Coping with Tics

Motor Tics

Rapid, Stressed Blinking – Motor Tic


Firstly, a long day of stressed blinking can cause swelling and fatigue in your eyes. ​Discomfort in the eyes often triggers the onset of more severe and frequent eye-related tics, which creates a harmful feedback loop. To combat this, use eye drops, cold compresses, and aloe vera. Eye drops can reduce redness, cold compresses can help you manage the pain/swelled areas, and aloe vera is a natural, anti-inflammatory agent. Do not directly apply aloe vera to your eyes, but rather, mix a pea-sized amount of the gel with cold water; using cotton pads or a clean washcloth, soak the fabric in the aloe vera/water mixture and gently place the pads on your closed eyes, letting them cool down your eyes for at least ten minutes.

Secondly, minimize the time you spend on your devices. Trust me, but bright LED lights and prolonged screen time has been repeatedly proven to be detrimental to optical health. This is something to especially keep in mind if you suffer with eye tics. Take frequent, hourly breaks from your devices, and give your eyes time to rest and recuperate. These mini lifestyle changes might seem trivial, but they are definitely not. These small adjustments can often reap the greatest benefits.

For temporary relief, you can close your eyes and gently massage your eyelids with your index and middle fingers in a circular pattern. Be careful not to accidentally damage the cornea.

Now that your eyes are slightly less irritated and more relaxed, the following strategies might help.

  1. To begin, you must resist the tic with all your might. Note how you might always be used to giving in so automatically, that your brain has been wired to associate your premonitory (pre-tic) urge with the tic itself. By actively resisting, you are able to identify the urge and how it can manifest. When you delay the onset of the urge and giving in to the tic as much as possible, your brain is learning to disconnect the urge from the tic, so that your body does not feel compelled to give in to such urges by ticcing.
  2. While delaying, we are going to try a slow, controlled blinking exercise. It will feel difficult, awkward, and maybe even exacerbate your symptom at first. But be patient. Try it out.
  3. Focus on a specific object in front of you.
  4. Relax your eyelids and remove any facial tensions so that your eyes are calm.
  5. While focusing on something in front of you, gently blink once every two seconds. Try your absolute best to resist the urge to blink more frequently or more violently. If you feel an extremely uncomfortable urge to blink aggressively, just gently massage your eyelids to relieve any existing tension.
  6. Repeat your slow, controlled blink for thirty seconds to one minute. After you've practiced one set, close your eyes gently to relieve any discomfort. Once your eyes feel calm and comfortable, pratice another set of controlled blinking.
  7. Keep in mind general eye health. Don't itch your eyes with your dirty fingertips or spend several hours one end in front of a bright screen without several breaks.

Important things to ask yourself....

  • Does engaging in the tics sustainably remove the urges? Or is it simply a temporary relief?
  • Once you've resisted for a significant amount of time, have you noticed that the urge has started to dissipate slightly? If so, this should signal to you that you do NOT need to engage in the tic in order for the urge to disappear!
  • Am I prioritizing consistency in my practice?
  • Am I expecting a vanishing of symptoms? Am I placing more importance on the result, rather than the processes by which progress is both achieved and sustained?




Neck Jerking – Motor Tic


Neck tics are particularly difficult to manage, since they often cause major tension and pain in addition to being extremely noticeable and ‘socially unacceptable.’ After a long day of constantly jerking and shaking the neck, it can cause severe pains and inflammation to the muscle and almost unbearable pain. Trust me, I know how you feel. Before you try to resist the neck jerking, you must address the already existing pain and soreness as a result of repeated tic-ing. To do so...

  1. Apply heat pads to inflamed areas.
  2. Use muscle relief gels like Theraworx. If you experience skin irritation, try using natural products and oils such as Hemp Extract or Arnica Oil. These usually provide the least epidermal irritation. Beware of allergies, though!
  3. Visit a chiropractor. Adjustments can help, and in severe cases, your chiropractor can fit you for a neck brace.
  4. Get a neck massage at a parlor. Tell the masseuse to focus on relieving knots and tension in the sternocleidomastoid area that can become inflamed as a result of constant neck tics.
  5. If options 3 & 4 are infeasible, an at-home self-massage can do the trick. Apply lotion or a massage oil (sweet almond, apricot, jojoba, coconut, sunflower, etc.) to the area at which you experience the most pain. Place both of your palms on the sides of your neck, interlocking the fingers at the nape. In a circular, back and forth motion, and massage the muscles to relieve existing tensions. Alternatively, you can use your index, middle, and ring fingers to release tensions in the muscle fibers by pressing the sides of your neck in a circular, slow motion.

