My thoughts on hypnosis, habit reversal, and CBIT

As it happens, hypnosis and habit reversal are more alike than different.  Both are behavioral approaches.  Both involve having patients be able to identify the premonitory urge before a tic occurs.  And, although in habit reversal the goal is to perform the “competing response,” in hypnosis, similar techniques are used to control and prevent the tic from happening.  With hypnosis, patients are taught how to get rid of the tics.

One of the main differences between my using medical hypnosis compared to comprehensive behavioral intervention for tics (CBIT) with habit reversal, is a difference in style.  CBIT with habit reversal includes using a “support person” to help the child.  Typically, this is the parent.

Although the CBIT people believe in using a support person, I am against this for a few reasons:

  1. It can infantilize the child by giving him/her the message, “You can’t do this without our help.”
  2. It can cause conflict if a parent or significant other “nags” the child or patient to “do your habit reversal” exercise. What if the person says, “It’s time to do your habit reversal now,” and the patient says, “No,” or, “Maybe later?”  This can lead to a power struggle and affect the outcome of the treatment.
  3. The tics are, after all, the patient’s problem, not the parents. I tell my families, “We are all on TEAM Jane, or TEAM John, and, Jane/John is the only one who can take care of this problem. Just like any other skill that needs to be learned and practiced, such as learning how to play the piano or kick a soccer ball, you need an instructor, or a coach.  I will be your coach, Jane/John, and, just like soccer, the more you practice, the better you get at it.  And the more you practice, the easier it gets.  And the more you practice, the faster you get at it.
  4. It can give the patient the message, “You’re not good enough.” I had one 10-year-old with Tourette syndrome whose tics went from an average daily tic activity of 9 to 3 after only 3 visits, with no medication.  Yet, his mother complained, in front of the child, “Yes, but he is still having tics!” How do you think he felt about this, especially after he had done so well, after only 3 visits, without medication?  He and I discussed this privately, and he felt ashamed, embarrassed, and angry at his mother.  Fortunately, I was able to meet with his mother alone and educate her about this.

Also, the CBIT people believe in rewarding patients with tangible or monetary rewards, and that this helps reinforce the program.  Although the rewards are given for compliance with the program, I believe that tic control should be its own reward.  And, I worry that if the main reason the patient is doing the exercises is to get a present, or gift card, that the patient is not truly motivated to gain control over those tics.

I am trained in both medical hypnosis as well as CBIT.  I always start with medical hypnosis because the results are typically so quick.  And, habit reversal is sometimes included as one of the hypnotic techniques I teach.  My goal is to give patients several tools and then have them choose the ones that work best for them. Most of my patients feel that habit reversal is equivalent to trading one tic for another.

Typically, my patients have significant improvement after only 1 to 3 visits, having learned only medical hypnosis, without habit reversal or CBIT.

For patients with Tourette syndrome, it’s important to remember that the above treatments are strictly to help manage the tics.  Other associated conditions that can accompany Tourette syndrome can include:

  • anxiety
  • learning disabilities
  • Obsessive compulsive disorder

And each of these needs to be addressed individually.

To contact Dr. Lazarus, click here.