Strategies for Tics: Non-Medication Interventions

NOTE: Below is a list of various strategies that help me when my tics are occurring more frequently. These strategies are things that personally help me as a person living with Tourette's. They are wroth a try, but I can't guarantee these things will work for you or help your tics calm down. I can tell you these things help to decrease my tics at times (not all the time, and they are not foolproof) but overall every person is different and something that helps one person might not help another. If your tics are getting to a point where they are difficult to live with or to control, the first thing I would recommend is seeing a neurologist. Your neurologist, psychologist, or psychiatrist should be your first line in treatment and suggesting interventions.
I hope some of you find these suggestions helpful! Please let me know if you try to implement any of them and how they affect you!

Distraction/ Focused activities- 

       Whenever I'm ticcing a lot, distraction and focused activities can help my tics get back under my control. Talking or telling a story takes up a huge amount of brain power! Ever tried singing while also saying the ABC's backwards in your head? It's pretty much impossible because the amount of brain power it takes for your mouth to form words is taking up too much space in your brain. The brain has less of an ability to misfire (aka tic) if your talking, engaged in conversation, telling a story, etc. Also focused activities like dancing, drawing, video editing, or playing an instrument takes up just as much if not more brain power. So, when my tics get bad I try to focus myself on something that will take up a lot of brain power.

Note: For vocal tics specifically chewing gum or sucking of sugarless cough drops can help to distract the mouth from tics! 

Sensory Toys-

   Sensory toys seem to help my tics. For me the kinds of sensory toys that help the most are ones that provide both tactile input and auditory input. So for example, I have a sensory toy that's basically a long chain of plastic blocks all connected. When I move it around in my hands I get both tactile (touch) feedback and auditory (sound feedback) from the clicking noise it makes. I also have quite a few others that give this dual feedback such as a fish that makes a popping noise and a chain of small wooden blocks that make clicking noises as well. Not sure exactly why they help, but they help lessen the tic urges in my body when I play with them.

Here's the website where I got most of my sensory toys (its a site for autism sensory toys and I found it though my mom because she works with a lot of kids who have autism, but most of the items on the site work great for TS as well!): http://www.autismshop.com/games-playthings/games-playthings-fidgets-sensory-items/?sort_by=position&sort_order=asc

Here are a few of the sensory toys that I have and find helpful:

Tangle Relax toy :No auditory component, but great for tactile input
What Zit : tactile and auditory input (clicking sound when blocks hit)
Wacky Tracks  : great for both tactile and auditory input (this one is my favorite!)
Roller Fidget: great for tactile
Pop Animal: fantastic for both tactile and auditory
Colorfall: Great for those who might like more visual input

Sensory Soothers -
 
Milk/ Soothing Drink- Not sure why but drinking milk or another soothing drink when my tics are bad really helps me! Cold milk usually works best for me, but cold water to a lesser extent can help in a pinch. It really depends on the person though. For me I find the plane milk the most  soothing, but for something a little fancier, try this great little recipe!
    Vanilla Milk:
 
    - 2 cups 2% milk
    - 1 tablespoon agave nectar    - 1 teaspoon vanilla extract  
Place all ingredients together in a mug or pitcher and stir well. Then place the mug/ pitcher into the microwave to warm. Also it can make a nice frosty drink with a few ice cubes and a blender! 

Weighted Blanket- My weighted blanket really helps my tics calm down, especially for night time. The weight is helpful most nights, depending on my sensory needs that day. Some nights i'll really feel the need to have something heavy on me, other nights i'd rather not. I have to listen to my body that day and depending on how i'm feeling the weighted blanket can help A LOT! It calms my body down incredibly and helps me fall asleep faster. I ordered my blanket online though sensa calm, but you can also make them yourself them depending on your level of craftiness!

Where I got my weighted blanket: http://www.sensacalm.com 

DIY weighted blanket videos and articles:
https://www.youtube.com/watch?v=Qw_IzkB2Cz0
http://www.mamasmiles.com/sewing-tutorial-how-to-make-a-weighted-sensory-blanket/http://qualityplasticpellets.com/2013/01/04/a-warm-night-in-the-diy-guide-to-a-weighted-blanket/

Cold compress/ cold pack/ cold pillow pad- for me cold sensory input seems to help my tics, so cold compresses and a cold pillow pad I have both help. Here are some links to some items that are helpful if you find cold or warm compresses to soothe your tics as well.

Chillow - Memory foam cooling pillow pad, requires you to fill it with water, but i've had one before and it works well and is pretty inexpensive too. There are other products that are a bit more pricy but I think may work better to keep a cooler pillow.
Chilloh- Another brand of cooling pillow pad that's a bit more expensive but might work to keep the pillow colder than the chillow.
Therapearl - can be heated to be hot or hold and also can double as a tactile sensory toy! 

