Biofeedback and Self-Regulation & Habit Reversal Training (Cognitive Behavioral Intervention for Tics – CBIT)
Treatment Objective: Supplement your medical treatment with behavioral health and wellness. Through evaluation of your unique pattern of symptoms and the biofeedback process, learn how to become more self-aware on a deeper level to enhance your ability to identify key triggers, underlying emotions & feelings, reactions, physical changes, and the patterns and dynamics of the tic symptoms. Learn and practice natural wellness strategies that may momentarily help reduce triggering factors, relax muscle tension, and reduce nervousness and anxiety. Through awareness and intentional practice, such skills may help to momentarily reduce the intensity, frequency, and duration of tic episodes, that is to the level possible within your control based on the nature of your unique symptoms and tic disorder. The biofeedback process can demonstrate your improvement in self-regulation of mind and body (relaxing, producing calmness, refocusing attention), teach you how to use your own internal awareness, and help you learn how to sense your own biofeedback and apply a strategy to attempt to self-correct the tic pattern in the moment, and most importantly, upon the build-up or onset of tic symptoms.
Please be aware that this process is not a cure for tics. However, these strategies may support improving interoception (inner awareness of bodily functioning and anxiety physiology, and various triggers that may increase tic symptoms, as well as those situations and dynamics that lower tic symptoms). The strategies focus on creating a relaxed and steady state of body and mind when possible, but it is not tic suppression. Tic suppression can be challenging, and create tension and frustration. This is a process of using specific skills to manage tic urges without having to use tic suppression.
Goals of Treatment:
Wellness Evaluation: Clinical Interview: Description, pattern, and history of tic disorder. Identify known symptom triggering factors with rating scale, general lifestyle factors and daily stressors that may also contribute to tic symptoms
Education: General scientific knowledge about the mind and body, biofeedback and self-regulation, and habit reversal training. Natural principles, lifestyle factors, and health strategies that may help reduce tic symptoms in the moment.
Design and Practice Treatment Goals and Objectives: Treatment objective: learn and practice self-awareness and self-regulation skills targeting the tic symptoms. Programs may include the following training goals and strategies: Biofeedback, self-monitoring of tics, self-awareness, and self-regulation (self-control) / ability to set intention
Calming skills for mind and body (muscle and overall physical relaxation, diaphragmatic breathing, mindfulness, and imagery) to interrupt the pattern of tic symptoms
Cognitive-Behavioral Therapy: (CBT) is a therapeutic approach that focuses on helping influence positive and proactive thoughts, emotional self-regulation strategies, and productive behaviors to support treatment goals and objectives
Habit Reversal Training: 1. Train self-awareness of tic symptoms and patterns. 2. Create a competing response (Divert the energy of the tic pattern to some other behavior that is more tolerable and less obvious or distressing). This can occur by making a soft fist, doing focused breathing, squeezing a stress ball, tense-relax strategies, or training some other mild behavior that you can repeat to replace a tic impulse. 3. Build motivation and generalization of skills (Practice these skills in daily life, in different situations, especially when the tics occur. Stay motivated and be intentional about treatment strategies. Self-monitor the process and seek to improve skills. Learn how to handle feelings in a productive way through CBT, lean stress management and emotional self-regulation, and practice impulse control strategies).
Guided Imagery and Supportive Behavioral Strategies: Learn how to use behavioral modification strategies and mental imagery to support treatment goals. The key is repetition and practice.
Surface Muscle Biofeedback
Biofeedback (Biology feedback) — sensors placed over muscles can reveal surface muscle tension in real time and increments to enable you to have a more effective internal and external self-awareness of muscle tension patterns. This process occurs with the computer screen displaying the rise and fall patterns of the muscles involved though several visual picture and numeric graphs. There is also sound feedback that may be used to support self-awareness of muscle tensing up and relaxing patterns. Through the computer screen feedback and also Dr. Allen’s supportive verbal feedback and training, the objective is to gain your own self-awareness and the use of healing strategies to learn how to correct unconscious muscle tensing and postural patterns, and let those muscles relax at will. These skills may be learned and internalized through self-awareness, and practice in between sessions. The goal is to become an expert at your own biofeedback, and to correct and restore optimal balance between muscle activity and relaxation. This process may help you reduce overall inner-tension and support awareness and ability to reduce tic symptoms in the moment.
Other Biofeedback Modalities & Strategies
The Autonomic Nervous System and Adrenal Glands: The brain to internal organs (heart, vascular system, gastrointestinal, etc.). This also includes “fight or flight” stress response, and the internal relaxation response. This nervous system may be involved in response to stress, (i.e., increased heart rate, sweaty palms, cold hands and feet, tension in breathing patterns), and stress may increase tic symptoms. Key strategies that may help restore a steady state of harmony to the autonomic nervous system includes diaphragmatic breathing and heart rate variability training, Autogenics and hand-feet warming, overall muscle and bodily relaxation, among other mental and physical techniques that are basic natural processes for adapting to stress and recovery. These processes help manage inner tension, which may help reduce tics.
The Central Nervous System: (brain, brainstem, spinal cord) — the brain communicates to the body. An overactive racing mind, or a mind filled with patterns of stressful thinking may trigger or exacerbate tic symptoms. Key strategies that may help reduce mental tension and restore harmony to the central nervous system includes quieting the mind, good sleep, meditation, yoga, chi gung, diaphragmatic breathing, mindfulness, guided imagery, among many other techniques that are natural processes for adapting to stress and recovery.
Additional biofeedback training modalities utilize heart rate variability, hand temperature, palm sweat, breathing patterns, and blood pressure to experience through sound and visual images the rise of a stress response in real time and to observe success in reducing the stress and anxiety. The objective is to develop internal awareness and anxiety reduction skills, and a tolerance for controlling a tic in the moment while reducing the urge and impulse to react.
Additional Wellness Strategies:
(Additional programs to help with OCD and Anxiety Disorders, ADD & ADHD)
- Stress management and coping skills training (learn ways to reduce stress and anxiety). Counseling and psychotherapy available for working with issues contributing to stress, anxiety, and depression.
- Diet and wellness lifestyle tips for managing stress, improving sleep, and restoring inner well-being
- Length of Treatment Programs: 3-5 sessions for basic skills exposure and training, additional sessions may be beneficial for more challenging conditions and to further enhance skills.
- Provide practice strategies and educational training handouts for in between sessions.