Therapy for Tourettes & ADHD

I offer CBT to adults with neurobehavioural conditions like Tourette Syndrome, Tic Disorder or ADHD. I have specialist training and experience in both these conditions as I previously worked in an NHS neurodevelopmental service. I have received supervision and training from Prof Doug Woods (University of Wisconsin-Milwaukee) and Dr Tara Murphy (Great Ormond Street Hospital) international leaders in the field of Tourettes. Doug has written one of the most important CBT manuals currently used in this field 'Managing Tourette Syndrome: a behavioural intervention for children and adults'

Tara has written a really useful book about TS in general. It looks at the biology, medication issues as well as psychological therapies for the disorder 'Tic disorders: a guide for parents and professionals' 

A great book for children and young people is Nix Your Tics by Dr Duncan Mckinlay. Unfortunately, you cannot buy a hard copy at the moment and only a KIndle version is available.

In the area of ADHD I have been trained by Dr Susan Young, the author of the book 'Cognitive-Behavioural Therapy for ADHD in Adolescents and Adults: a Psychological Guide to Practice'.

What does therapy for Tourette Syndrome look like?

I deliver an evidence-based form of behaviour therapy called Comprehensive Behavioral Intervention for Tourettes Syndrome (CBITS). This was developed by Prof Doug Woods, an American clinical psychologist who has completed several scientific trials demonstrating its effectiveness.  Typically you would have two assessment sessions where I would ask you about your tics and give you some questionnaires to fill out. In these sessions we would get to know one another and I would identify what your main tics are, and how they impact on your everyday life.

The therapy phase comprises typically 8 sessions where we tackle your tics one by one. The aim is to help you manage the tics so you are more in control of them and less distressed.

1. First of all we would do what is called a 'functional assessment'. This analyses if there is anything in your environment or social context which makes the tics worse. We would then seek to modify those triggers with a 'function-based intervention'. We make a list of all the most bothersome tics in a hierarchy, with the most distressing at the top.
2. Next I would teach you a strategy called 'Habit Reversal Therapy'. Here you learn to identify when a tic is about to happen by tuning into your body and spotting the 'premonitory urge'. This 'tic awareness' training then leads to actually learning how to tolerate the urge and control the tic. I will teach you a 'tic blocker', or 'competing response'. This is a replacement behaviour you can do until the urge reduces and does not bother you anymore. This tic blocker has to be something you can do which is socially acceptable and easy to do anywhere.
3. We then apply the competing response to each tic on your hierarchy.
4. Along the way I will teach you relaxation strategies, as stress can sometimes make tics worse.

After the 8 weekly treatment sessions you should feel confident in dealing with your tics. I offer three 'booster' sessions once a month to make sure you are able to fully implement the strategies on your own.

There are some fantastic videos where you can see behavioural therapy in action. Tara Murphy has done one for Tourettes Action here - look at the one called 'Rupert shares his experience of CBIT therapy with Tourettes Action'  TS Behavioural therapy video with Tara. This video addresses some of the misconceptions about CBiTs.

Sometimes if the person has several tics and finds the CBIT therapy too complicated, another form of therapy called Exposure and Response Prevention is helpful. However, this is a more recent form of therapy and dose not have quite as much evidence to support it yet. Nonetheless, children and young people especially sometimes find it more straightforward and effective for them.