Managing Tic and Habit Disorders

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 ixAbout the Authors xiiiAcknowledgments xvAbout the Companion Website xviiIntroduction 11 The Nature of Tics and Habits 9Overview of the Nature of Tics and Habits 9Idea of a Tourette or Tic and Habit Spectrum 10Current Diagnostic Criteria of Tics and Habits 10Current Multidimensional Etiology of Tics and Habits 13Social Impact and Consequences 17Current Treatment Options 182 Evaluation and Assessment 21Evaluation and Assessment: What are Tics and Habits? 21Evaluating the Severity of Tics and Habits and Their Impact on the Client’s Life 22Assessing Style of Planning and Thinking and Beliefs about Tics or Habits 323 Motivation and Preparation for Change 43Motivation: Ready to Change the Habit 43The Pros and Cons of Tics and Habits; and Setting Goals and How to Attain Them 50Client’s Perception of the Tic or Habit 52Dealing with Stigma and Self-stigma 53Control: Micro- and Macro-control 55The Contextual Nature of Tic or Habit Onset 574 Developing Awareness 61Choosing and Describing the Tic or Habit 61Awareness of the Tic or Habit 63Discovery of Seeing the Habit Differently 63Discovery Exercises 64Making a Video: Replaying and Watching the Video 64Premonitory Signs 67Daily Diary 68Tic or Habit Variations 73Tics or Habits in Context 745 Identifying At-Risk Contexts 77Identifying Variations in the Context of the Tics or Habits 77Discovering High and Low Risk Situations or Activities 78Evaluating the Situation or Activity 79Linking High Risk Activities and Evaluations to Feelings and Thoughts and Assumptions 836 Reducing Tension 87Tension Before Ticking: How to Use Your Muscles 87Conflicting Preparation Versus Coherent Preparation 92Unhelpful Attempts at Self-management of Tics or Habits 95Mindful Engagement 96Mindfulness Exercises 977 Increasing Flexibility 101Discriminating Muscle Contractions 101Rationale and Procedure for Discrimination Exercises 102Whole Body Muscle Control 105Muscle Relaxation 105Check the Breathing, Posture, and Flow During Movement 106Breathe Better 106Relaxation Exercises 107Refocusing Sensations 1118 Addressing Styles of Planning Action 115Style of Planning: Pulling Together Sensory, Emotional, and Motor Aspects of Ticking 115Styles of Action 116Behavioral Cost 118Thoughts associated with Styles of Action: Perfectionism in Personal Standards and Personal Organization 1209 Experiential Avoidance, Cognitive Fusion, and the Matrix 127Experiential Avoidance and Cognitive Fusion 127Improving Flow and Goal Directed Action Using the ACT Matrix 131Discriminating Thoughts, Actions, and Experiences 134Using the ACT Matrix to Work with Styles of Action 13710 Emotional Regulation and Overcoming the Habit–Shame Loop 141The Habit–Shame Loop 145Adaptive and Maladaptive Coping 146Validating Emotion 147Working with Self-talk 148Relational Frame Theory 149An RFT-inspired Link between Dysfunctional Thoughts and Tension 15211 Achieving Goals and Maintaining Gains 155Maintaining the New Behavior 155New Situations 158Reward and Self-compassion 159Relapse Prevention 160Achieving Non-tic Goals 160Finally 161References 163Author Index 171Subject Index 175