Now, for the actual exercises.

  1. To begin, you must resist the tic with all your might. Note how you might always be used to giving in so automatically, that your brain has been wired to associate your premonitory (pre-tic) urge with the tic itself. By actively resisting, you are able to identify the urge and how it can manifest. When you delay the onset of the urge and giving in to the tic as much as possible, your brain is learning to disconnect the urge from the tic, so that your body does not feel compelled to give in to such urges by ticcing.
  2. While delaying, take deep breaths in and out. Breathing is essential in every single competing response, since our body functions by inhaling and exhaling. As you breathe in and out, imagine the tension in your neck slowly subsiding. Feel your muscles relax after every exhale.
  3. As you resist, we can also use powerful imagery to aid us. Imagine your neck is a tall, sturdy tree trunk. Imagine sandbags placed on your shoulders to stretch your neck out nice and tall. These imagery techniques don’t work for everyone, but it can surely help you to divert attention away from the urge and more towards the sturdiness and stability of your neck.
  4. Never. Stop. Resisting. Your objective is to resist indefinitely, but we all know that it’s unrealistic, especially your first time trying to combat these tics. Thus, when the urge becomes absolutely unbearable, we can practice a competing response: look over your right shoulder and then your left shoulder as if you were simply stretching your neck after a poor night’s sleep. This motion should be executed once only in a controlled, calm manner.
    1. Alternatives to the above competing response....
      1. Move neck counterclockwise then clockwise once each, like you are just stretching your neck.
      2. Use your hand to gently pull your neck to right shoulder, then the left, to feel the sides stretch.
  5. The objective of the competing response is to engage in a socially ‘normal’ action that can somewhat relieve your urge to tic. Your competing response should look normal to others, which is why the selection of the exercise is important – we do not want to simulate another harsh, tic-like motion that could eventually cause similar pain and discomfort. This is why the combination of resilient resistance, imagery, and the competing response is essential to prevent a relapse of symptoms. It takes time, effort, and failure, but you must practice daily!




Lip Pouting – Motor Tic


Sometimes severe lip/mouth tics can cause ulcers and canker sores in the mouth. Before we get started on our competing responses, I have a few tips to remedy inner mouth pain and bruises.

  • Purchase and use an anti-ulcer mouth wash or toothpaste. Good brands are Phillips’ for a mouth wash or Orajel for a topical gel.
  • If you have braces, apply generous amounts of wax on sharp edges or pointy surface. Repeated mouth tics can cause permanent abrasions to your gums and inside of the mouth, so be very careful and prevent damage.

For the competing responses, I have a couple of techniques to share regarding how to prevent the onset of lip pouting or unwanted mouth movements.

  1. Lightly press the tongue to the roof of your mouth. This will help resist harsh, repeated jerking and pouting motions.
  2. After stabilizing the tongue to the roof of your mouth, lightly purse your lips in a controlled, natural manner. Do not press too firmly or harshly, this can cause unwanted tension. We only want to lightly close the lips to counteract pouting or jerking motions.
  3. Lightly clench your jaw by softly biting down on your molars. The objective is NOT to create jaw pain, but rather, we are trying to sustain a mild tension to combat the onset of a greater, more noticeable tic. If you feel any extreme pain or discomfort doing any of these exercises, stop immediately and think to take a different approach.




Shoulder Shrugging – Motor Tic


Shoulder shrugging can be very difficult especially if you are an athlete. When I used to run track, constantly shrugging my shoulders would inhibit my form and cause additional fatigue. As always, we will work on alleviating existing shoulder pains while simultaneously combating tic urges.

