Novel psychological formulation and treatment of “tic attacks” in Tourette syndrome
Open accessAbstract
One important, but underreported, phenomenon in Tourette syndrome (TS) is the occurrence of "tic attacks." These episodes have been described at conferences as sudden bouts of tics and/or functional tic-like movements, lasting from 15 min to several hours. They have also been described by patients in online TS communities. To date, there are no reports of tic attacks in the literature. The aim of this article is to stimulate discussion and inform clinical practices by describing the clinical presentation of 12 children (mean age 11 years and 3 months; SD = 2 years and 4 months) with TS and tic attacks, with a detailed case report for one case (13-year-old male). These children commonly present acutely to casualty departments and undergo unnecessary medical investigations. Interestingly, all children reported comorbid anxiety, with worries about the tics themselves and an increased internal focus of attention on tics once the attacks had started. In keeping with other children, the index case reported a strong internal focus of attention, with a relationship between physiological sensations/tic urges, worries about having tic attacks, and behavioral responses (e.g., body scanning, situational avoidance, and other responses). In our experience, the attacks reduce with psychological therapy, for example, the index case attended 13 sessions of therapy that included metacognitive and attention training techniques, as well as cognitive-behavioral strategies. Following treatment, an improvement was seen across a range of measures assessing tics, mood, anxiety, and quality of life. Thus, psychological techniques used to treat anxiety disorders are effective at supporting a reduction in tic attacks through modifying attention, worry processes, and negative beliefs. It is hypothesized that an attentional style of threat monitoring, difficulties tolerating internal sensory urges, cognitive misattributions, and maladaptive coping strategies contribute to the onset and maintenance of tic attacks. These cases provide support for the view that tic attacks are triggered and maintained by psychological factors, thereby challenging the view that tic attacks merely reflect extended bouts of tics. As such, we propose that the movements seen in tic attacks may resemble a combination of tics and functional neurological movements, with tic attacks reflecting episodes of panic and anxiety for individuals with TS.
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The role of stress and anxiety in precipitating and maintaining complex tic presentations has been previously reported.
“The role of stress and anxiety in precipitating and maintaining complex tic presentations has been previously reported (12, 20, 21).”
From Integrated cognitive behavioral intervention for functional tics (I-CBiT): case reports and treatment formulation (2023) · cites this paper as [21]
The Discussion says anxiety-related beliefs and sensations contribute to the onset and maintenance of tic attacks in children with Tourette syndrome. The paper does not separately establish a role for stress or extend this account to complex tic presentations generally. (LLM, conf=0.79)
Experimental — accuracy not yet measuredRobinson and Hedderly demonstrated the utility of managing co-occurring FND symptoms ('tic attacks') by modifying attention, worry processes, and negative beliefs related to symptom presentation using a novel cognitive behavioral therapy-based approach.
“In their case report, the authors demonstrated the utility of managing co-occurring FND symptoms (“tic attacks”) by modifying attention, worry processes, and negative beliefs related to symptom presentation using a novel cognitive behavioral therapy-based approach”
From Integrated cognitive behavioral intervention for functional tics (I-CBiT): case reports and treatment formulation (2023) · cites this paper as [21]
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- Authors
- Robinson, S., & Hedderly, T.
- Affiliations
- St Thomas' Hospital (GB)
- Corresponding author
- Robinson, Sally
- Hedderly, Tammy
- Venue
- Frontiers in Pediatrics
- Publisher
- Frontiers Media SA
- Published
- 2016-05-11
- Volume
- 4
- Pages
- 46-46
- ISSN
- 2296-2360 (ISSN-L)
- PMC
- PMC4862969
- OpenAlex
- W2409237931
- Cited by
- 53
- References
- 22
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 3 · 2023: 5 · 2022: 17 · 2021: 7 · 2020: 5 · 2019: 3 · 2018: 6 · 2016: 1
- FWCI
- 4.46
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Frontiers in Pediatrics (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Stuttering Research and Treatment
- Keywords
- Tourette syndrome, psychological formulation, metacognitive training, attention training, cognitive behavioral therapy, anxiety comorbidity, internal focus, panic, children
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