Behavioral therapy for Tourette’s syndrome and chronic tic disorders now offered at Carris Health Rehabilitation Center

Published in Wellness Rehab & Therapies News Tag: Merlin Nelson, MD   Abby Heiderscheit, OTR/L,MS  

Author: Staff

Tourette syndrome is a neurological disorder that affects the body’s brain and nervous system by causing tics – sudden repetitive movements or sounds that some people make. Those with Tourette syndrome usually begin noticing symptoms when they’re kids or teens. In the United States, one in 100 people may have milder symptoms and approximately 200,000 have a severe form of Tourette's, according to the National Institute of Neurological Disorders and Stroke. It often runs in families, with a history of tics occurring in about half of patients.

A behavioral approach to treatment

Dr. Merlin Nelson

Dr. Merlin Nelson cares for a number of individuals with Tourette syndrome in his neurology practice at Carris Health in Willmar. He was familiar with a non-medication treatment, that when used appropriately, can help individuals better manage their tics and reduce the negative influence that tics may have on their lives. However, this behavioral approach is not widely available in outstate Minnesota. The nearest location offering this service was in the Twin Cities metro. Dr. Nelson wanted to provide a behavioral option for patients with tics in our region.

Earlier this year, Dr. Nelson reached out to the occupational therapy team at Carris Health Rehabilitation Center. He shared information about training he had researched on Comprehensive Behavioral Intervention for Tics (CBIT).

CBIT was developed in 2001 by the Tourette Association of America’s Behavioral Science Consortium. It’s a behavioral treatment that has been demonstrated to decrease the severity and frequency of tics. This non-drug treatment consists of three important components:

  • training the patient to be more aware of tics,
  • training patients to do a competing behavior when they feel the urge to tic, and
  • making changes in day to day activities that can be helpful in reducing tics.

Regaining control

Abby Heiderscheit

Carris Health Occupational Therapist, Abby Heiderscheit, took an immediate interest in learning more about the benefits of this therapy and decided to jump right in with her CBIT training.

“I imagined having motor tics that are so extreme and bothersome that you can’t even get yourself dressed in the morning,” said Heiderscheit. “As an occupational therapist it’s my role to make certain our patients can do their daily activities to the best of their ability.”

In many cases, a person will feel a slight sensation before they tic, also known as a premonitory urge, and doing the tic will provide them with relief. Common external factors that can trigger premonitory urges are stress, your job or school, people around you, and your environment. CBIT starts by addressing what could be triggering your premonitory urge and working on interventions to help work through those.

Once the patient has identified this urge, a competing behavior or response is identified to counteract the tic. For example, if someone has a hand tic, the competing response might be to hold your hands together.

Patients will typically complete CBIT therapy in 12 weeks with a follow-up session between three to six months out.

At six months, over half of patients nationwide report improvements in their severity and frequency of tics.

Even more compelling, patients are ranked on a Yale global tic severity score on a range of 0-50. A higher score on the scales suggests a more severe tic and greater impact the tic has on the person’s life. Patients that have completed CBIT, on average, see a 7.5 point decrease on their score.

“A reduction of 7.5 points may not seem like a lot, but this is significant for people in their day-to-day activities,” said Heiderscheit.

CBIT is not a ‘cure’ for Tourette syndrome, but a tool that can help individuals better manage their tics and reduce the negative impact that tics may have on their lives.

Who is eligible for CBIT?

To qualify for this treatment, patients need to have vocal or motor tics that are bothersome enough that it’s interrupting their daily or weekly function. A primary care physician or a neurologist can refer to the Carris Health Rehabilitation Center for CBIT.

“In order for CBIT to be successful there also needs to be a strong motivational level from the individual and their family,” adds Heiderscheit. “There’s homework that comes with this therapy: practicing exercises, learning relaxation techniques, and being willing to make changes to your environment.”

Empowering patients

Although there is currently no cure for Tourette syndrome (TS), CBIT is a behavioral alternative that can help manage tics and give individuals an active role in their treatment.

“Medication treatment for tics is still a valid and effective option for many, but to have a behavior therapy option has the potential to be life-changing,” Heiderscheit says. “I cannot wait to get started helping people.”

To inquire if CBIT treatment might be right for you or your child, speak with your primary care physician, your neurologist, or contact Carris Health Rehabilitation Center at 320-231-4175.