  1. Shrug your shoulders all the way to the ears, and drop your shoulders to a resting, relaxed position.
  2. Imagine sandbags resting on your shoulders, always pressing them firmly downwards. While you resist, notice the urge, but let it subside, as the ‘sandbags’ keep your shoulders in place.
  3. When the urge becomes unbearable, we have several competing responses to try.
    1. Stretch your arms behind your back and lock your fingers. Pull your arms further and further away from your back, and feel your shoulders relax and stretch.
    2. Slowly roll your shoulders once forward and backwards. Make sure to release all tension after doing this exercise by shrugging your shoulders and dropping them. The purpose of these competing responses is to minimize tension, not create more!
  4. The tricky part of all competing responses is to make it seem natural to the common eye. These strategies are especially great, since they seem natural, as if you were to simply stretch your muscles. To maximize their efficacy, we need to practice these strategies every day! Do not expect immediacy; settle for progress. : )




Hand Shaking/Trembling – Motor Tic


This tic was one of the most painful tics I had to deal with, and as a pianist, it was especially heartbreaking to know certain pieces I had the skill to play were rendered impossible. It took a lot of control, resilience, and failure to overcome this tic, and I still cannot control it fully today. However, certain techniques and strategies have helped me lessen the severity and begin playing again.

  1. Remember that competing responses and behavioral therapy techniques are not cures. Rather, they are coping mechanisms and management techniques. With very fine, rapid, motor movements such as a hand tremor, you must be patient and accept that progress takes both patience and effort. Do not expect immediate results or relief. Rather, have an open mind and accept the ups and downs of Tic Disorders.
  2. If you are walking or standing, a strategy you can use to stop hand trembling is to clench your hands in a fist, then extend all five fingers out. Repeat this “fist to five” exercise. This particular action can help you resist the urge to bring your hands up or shake them above your torso, which often draws more attention. Once again, make sure not to put too much tension in the exercise, as we do not want another tic-like motion to arise.
  3. If you are sitting in class or at work, and your hand tics disrupt the meeting and draw unnecessary attention, try the following exercise. In your desk, place your palms on your knees. Resist the urge to bring your hand up or shake it uncontrollably. Simply resting your hands on your knees will feel uncomfortable at first, but rest assured, all urges generally subside after a period of resistance.
  4. When the urge is unbearable, lightly clench your knee cap. Do so in a way that is both quiet, unnoticeable to others, and painless. You do not want to jab your skin with your fingernails. Alternatively, you can grip your knees with your fingertips and provide pressure as needed. This will hopefully assuage your urges, and you will be able to continue resisting.
  5. If all preventive measures fail, simply sit on your palms when sitting or place your hands in your pockets while standing or walking.

If your hand tics are especially bothersome while engaging in a specific activity such as writing, typing, or playing an instrument, consider the following tips.

  1. This approach is more geared towards treating OCD symptoms, and professionals call it exposure-response therapy. Remember that I am not a licensed medical professional! I am simply here to share strategies that have been effective for me!
  2. This style at approaching symptoms is pretty self-explanatory. You will exposure yourself to your urges and respond to the urges by resisting. For example, if you are writing a paper and notice a strong urge to tic by shaking your hand, what you will automatically do is identify the urge and subsequently resist it.
  3. As you are writing or typing or engaging you hand, notice the urge. Stop what you are doing and notice the urge rise. As the urge rises, do your absolute best to resist it as much as possible. As we prolong this urge -> tic instinct, we are actively rewiring our brain to disconnect the urge with the compulsive tic. With repeated practice, this codifies resistance techniques into our behavioral psyche. Resist!
  4. Many Tic Disorder/OCD patients notice that at the beginning of their resistance, the urge is the highest. However, as one continues to resist, you realize how the urge begins to subside. This should be a huge signal that you do not need to tic to feel relief. In reality, just waiting and resisting can do the trick.
  5. Once the urge has sufficiently subsided, proceed with whatever action you were performing, whether it be writing, typing, pressing something, etc. This process takes time and patience. Do not expect immediate results but continue to practice stopping the tic in its tracks and resisting until the urge subsides! As you continue practicing these exposures, your brain will slowly disconnect the urge with the tic.




More strategies to come soon!


