Managing Tic and Habit Disorders

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