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EEG Biofeedback and Neuro-hypnotherapy as Integrative Treatment for Tics and Tourette Syndrome

EEG Biofeedback and Neuro-hypnotherapy as Integrative Treatment for Tics and Tourette Syndrome

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EEG Biofeedback and Neuro-hypnotherapy as Integrative Treatment for Tics and Tourette Syndrome

INTRODUCTION

Human brain can be trained at any age and new neurons are produced throughout our life. The term of neuroplasticity are well accepted nowadays. EEG biofeedback or neurofeedback is based on the concept of neuroplasticity that trained the brain likes a muscle. It is safe, non-invasive and no known side effects. It is basically based on the operant conditioning concept which utilizing the reinforcement concept to change the brain.

When comes to neurological or mental disorder, pharmaceutical intervention is usually recommended to deal with the brain by improving neurochemical or brain structure components. Interestingly, the electrical component which is brainwaves has been neglected most of the time. Even a person with perfect neurochemical and brain structure but without any noticeable brainwaves, they can be certified as brain death by a qualified neurologist or physician. Thus, brainwaves intervention such as EEG biofeedback training should include as one of the treatment plans when need to deal with issues related to our brain and mind. In fact, EEG biofeedback is not something new as it has more than 50 years of proven scientific studies. It is proven to be helpful in cases such as Attention Deficit Hyperactivity Disorder (ADHD), Obsessive Compulsive Disorder (OCD), anxiety, insomnia, depression, tics and Tourette Syndrome.

EEG biofeedback for tic disorder is worth investigated for as it directly deals with the brain and another major benefit is the hope that it can help patients avoid pharmaceutical intervention which might cause side effects. As mentioned earlier, a healthy state of mind includes the component of electrical, brain structure and neurochemical. EEG biofeedback alone might not be sufficient to get rid the entire problem as it primarily improves the brain function to perform better. In this case, integrative treatment approach such as combining with psychotherapy, hypnotherapy and nutritional therapy can be recommended to get the best therapeutic outcome.

Neuro-hypnotherapy on the other hand, is first of its kind in Malaysia. It is a technique by combining EEG biofeedback technology and the science of hypnosis. Hypnosis is a skill which involved the use of words and suggestions to achieve therapeutic outcome, meanwhile the clinical hypnotherapy is a technique which utilize the concept of hypnosis to achieve clinical outcomes (Kaya &Alladin, 2012). Clinical hypnotherapy has been acknowledged as an evidence based therapy tool by various medical councils in the world and it has been proven to be helpful for various medical conditions (NC, A., LF, S., & J, B., 2008). In Malaysia, clinical hypnotherapy is one of the recognized modalities which classified under complementary medicine and regulated by ministry of health. Clinical hypnotherapy is considered as an oldest form of psychotherapy as well as complementary medicine (Lam, 2013). By utilizing this technique, we can combine self-hypnosis method with other psychotherapy method such as habit reversal training. Habit reversal training (HRT) is evidence based non-pharmaceutical interventions for tics and Tourette syndrome, it has been found to alleviate motor and vocal tics (Piacentini and Chang, 2006). Once a patient learned how to utilize the self-hypnosis technique, they learn to deal with their stressors and a healthier way to remain calm.

Tourette Syndrome (TS) or Gilles de la Tourette Syndrome is one type of Tic disorder. TS is characterized by involuntary tics, repetitive movements and vocalizations. Normally it will start between the ages of 5-7 years old and becoming more severe between the ages of 8-12 years old. Motor tics (simple or complex motor tics) and vocal/phonic tics (simple and complex vocal tics) are two common characteristics of tic disorder. Simple motor tics include eye blinking, head jerking, jaw movements, shoulder shrugging, neck stretching, and arm jerking. Complex motor tics include hopping, twirling and jumping. Simple vocal tics include sniffing, throat clearing, grunting, hooting, and shouting. Complex vocal tics include words may or may not be recognizable or it could be socially unacceptable words.

Tic disorder can be differentiate into three types which is Tourette Syndrome, Chronic Tic Disorder (Vocal or motor type) and Provisional Tic Disorder. Individual with at least two motor tics and at least one vocal/phonic tics over the course of more than 1 year can be classified as TS. One suffered with either motor tics or vocal/phonic tics for more than 1 year can be classified as Chronic Tic Disorder. If the tics were presented less than 1 year, it can be classified as provisional tics disorder. Patients with TS are at high risk of having comorbid major neurodevelopmental and neuropsychiatric conditions such as Attention Deficit Hyperactivity Disorder (ADHD), Obsessive Compulsive Disorder (OCD), Learning difficulties, behaviour problems, anxiety, mood issues, social skills deficits or sleep related problems.

ROLE OF NEURO-HYPNOTHERAPY IN HELPING PEOPLE WITH TIC DISORDER

Neuro-hypnotherapy is practiced by clinical hypnotherapist who has been trained in the area of EEG biofeedback technique. It is based on the concept of clinical hypnotherapy and it can be classified as psychotherapy as well. It is well known to deal with subconscious mind directly and it is commonly used to deal with symptoms of various problems such as habit breaking, quit smoking, weight management and mood related issues. There are many approaches and techniques in the field of clinical hypnotherapy. The most commonly used clinical hypnotherapy techniques for patient with tic disorder are hypnobehavioural methods such as hypnodesensitization and habit reversal therapy. Cognitive behavioural hypnotherapy (CBH) also can be used to deal with tic disorder or the comorbid feature of TS such as OCD or anxiety related symptoms. Neuro-hypnotherapy for tic disorder includes a combination of different types of therapies.