Thank you for supporting! Have an amazing day. : )





Vocal Tics

Coughing/Throat Clearing – Vocal Tic


Repeated coughing and throat clearing can cause inflammation in the throat and “itchy neck” discomfort. To combat coughing/throat clearing and many other vocal tics, I have used slow and controlled breathing techniques to nullify the urges.

Before getting started with the actual breathing exercises....

  • Drink warm water.
  • Drink a throat calming tea like Licorice, Elm, Chamomile (my favorite), or Turmeric.
  • Brush your teeth.
  • ALWAYS protect your neck when you cough. If it gets too severe to the point that your neck is susceptible to damage, contact your doctor immediately and inquire about a neck brace.

Now, for the competing response.

  1. Inhale slowly and feel your stomach inflate like a balloon with oxygen.
  2. Exhale even slower, feeling the air flow out of your throat. As you exhale, resist the urge to clear your throat or cough. The key to resisting this tic is a very slow, controlled inhalation and exhalation. Feel the breath in your core and stomach, not in your throat. If you focus on your throat as the focal point of your breathing, that can cause more temptations to cough/clear your throat.
  3. Always. Drink. Water. Whenever I felt an urge to clear my throat, I always felt that there was a dryness or “air bubble” at the back of my throat. To remedy this, you can sip water, preferably warm!




Humming/Grunting Sounds – Vocal Tic


This tic can be quite tricky to handle. Before you begin this exercise, drink some water or a hot beverage to assuage the throat.

  1. Inhale slowly and feel your stomach inflate like a balloon with oxygen.
  2. Exhale even slower, feeling the air flow out of your throat. As you exhale, resist the urge to hum/grunt/engage in the vocal tic.
  3. Whenever you feel the urge to tic, inhale slowly once more.
  4. Repeat.

This exercise is extremely simple but incredibly effective. Not only can this exercise be used all day, but paying close attention to a calm, relaxed breathing state is beneficial for general calmness and to feel at ease.

Make sure that your breathing comes from the belly and NOT the throat. Throat breathing causes unwanted tension in the chest cavity, but when you engage the core and breathe deeply from the diaphragm and belly area, you are truly allowing the air to flow throughout the entire respiratory system.





Before You Get Started

INTRODUCTION


Tics are both difficult to live with and control. However, with daily practice and habit reversal techniques, I am able to mitigate the frequency of my symptoms. Before even beginning to attempt any techniques firsthand, it is crucial to log and journal each tic and technique, so you are able to track progress and identify strengths and weaknesses to each strategy. A simple way in which you can do so is by creating a weekly "Tic Log." Making a tic log is simple and helpful. It does not have to be fancy or pretty, but organization is important. Following these steps are critical in your journey to coping with any tic disorder, mild or severe.




STEP 1 -- Bulleting Your Tics


Bullet down a list of all of your tics. Don't worry about describing it or ordering it perfectly. As long as you are able to recognize the tic by the log, that is perfectly sufficient.




STEP 2 -- Scoring Your Tics


Now, for each tic, write a corresponding 'score' of 1-10 for each tic. Your score should be based on the severity, frequency, and general discomfort for each symptom. A precisely calculated score to the decimal point is not the objective, but rather, these scores will help you evaluate which tics you should focus on first and which ones can take the back-burner. After finalizing your list of symptoms and assigning a corresponding rating to each tic, circle the symptoms with the highest rating. Since this tic is the most frustrating and severe, we can start with this one.




STEP 3 -- Making Your Practice Log


Make a 'Practice Log,' where you can freely record and write out the active techniques and coping mechanisms you've been practicing for this tic. Ideally, you want to be practicing said techniques every day, so that your brain becomes rewired to identify and control urges quickly. Since we are usually so used to giving into our premonitory urges instantaneously, it will take practice and repetition to finally learn to cope with each symptom. We will be recording each time we practice daily in order to most accurately track progress and identify growth.




STEP 4 -- Things to Keep in Mind


Remember that there's no panacea for solving tics. Some methods might work, and many won't. Don't let frustration discourage you from continuing to fight. By being here, you are already taking significant steps in the right direction. Be patient with the techniques and practice them regularly. If you see immediate results, great. If you don't see any results, that's also okay. At least, now you will know what techniques work and what don't work.​