Cognitive-Behavioral Management of Tic

Tics affect more than 10% of the population, and can be an unpleasant and disruptive problem. They include chronic tic disorder, Tourettes syndrome and habit disorders such as hair pulling, nail biting and scratching. Treatment is either by medication (without convincing evidence) or psychological means. Before the introduction of habit reversal psychologists had no real alternatives to offer, and even this method lacks evidence for its efficacy and is not widely used. Illustrated throughout with case study examples and containing detailed guidelines for patient and therapist on the use of CBT, this book provides a comprehensive review of what is known about the occurrence and diagnosis of tics. Kieron O'Connor explores the various theories currently available to explain the causes and progression of these disorders, and discusses the assessment and treatment options available. Finally he takes the most widely accepted psychological therapy – cognitive behaviour therapy - and applies it for the first time to the treatment of tics.

Kieron O'Connor began his research career working as a research officer at the Medical Research Council (UK) Clinical Psychiatry Unit at Graylingwell Hospital, Chichester, Sussex. In 1979, he was awarded a Master of Philosophy (MPhil) by thesis in experimental psychology from the University of London. He completed the British Psychology Society clinical diploma training course in 1986, and transferred to the University College, Institute of Laryngology and Otology, working partly as a research lecturer, investigating psychological aspects of vertigo and dizziness, and also as a clinical psychologist at Bloomsbury Health Authority.

In 1988, he was awarded the first of a series of fellowships by the Fonds de la recherche en Santè du Quèbec, and established a clinical research program at the Fernand-Seguin Research Center, Louis-H. Lafontaine Hospital, University of Montreal, Canada. The multidisciplinary research program, which focuses on obsessive-compulsive disorder (OCD), Tourette and tic disorder and delusional disorder, is currently funded by the Canadian Institutes of Health Research. He is actively involved in several community-based initiatives to provide support and information to people with OCD and Tourette's syndrome and their families, and is scientific advisor to the Quebec OCD Foundation.

He is currently associate research professor at the Psychiatry Department of University of Montreal, and also holds an honorary cross appointment as associate professor in the department of Psychology, University of Quebec at Montreal. He is author or co-author on over 1000 scientific publications. He is also co-authored with Frederick Aardema and Marie-Claude Pèlissier of Beyond Reasonable Doubt: Reasoning Processes in ODC Disorder and Related Disorders, published in 2005 by Wiley.

About the Author.

Preface.

Acknowledgments.

Chapter 1: The Nature of Tic Disorders.

Definition.

Diagnosis.

What counts as a tic?

Comorbidity and covariation.

Secondary distress.

Prevalence.

Relationship of tics with other disruptive behaviors.

Distinguishing impulsions and compulsions: sensory tics, cognitive tics and obsessions.

Emotional associations.

Self-management strategies.

Coping strategies maintaining the tic cycle.

Functional analysis and situational variability.

Conclusions.

Chapter 2: Understanding Tic Disorders: Etiological Models.

Overview of neurobiological models.

Neurophysiological studies.

Neurobiological treatments.

Genetic factors.

Psychosocial factors.

Neuropsychological aspects.

Emotional regulation.

Learning model.

Psychological treatments.

Behavioral approaches.

Abbreviated versions of habit reversal.

Other tension prevention and exposure techniques.

Conclusions.

Chapter 3: Motor Processing in Tic Disorders.

Motor processing.

Psychology of action.

Tics as behavioral acts.

Human ecology of action.

Motor psychophysiology.

Chronic muscle tension.

The role of frustration in tic onset.

Tic onset and muscle use: the frustration–action/tense–release cycle.

Perfectionist styles of action.

Heightened sensorimotor awareness.

Dysregulation of motor activation cycle and sensory feedback mechanisms.

A cognitive-behavioral/motorpsychophysiological model of tic disorder.

Clinical implications.

Conclusions.

Chapter 4: Empirical Studies Testing the Cognitive–psychophysiological Model.

Overview.

Behavioral activity associated with tic onset in chronic tic and habit disorders.

Validation of a style of planning action (STOP) as a discriminator between tic disorder, obsessive-compulsive disorder and generalized anxiety.

Brain–behavior relations during motor processing in chronic tic and habit disorders.

A cognitive-behavioral program for the management of chronic tic disorders.

Does behavior therapy modify visuo-motor performance in chronic tic disorder?

Conclusions.

Chapter 5: Future Directions.

The cognitive-behavioral/psychophysiological conceptualization of tic disorders.

Implications for future research.

The TS–OCD spectrum.

Separating impulse from compulse: the case of cognitive tics.

Adaptation of the program to children and to other groups with special needs.

Application of the program to other tension problems.

Chapter 6: Therapist Manual.

Overview of the program.

Assessment procedures.

Ten-stage program.

Session by session protocol.

Trouble-shooting guide.

Case illustrations.

Chapter 7: Client Manual.

Introduction: who is the manual for?

About tics.

A cognitive-behavioral management approach to changing habits.

Overview of tic management model.

Motivation.

Mind over muscle.

Awareness training.

Identifying high- and low-risk activities, and associated thoughts and feelings.

Muscle discrimination exercises.

Relaxing in three dimensions.

Refocusing sensations.

Thinking in action.

Rethinking your thinking.

Beliefs relevant to planning action.

Motor and behavioral restructuring.

Maintaining the new behavior.

Conclusions.

Appendices.

Appendix 1: Questionnaires 1a–1h.

Appendix 2: Manual worksheets 2a–2j.

Appendix 3: Cognitive tics: special Considerations.

Appendix 4: Tic-monitoring diary.

Appendix 5: Graphic examples from daily diaries.

Appendix 6: Daily diary forms and questionnaire.

Appendix 7: Tic quiz.

Appendix 8: Follow-up questionnaire.

Appendix 9: Answers to tic quiz.

References.

Index.

What is included with this book?

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Cognitive-Behavioral Management of Tic Disorders

Summary

Author Biography

Table of Contents

Supplemental Materials

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Rent More, Save More! Use code: BBRENTAL

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Cognitive-Behavioral Management of Tic Disorders

Summary

Author Biography

Table of Contents

Supplemental Materials

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