Tics are sudden, repetitive, non-rhythmic motor movements or vocalizations that can be disruptive and stressful for adults, especially when co-occurring with conditions like Obsessive-Compulsive Disorder (OCD). Tics are often preceded by a noticeable physical sensation. Although tics and OCD compulsions are distinct, they frequently co-occur, sometimes affecting up to 60% of people with tic disorders such as Tourette Syndrome. Managing tics in adulthood requires a structured approach to suppress these unwanted behaviors and improve quality of life. This typically involves specialized behavioral therapies, targeted medications, and lifestyle adjustments.
Differentiating Tics from Compulsions
Tics and compulsions are both repetitive behaviors, but their underlying drivers are fundamentally different. A tic is a response to a premonitory urge—a physical sensation like tension or pressure that builds until the tic is performed, offering temporary relief from sensory discomfort. This urge-driven behavior is not connected to a cognitive fear. In contrast, an OCD compulsion is a ritualistic behavior or mental act performed to reduce anxiety or prevent a feared outcome associated with an obsession. The compulsion is goal-oriented; the person feels they must perform the action precisely to neutralize distress. This distinction is important for determining the most effective treatment approach: a tic relieves a physical sensation, while a compulsion relieves cognitive anxiety.
Targeted Behavioral Therapy
Behavioral therapy is considered a first-line treatment for managing tics, utilizing two highly effective, evidence-based approaches: Habit Reversal Training (HRT) and the Comprehensive Behavioral Intervention for Tics (CBIT). Both therapies are structured and focus on teaching the individual skills to gain control over the involuntary movements or vocalizations. They are based on the principle that tics are learned habits that can be modified and redirected.
The first step in these therapies is awareness training, where the individual learns to identify the specific premonitory urge that precedes the tic. The person works with a therapist to recognize the subtle physical sensations and environmental cues that signal an impending tic. This heightened self-awareness is a foundation for intervention, as it creates a small window of opportunity before the tic is fully expressed.
Following awareness, the individual is taught competing response training. A competing response is a voluntary movement or posture that is physically incompatible with the tic and is performed immediately upon experiencing the premonitory urge. For instance, if the tic is a neck jerk, the competing response might be an isometric tensing of the neck muscles or a gentle stretch in the opposite direction, held for about a minute until the urge subsides. This response is designed to block the tic while also being less noticeable or disruptive than the tic itself.
CBIT expands upon HRT by incorporating a function-based environmental intervention and relaxation training. The environmental intervention involves identifying and modifying situations that worsen tics, such as specific activities or social settings. This broader approach helps manage the overall context in which tics occur, contributing to a more sustained reduction in tic severity.
Medications for Tic Suppression
When behavioral therapy alone does not provide sufficient relief, or when tics significantly impair daily functioning, pharmacological intervention may be recommended, often in conjunction with therapy. Medications work by modulating neurotransmitters in the brain, particularly dopamine, which plays a role in movement control and the neurological mechanisms underlying tics. The choice of medication is tailored to the individual, considering tic severity and the presence of co-occurring conditions like Attention-Deficit/Hyperactivity Disorder (ADHD) or OCD.
Alpha-adrenergic agonists, such as clonidine and guanfacine, are often considered a first-line option for tic suppression. These can be beneficial if the person also experiences symptoms of ADHD, as they help manage both conditions. Side effects, such as sedation or sleepiness, are monitored carefully.
Another category of medication employed is atypical antipsychotics, also known as anti-dopaminergic medications because they block dopamine receptors in the brain. These are typically reserved for more severe or complex tics. Examples include risperidone and aripiprazole, which are effective in reducing tic severity. Their use requires weighing benefits against potential side effects, which can include weight gain or metabolic changes.
Lifestyle Management and Trigger Avoidance
Daily lifestyle choices and the management of environmental factors provide supportive benefits for reducing tic frequency and intensity. Tics are highly sensitive to internal and external stressors, making stress and anxiety common exacerbating factors. Prioritizing consistent, high-quality sleep is an effective management strategy, as fatigue is a known trigger that can increase the severity and frequency of tics. Integrating structured relaxation practices, such as mindfulness, deep breathing exercises, or gentle yoga, can help calm the nervous system and mitigate the build-up of tension that often precedes a tic. Identifying personal triggers, which may include specific environments, high-sugar foods, or periods of intense concentration, allows for proactive avoidance or mitigation. These supportive measures are valuable tools for maintaining stability and complementing clinical treatment.