ROLE OF NEURO-HYPNOTHERAPY IN HELPING PEOPLE WITH TIC DISORDER - By Hiro Koo

ROLE OF NEURO-HYPNOTHERAPY IN HELPING PEOPLE WITH TIC DISORDER

Neuro-hypnotherapy is practiced by licensed clinical hypnotherapist who has been trained in the area of EEG biofeedback technique. Neuro-hypnotherapy is first of its kind in Malaysia developed by Hiro Koo. It is based on the concept of clinical hypnotherapy which can be classified as psychotherapy as well. It is well known to deal with the subconscious mind directly and is commonly used to deal with symptoms of various problems such as habit breaking, smoking cessation, 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 hypno-behavioural methods such as hypno-desensitization and habit reversal therapy. Cognitive behavioural hypnotherapy (CBH) can also 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.  The first step of the neuro-hypnotherapy is psychoeducation. During this initial step, the possible causes of tic disorder will be elaborated by the clinical hypnotherapist. Patients will be guided on ways to communicate with the school or co-workers effectively to prevent conflict and misunderstanding, while their caregivers will be educated on ways to provide appropriate amount of support. Furthermore, although habit reversal is an effective intervention for tic disorder, individuals should be informed that tic disorder is not just a bad habit but neurological disorder. Thus, it cannot be solved based on positive or negative reinforcement alone, let alone the possibility that reinforcement in either positive or negative manner may worsen the symptoms. It is very important to neutralize the self-defeating belief, while empowering the patient and setting realistic expectations.

The following sessions 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 ways.

According to the systematic review done by Dutta and colleague (2013), HRT can significantly reduce tic severity for patient with tic disorder. During the neuro-hypnotherapy session, the hypnotized patient will observe all of their tics in detail such as how it feels in the particular muscle group and where it feels 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. Hypno-desensitization focuses on helping patient getting used to the premonitory urge, so that the patient doesn’t 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 becomes more aware of the premonitory urge, competing response will be discussed and implemented. During the neuro-hypnotherapy session, an intentional movement that can prevent tic from happening 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 to become worse when triggered by stress. Progressive hypnotherapy relaxation technique which requires patient to progressively tensing and then relaxing the different muscle groups is taught in a self hypnosis format. This is a very helpful method to reduce the arousal level in the brain and empower the patient with positive coping strategy. Patient was taught to utilize this 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 allows 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 individuals see exactly what is going on in their brain as they think of certain thoughts, feel stressed, or relaxed. After the self hypnosis session, patient commonly will learn how to self regulate their brain activity naturally, without pharmaceutical medications.

Retrieved from the Integrative treatment for tics and tourette syndrome in Malaysia (Author: Hiro Koo).

References

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, 60(2), 175-205. 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, B. S., Buodo, G., Leone, V., & Palomba, D. (2011). Neurofeedback training for

Tourette Syndrome: An uncontrolled single case study. Applied Psychophysiology and Biofeedback, 36(4), 281-288. doi: 10.1007/s10484-011-9169-7

Abbot, N. C., Stead, L. F., & Barnes, J. (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, J. C., & Chang, S. W. (2006). Behavioral treatments for tic suppression: Habit

reversal training. Advances in Neurology, 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

Integrative treatment for tics and tourette syndrome in Malaysia - By Hiro Koo

INTRODUCTION

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

When it comes to neurological or mental disorders, 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, this can be certified as brain death by a qualified neurologist or physician. Thus, brainwaves intervention such as EEG biofeedback training should be included as one of the treatment plans while dealing with issues related to our brain and mind. In fact, EEG biofeedback is not something new as it has more than 50 years of established scientific studies. It is proven to be helpful in cases such as Attention Deficit Hyperactivity Disorder (ADHD), Obsessive Compulsive Disorder (OCD), anxiety, insomnia, depression, and tics and Tourette Syndrome. EEG biofeedback for tic disorder is worth investigating as it directly deals with the brain. 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 brain includes the component of electrical, brain structure and neurochemical. EEG biofeedback alone might not be sufficient to get rid of 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 the 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 involves the use of words and suggestions to achieve therapeutic outcome, while the clinical hypnotherapy is a technique which utilizes 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 (Abbot NC, Stead LF, White AR, Barnes J, Ernst E., 2008). Clinical hypnotherapy is considered as the 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, which has been found to alleviate motor and vocal tics (Piacentini & Chang, 2006). Once patients learn the self-hypnosis technique, they learn to deal with their stressors and healthier ways 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 which may or may not be recognizable or it could be socially unacceptable words. Tic disorder can be differentiated 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, behavior problems, anxiety, mood issues, social skills deficits, or sleep related problems.

Author: Hiro Koo

References

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, 60(2), 175-205. 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, B. S., Buodo, G., Leone, V., & Palomba, D. (2011). Neurofeedback training for

Tourette Syndrome: An uncontrolled single case study. Applied Psychophysiology and Biofeedback, 36(4), 281-288. doi: 10.1007/s10484-011-9169-7

Abbot, N. C., Stead, L. F., & Barnes, J. (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, J. C., & Chang, S. W. (2006). Behavioral treatments for tic suppression: Habit

reversal training. Advances in Neurology, 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

Tourette syndrome therapy malaysia - H Case

“Stress has made my son’s tics worst. My son is diagnosed with Tourette syndrome and his condition turned distressing when he was 15 years old, the year when he would sit for his PMR examination. Hamzah’s tics are very obvious, believed to be caused by the stress he received from the important exam and it had caused an impact to his academic performance. He could not control his tics as it affected his writing and concentration. Even though he was given extra time in exam, it was still very difficult for him to complete it due to his uncontrollable movement and his low concentration level. Not only that, his daily-struggle includes dealing with the jokes and sarcastic statements made by his school mates.”

“It was suffering to see him going through all these difficulties. I started to seek for all kinds of treatments for Tourette syndrome. But it is disappointing that there are not much treatments for Tourette syndrome in Malaysia. H is taking medications prescribed by hospital though it helps him to relax a bit, I would still want to look for a better solution for him. Then, I found here. I’d read through the testimonials regarding the Brain Trainer therapy in the website and the outcomes of the therapy gave me confidence to bring H here.”

“I’d been introduced to Brain Trainer, the EEG-Biofeedback treatment which can help to relieve H’s condition. According to the professional neurotherapist here, they recommended H to first take up a 20-session therapy and I decided to give it a shot. I am totally impressed by the result of the treatment as on the 15th session of the therapy, H starts to show positive feedbacks on his tics control. And his condition is remarkably improved after completing the 20th sessions of Brain Trainer.”

“H is now becoming calmer, being able to control his movement and becoming more confident. He is more sociable now and he managed to proceed to his tertiary studies on culinary art. His teacher and friends are very surprised of his improvement. Most importantly, I can see him living happier and more healthily now.”

By H'S MOTHER

Remark: Our client's information will be kept strictly confidential all the time. All reviews and photos have been acknowledged and provided by past and current clients of Spectrum of Life proactive healthcare centre (Clinical Hypnotherapist Hiro Koo). Clients names have been changed to protect their identity.