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.