Motor tics are spasmodic contractions of muscles, which typically involve the face and are habitual. Examples include squinting the eyes, grimacing, or even turning the head. Sometimes motor tics involve muscles of the trunk, arms, and legs.
Typically, tics begin between the ages of 5 and 10 years. Many tics are transient and improve with time, often during puberty. If motor tics persist for longer than a year, they are considered to be persistent.
If they are also associated with vocal tics, they can be diagnosed as Tourette’s Syndrome, which affects about 200,000 people in the United States. Vocal tics can cause throat clearing, grunting, repeated words, swearing, or even repeating what other people say, which is known as echolalia (Ueda and Black, 2021).
Tics are often associated with other psychiatric disorders including attention deficit hyperactivity disorder, obsessive-compulsive disorder, anxiety, and depression.
Treatment of tics is indicated when they significantly affect patients’ lives. Otherwise, patients can be counseled that tics often do not progress and frequently resolve without therapy.
Behavioral approaches should be used as first-line therapy for tics. Tics can worsen with excitement, stress, anger, or physical strain such as fatigue or illness, and tend to improve when patients are calm. Sometimes, tics are triggered by the environment—when wearing a shirt with a tight collar, or hearing a certain sound such as nasal sniffing or throat clearing. Teaching patients to avoid or tolerate tic triggers can help reduce the occurrence.
In working with a therapist, patients can be taught to resist their tic behavior when faced with tic triggers. Patients can also be taught to engage in a competing response to the tics, such as tensing their muscles as a way of preventing their tics from recurring. Therapy using apps can also help improve tics.
Tics can be treated with different kinds of medications such as those that block dopamine, lower blood pressure, or antidepressants. However, given the cost and potential side effects of therapy with medications, this should only be offered when behavioral approaches are insufficient.
Hypnotic stress reduction techniques can help reduce tic frequency significantly. Such techniques include imagining going to a relaxing place, relaxing from head to toe while in hypnosis, and deep, slow breathing that involves inhaling through the nose and exhaling through the mouth.
Positive thinking can help calm tics in some instances. For example, “I would like my body to be peaceful.” “It is comfortable when my eyes blink calmly.”
Specific imagery to help reduce tic frequency includes imagining turning a dial that controls the tics, flipping an imaginary switch to turn them off, imagining holding up a stop sign when the patient feels the tics are about to start, and locking the tics in a treasure chest and throwing the chest and its key into the ocean.
Some people choose to imagine placing their tics in a filing cabinet during the day and letting them out at night, when they can be in the privacy of their own home, as a way of letting go of stress.
Finally, using hypnosis for “age regression” allows patients to imagine revisiting the time when they first developed their tics. The patients are then prompted to imagine teaching their younger selves how to remain calm at that time, rather than developing a tic response. Following such an interaction, the tic frequency of some patients decreases dramatically.
Hypnosis can be an effective first-line behavioral intervention in the treatment of tics.
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