A pioneering guide for the management of tics and habit disorders

Managing Tic and Habit Disorders: A Cognitive Psychophysiological Approach with Acceptance Strategies is a complete client and therapist program for dealing with tics and habit disorders. Groundbreaking and evidence-based, it considers tics and habit disorders as part of the same spectrum and focuses on the personal processes that are activated prior to a tic and habit rather than the tic or habit itself. By drawing on acceptance and mindfulness strategies to achieve mental and physical flexibility in preparing action, individuals can release unnecessary tension, expend less effort and ultimately establish control over their tic or habit.

The authors explain how to identify the contexts of thoughts, feelings and activities that precede tic or habit onset, understand how self-talk and language can trigger tic onset, and move beyond unhelpful ways of dealing with emotions - particularly in taking thoughts about emotions literally. They also explore how individuals can plan action more smoothly by drawing on existing skills and strengths, and overcome shame by becoming less self-critical and more self-compassionate. They conclude with material on maintaining gains, developing new goals, and creating a more confident and controlled lifestyle.

Managing Tic and Habit Disorders is a thoughtful and timely guide for those suffering from this sometimes all-consuming disorder, and the professionals who set out to help them.

Kieron O'Connor, PhD, is currently director of the OCD Spectrum Study Centre at the University Institute of Mental Health at Montreal, and Centre Integré Universitaire de Santé et de Service Sociaux de L'Est de l'Ile de Montreal. He is also Full Professor at the Psychiatry Department of the University of Montreal and affiliated professor at the University of Quebec.

Marc E. Lavoie, PhD, is a professor of psychiatry and neuroscience at the University of Montréal and is currently head of the Cognitive and Social Psychophysiology laboratory at the research center of the Institut Universitaire en Santé Mentale de Montréal.

Benjamin Schoendorff, MA, MSc, is a clinical psychologist and director of the Contextual Psychology Institute in Montreal, Canada.

List of Tables and Figures ix

List of Contributors xiii

Acknowledgments xv

About the Companion Web Site xvii

Introduction 1

1 The Nature of Tics and Habits 9

Overview of the Nature of Tics and Habits 9

Idea of a Tourette or Tic and Habit Spectrum 10

Current Diagnostic Criteria of Tics and Habits 10

Current Multidimensional Etiology of Tics and Habits 13

Social Impact and Consequences 17

Current Treatment Options 18

2 Evaluation and Assessment 21

Evaluation and Assessment: What are Tics and Habits? 21

Evaluating the Severity of Tics and Habits and Their Impact on the Client’s Life 22

Assessing Style of Planning and Thinking and Beliefs about Tics

or Habits 32

3 Motivation and Preparation for Change 43

Motivation: Ready to Change the Habit 43

The Pros and Cons of Tics and Habits; and Setting Goals and How to Attain Them 50

Client’s Perception of the Tic or Habit 52

Dealing with Stigma and Self-stigma 53

Control: Micro- and Macro-control 55

The Contextual Nature of Tic or Habit Onset 57

4 Developing Awareness 61

Choosing and Describing the Tic or Habit 61

Awareness of the Tic or Habit 63

Discovery of Seeing the Habit Differently 63

Discovery Exercises 64

Making a Video: Replaying and Watching the Video 64

Premonitory Signs 67

Daily Diary 68

Tic or Habit Variations 73

Tics or Habits in Context 74

5 Identifying At-Risk Contexts 77

Identifying Variations in the Context of the Tics or Habits 77

Discovering High and Low Risk Situations or Activities 78

Evaluating the Situation or Activity 79

Linking High Risk Activities and Evaluations to Feelings and Thoughts and Assumptions 83

6 Reducing Tension 87

Tension Before Ticking: How to Use Your Muscles 87

Conflicting Preparation Versus Coherent Preparation 92

Unhelpful Attempts at Self-management of Tics or Habits 95

Mindful Engagement 96

Mindfulness Exercises 97

7 Increasing Flexibility 101

Discriminating Muscle Contractions 101

Rationale and Procedure for Discrimination Exercises 102

Whole Body Muscle Control 105

Muscle Relaxation 105

Check the Breathing, Posture, and Flow During Movement 106

Breathe Better 106

Relaxation Exercises 107

Refocusing Sensations 111

8 Addressing Styles of Planning Action 115

Style of Planning: Pulling Together Sensory, Emotional, and Motor Aspects of Ticking 115

Styles of Action 116

Behavioral Cost 118

Thoughts associated with Styles of Action: Perfectionism in Personal Standards and Personal Organization 120

9 Experiential Avoidance, Cognitive Fusion, and the Matrix 127

Experiential Avoidance and Cognitive Fusion 127

Improving Flow and Goal Directed Action Using the ACT Matrix 131

Discriminating Thoughts, Actions, and Experiences 134

Using the ACT Matrix to Work with Styles of Action 137

10 Emotional Regulation and Overcoming the Habit–Shame Loop 141

The Habit–Shame Loop 145

Adaptive and Maladaptive Coping 146

Validating Emotion 147

Working with Self-talk 148

Relational Frame Theory 149

An RFT-inspired Link between Dysfunctional Thoughts and Tension 152

11 Achieving Goals and Maintaining Gains 155

Maintaining the New Behavior 155

New Situations 158

Reward and Self-compassion 159

Relapse Prevention 160

Achieving Non-tic Goals 160

Finally 161

References 163

Index 171