After the brainwaves analysis session, EEG biofeedback alone or EEG biofeedback combining with neuro-hypnotherapy sessions or other intervention such as nutritional therapy will be recommended based on individual need. After that, if the patient was suggested to do the neuro-hypnotherapy, then psychoeducation will be started first. During this initial step, the possible causes of tic disorder will be elaborated by the clinical hypnotherapist. Patient or patient’s caregiver will also be guided on how to give appropriate support as well as how to communicate with the school or co-worker effectively to reduce conflict and misunderstanding. Furthermore, although habit reversal is an effective intervention for tic disorder, individual should be informed that tic disorder is not just a bad habit but a neurological disorder. Thus, it cannot be solved based on positive or negative reinforcement alone. In fact, reinforcement either positive or negative may worsen the symptoms. It is very important to neutralize the self defeating belief and empower the patient with confident and setting realistic expectations.

The following session will focus on functional intervention, cognitive behavioural hypnotherapy, HRT as well as relaxation therapy. During the functional intervention session, patient will be hypnotized in order to identify how environmental factors may worsen, maintain or improve the symptoms. Patient is able to observe his or her behaviour before and after the tics occurrence during the neuro-hypnotherapy session. CBH technique can then be applied to deal with the irrational feelings, cognitive distortion and unhealthy coping technique.

According to the systematic review done by Dutta, N. and Cavanna, A. E. (2013), HRT can significantly reduce tic severity for patient who suffered for tic disorder. During the neuro-hypnotherapy session, patient will be hypnotized and observe all of their tics in detail such as how it feels in the particular muscle group and where it feel most intensively in the body. During this stage, HRT will be incorporated into neuro-hypnotherapy session to find out the premonitory urge. Thus, patient will notice how it feels before the tics occur more clearly. Hypnodesensitization focuses on getting patient get used to the premonitory urge, so the patient no need to react to it by doing the tic. In this way, premonitory urge can be controlled before the tic happens. Soon after the patient more aware the premonitory urge, competing response will be discussed and implemented. During the neuro-hypnotherapy session, an intentional movement that can prevent tic to happen will be suggested. After that, the clinical hypnotherapist will use the hypno exposure therapy to reinforce the competing response.

Progressive hypnotherapy relaxation is taught to relax the patient as it can directly reduce the stress response. Tics are commonly known become worse when triggered by stress response. Progressive hypnotherapy relaxation technique which requires patient to progressively tensing and then relax the different muscle groups is taught in a self hypnosis format. This is very helpful method to reduce the arousal level in the brain and empower the patient with this appropriate self coping technique. Patient was taught to utilize the progressive hypnotherapy relaxation technique whenever he or she has the need to stay calm and relax.

During the neuro-hypnotherapy session, electrodes are applied to the individual’s scalp, which allow the patient and therapist to observe the brainwave activity. The electrodes do not hurt and conduct no amount of electricity that one can feel. The person’s hair is not removed or shaven during the electrode placement. This is done in real-time setting, so the person sees exactly what is going on in their brain as they think certain thoughts, feel stressed, or feel relaxed. After the self hypnosis session, patient commonly will learn how to self regulate their brain activity naturally, without pharmaceutical medications.

In Malaysia, clinical hypnotherapy is regulated under ministry of health – Traditional and complementary medicine division. Patient can search for a licensed clinical hypnotherapist who may have a special interest in working with tic disorder sufferer.

Reference

Bronfeld M & Bar-Gad I (2013). Tic Disorders: What Happens in the Basal Ganglia? Neuroscientist (19), 101 – 108. doi:10.1177/1073858412444466

Dutta, N., & Cavanna, A. E. (2013). The effectiveness of habit reversal therapy in the treatment of Tourette syndrome and other chronic tic disorders: a systematic review. Functional Neurology, 28(1), 7 – 12. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23731910

Kaya, Y., & Alladin, A. (2012). Hypnotically assisted diaphragmatic exercises in the treatment of stuttering: a preliminary investigation. International Journal of Clinical and Experimental Hypnosis. doi:10.1080/00207144.2012.648063

Lam, T. (2013). Hypnosis for insomnia: an exaggerated myth or an underrated intervention. Sleep Medicine, 14(1). doi:10.1016/j.sleep.2013.11.412

Messerotti BS, Buodo G, Leone V, Palomba D (2011). Neurofeedback training for Tourette Syndrome: an uncontrolled single case study. Appl Psychophysiol Biofeedback, (36): 281 – 288. doi: 10.1007/s10484-011-9169-7

NC, A., LF, S., & J, B. (2008).Hypnotherapy for smoking cessation (Review).The Cochrane Library, (10), 1 – 39. Retrieved from http://bscw.rediris.es/pub/bscw.cgi/d5001301/Barnes- Hypnotherapy_smoking_cessation.pdf

Piacentini JC, Chang SW (2006). Behavioral treatments for tic suppression: habit reversal training. AdvNeurol, 99, 227 – 233. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16536370

Shanbao, T, & Nitish, V, T. (2009). Quantitative EEG Analysis Methods and Clinical Applications. UK: Artech House

 

Contributed by:

Mr. Hiro Koo

Neurotherapist at Spectrum of Life