dangerous and, short of an accident, not lethal. For this reason, most tic disorders will not require any treatment. However, if tics are painful or dangerous, get in the way at school, work, home or socially, or have a negative impact a person's mental health, treatment is usually recommended.
How are tic disorders such as Tourette disorder treated?
1. Behavioral Treatment
The global consensus is that a recommended first-line treatment for tics is specialized behavioral therapy for tics, which can be done with both children and adults. When we say global, we aren't exaggerating! Behavioral treatment for tics is recommended in the Canadian, American and European treatment guidelines for tics and Tourette.
There are three main types of behavior therapy for tics:
Comprehensive Behavioral Intervention for Tics, or CBIT. The main component of CBIT is a type of therapy called Habit Reversal Therapy (HRT, the most widely studied specialized therapy for tics). The majority of people studied have shown improvement in tic severity (such as the number, complexity, frequency, and intensity of tics) using CBIT.
A second, innovative approach is called Cognitive Psycho-physioloical Intervention for Tics, or CoPs (the adaptation for children and teens is called Façotik). CoPs and Façotik have shown strong preliminary results, with up to 80% of adults and children studied showing some degree of improvement in their tics. While the CoPs/Façotik approach has not been as heavily researched as CBIT, it offers a promising approach for treating tics with early results showing comparable effectiveness to CBIT. Importantly, CoPs and CBIT are complementary treatments, with each contributing different tic management tools and strategies, so clients completing one can safely explore the other if desired.
Exposure and response prevention (ERP) is another behavioral intervention that has been shown to be effective for reducing tic severity. ERP for tics involves suppressing all tics simultaneously while practicing coping skills. It is appropriate for children and adults beginning at age 9. ERP for tics is typically described as subjectively very difficult to do and thus requires high motivation. Despite its difficulty, ERP for tics has been shown to be an effective method for improving tic severity.
What makes behavioral therapy for tics so great?
Behavioral therapies for tics are effective, reducing tics in the majority who have tried it in research studies
Behavioral therapies for tics are brief, typically lasting 10-14 sessions
Behavioral therapies for tics, teaches children and adults concrete skills that they can use every day to manage their tics for the rest of their lifetimes
One type of behavioral therapy for tics, called CBIT or Comprehensive Behavioral Intervention for Tics, was shown in a study published in 2018 to be as effective at improving tics among children as some of the most effective medications (Abilify, Risperdal)
Behavioral therapies for tics have been shown to be effective at improving tic severity among persons already taking medication for their tics. It is therefore possible to continue taking medication for tics while engaging in behavioral therapy for tics
Behavioral therapies for tics have not been associated with substantial side effects
2. Medical Treatment
Tic disorders may also be treated with medications, although there are no approved medications to date that have been created specifically for the treatment of tics. Most medications approved for treating tics fall into one of two main categories:
Alpha-2 agonist (antihypertensive) medications (such as clonidine and guanfacine/Intuniv);
Antipsychotic medications (such as aripriprazole/Ability and risperizone/Risperdal).
Some clients may also benefit from anticonvulsant (anti-seizure) medication such as Topimirate.
Other medical treatments for tics include Deep Brain Stimulation (DBS), and Botulinum Toxin (Botox) injection. Other interventions, such as dietary changes, dental devices and medical cannabis are being researched; as there is still insufficient evidence for their use in treating tics, we recommend careful exploration with your doctor.
While these and other medical treatments for tics may be beneficial for improving tics, they aren’t appropriate in all cases and may be associated with important possible side effects. Nevertheless, medical treatment of tics is an important option that many clients count on.
Discussion with your tic specialist can help you to determine whether this option might be helpful for you. Careful exploration with a neurologist, psychiatrist or family doctor of the potential benefits and drawbacks of medications and other medical treatments for tics is also recommended.
3. Combination Treatment
Many persons with tics who found only partial relief with medications or behavior therapy have found that blending the two approaches to be the winning combination for them. Similarly, clients who have found only partial relief form one type of behavior therapy may find that combining skills from both CoPs and CBIT works well for them.
Treatment Options Available At Our Clinic
Both CBIT and CoPs for adults and teens age 16+ are available at our clinic with Dr. Cartwright. Dr. Cartwright is a certified CBIT Therapist with the Tourette Syndrome Behavioral Therapy Institute (TS-BTI) of the Tourette Association of America. She has also completed advanced training in CoPs at the Centre for the Study of Obsessive-Compulsive Disorders & Tics (CETOCT) in Montreal, Canada. Dr. Cartwright feels privileged to have received training under international experts Dr. Douglas Woods, Dr. Keiron O’Connor and Dr. Julie Leclerc.
We are actively recruiting for a CBIT and Façotik therapist to work with children and younger teens, and hope to be able to add this to our offering of services soon!