Changing the environment- 

For me, when i'm ticcing a lot it may be environment dependent. For example, I tend to tic a lot in classrooms, lectures, while sitting in an audience, when i'm in a quiet environment, a stressful environment, and also strangely enough while in the shower. So if i'm ticcing a lot, one of the first things I do is I assess the environment and ask myself, am I being triggered by something around me? Am I in an environment that would cause me to tic more? If so, and if I am able to, I try to change the environment.

For example, the other day I noticed that I started ticcing more and started to become uncomfortable because of this. I looked at the environment around me and realized that my tics may have been triggered because I was in a quieter and more enclosed environment. So I got up, walked outside in a more open and louder area, and my tics started to calm down. Later that day I was walking around a lot and started to get hot and tired, which started to make me tic more. I decided it was time for me to go inside and sit in the air conditioning which helped decrease my tics.

Also sometimes I start ticcing a lot, look around at my environment, and can't seem to find anything specifically that I can think of that would be triggering me. In this case, I get up and change the environment anyway because even though i'm not able to discern what seems to be making me tics worse, changing the environment will tend to help to some extent regardless, even if that means just getting up, walking around for a while, and then coming back.

Putting your body in a different position- 

This may just be unique to  me,  but something that helps me when i'm ticcing a lot is changing the position my body is in or putting my body in an "different" or "odd" position. So if my tics are bad while i'm laying in bed, if I put my pillow on the opposite side of the bed and lay backwards for a while this will help my tics. Or if I hang my head off of my bed so that i'm essentially upside down this will also help. Whatever I can do to get my body in a different position seems to help. I'm not sure why this helps but my best guess is that it gives my body different sensory cues and serves as a form of proprioceptive sensory input. I'm also not sure if it will work for anyone else, but it might be worth a try.

Also giving your body different sensory signals in general may be helpful! Some other ideas of giving your body different sensory signals than those when you're just sitting or standing are doing yoga, running, jogging, jumping rope, fast walking, swimming, playing a sport, dancing, swinging, yoyo-ing, or whatever other crazy (or not so crazy!) bodily activity you can think of to get your body active and engaged in movement!

Decreasing frustration/anxiety-

When i'm ticcing a lot, sometimes I get frustrated with myself and pretty anxious with the fact that i'm not able to control my body. Its pretty frustrating and anxiety provoking to not be able to stop yourself from doing something that's annoying, painful, and often times embarrassing. So sometimes with each tic i'm not able to control, I get more and more frustrated and anxious,  which in turn of corse makes me tic even more and it becomes a vicious cycle. I tic, I get frustrated and anxious, I tic more, I get even more frustrated and anxious, and then I tic much much more, and repeat. You can see how this might be a problem. 

Not many people know the emotional components that come with having TS. They see the tics, but what they don't see are the emotions that come with living in a body you can't always control. They don't see the anxiety, the embarrassment, and the frustration that comes with having Tourette's, but this side of TS is no less real and no less important to address than the tics themselves.

So whatever I can do to  decrease my frustration and stress level will help stop this vicious cycle and help to decrease my tics. This is another reason why distraction, focused activities, and calming sensory activities help to decrease tics. These activities help us take our mind off the frustration and anxiety that tics bring. Listening to music may also help.

Another thing that can help is talking to the rational side of your brain by using coping statements. I start out by telling the rational side of my brain "being frustrated and stressed will only make my tics worse"and giving myself self assuring and soothing statements such as "i'm just fine", "it's okay that i'm ticcing right now", and "this will soon pass, it always does". I give myself a little time to tell myself everything's okay, and then I move on to calming, focused, distracting activites to take my mind off the tics.

CBIT-

Cognitive Behavioral Intervention for Tics (CBIT) is a behavioral intervention for tics, it's non-pharmacitical, and is proven to be as affective or even in some cases more affective than mediation for tics. It doesn't work for everyone, and it's not a cure, but for some people it can significantly decrease the severity and frequency of tics. It worked very well for me, and I still use the strategies I learned in CBIT when I feel like I need to.

I still have tics of course, and I still have bad days, or bad weeks even, but overall my tics are less frequent and less severe than they were a year ago before I started CBIT. CBIT has worked better for me than any mediation has, and the best part is NO SIDE EFFECTS!

A lot of the behavioral interventions i've listed above are strategies I learned in CBIT. CBIT is not only about targeting tics with a competing response, but its also about learning how to manage your tics, finding strategies, and assessing your environment, your triggers, and finding various things you can alter in your environment to help your tics. The ideas of distraction/focused activities, changing the environment, and deceasing frustration and anxiety are all environmental components of CBIT that I have learned both on my own and with the help of my CBIT therapist. The competing response component of CBIT is important, but the environmental assessment is just as important as well!

You can read more about CBIT and watch videos on CBIT on the Tourette Syndrome association website here: http://www.tsa-usa.org/Medical/CBIT.html