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Professional CBIT Training

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  • #16
    Re: Professional CBIT Training

    Is this something that is covered in CBIT training?

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    • #17
      Re: Professional CBIT Training

      Journey, I described your client's tic to my son. I said it involved blowing out through the nose, but not enough for mucous to come out. He could easily imagine such a tic. I asked for suggestions for what he and I call "substitute behaviors." He suggests blowing out through the mouth instead.

      If the tic originated from a physical sensation of discomfort relating to dry winter air or respiratory congestion, I would suggest using a saline spray in the nose twice a day, or more often if it's helpful.

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      • #18
        Re: Professional CBIT Training

        Originally posted by aparente001 View Post
        Is this something that is covered in CBIT training?
        Advocacy and negotiation for accommodations and special needs may not be directly part of CBIT training, although depending on circumstances and issues raised by the client, while discussing psychoeducation, I suppose if the therapist recognized the need for guidance in this regard, it might be discussed.

        Advocacy is most often discussed in peer to peer support, in local support encounters or in literature published by our advocacy organizations like Tourette Canada, Tourette Association of America, Tourettes Action etc.
        Steve

        Dum spiro spero....While I breathe, I hope

        Tourette Canada Homepage
        If you enjoy the TC Forum, please consider a Tourette Canada membership
        Please visit our sister Forum: Psychlinks Psychology and Mental Health Support Forum

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        • #19
          Re: Professional CBIT Training

          Hi Steve
          As usual I am so appreciative and amazed and your level of knowledge and compassion toward helping people.. Thank you.
          I do have the book you mentioned, and found your slide presentation extremely helpful. As I have pondered how to best serve my client's with tic disorders, and TDplus, I wonder how you view trauma as an impact on this entire process. Many of us with TDPlus will have a flashback or memory of a significant trauma event right before the tic. I tend to work from a interpersonal neurobiology perspective on this so I love the concept of your last paragraph

          The process of building or strengthening neural circuits by means of brain plasticity can be compared to people who have a stroke, a neurological event where some functionality is lost or impaired. As we know, not all people who have a stroke remain impaired the rest of their lives, because through therapy....like physical therapy and occupational therapy (forms of behavioural therapy) by repeating the same activity again and again, they can recover many of their lost or impaired functionality.
          How do you see trauma and complex trauma playing a role in TD? I have done some research and currently am researching as I work with clients, but so little is really known about how this is all linked. I find it exciting to work with clients and see them overcome battles, so I am hoping to move more in that direction with tics...finding a treatment plan that works for the individual. Look forward to any thoughts.

          And regarding your above reply I will be working harder to build my protocol for working with tics, especially being more mindful about all that was going on for the client, and using more of the science for this aspect of therapy.
          Thank You Steve
          Journey

          ---------- Post Merged at 05:17 PM ---------- Previous Post was at 05:16 PM ----------

          Hello Aparente001,
          Tell your son thanks, as his advice was the same as an LMFT so nice work young man!

          ---------- Post Merged at 05:42 PM ---------- Previous Post was at 05:17 PM ----------

          Advocacy is extremely important, and at times clients must first build their own self compassion and awareness prior to trying to educate others. Advocacy within the home and social networks come first, often with me helping educate partners, parents etc. And honestly, collaborating with the client to accept self and build strength. With my adult clients I tend to help them process safe vs unsafe societal situations, and for times when it does not make sense to explain the disorder my clients practice using CBIT and draw from a multisensory kit we create in therapy (well actually they always use these coping skills haha).. It is my belief that therapy is simply an experiment for life, so in sessions we experiment and practice using all senses and discover what is helpful to clients; I use expressive arts, music, various forms of mindfulness, and multisensory items. The client creates a kit that they keep in a purse or pack, and pull out when triggered…it might contain an essential oil, a fidget, gum, hard candy, a transitional item from my office or a partner (often a rock or similar item I have brought in), art materials, quotes etc.
          Most of my clients have associated disorders that impact TD, especially TDplus, so at times explaining it to a clerk in a store is not helpful, especially if the client is dissociated or extremely triggered, other times it makes total sense. Knowing the difference I am finding has been very helpful to my amazing clients. We celebrate every victory, and there are no small victories, they are all worth celebrating.
          For children I would advocate in all domains, school, extended family, church, sports, etc toward building awareness and paving the way for the child client to build his or her own skills and attend school and events without difficulty. Most schools are very open to education and happy to build their awareness toward diversity etc. Coaches are happy to chat about how to accommodate kiddos, for the most part it is generally about helping peers to build emotional intelligence about TD, and this is accomplished often quickly, then adults will follow along
          Last edited by Steve; January 15, 2017, 11:59 AM. Reason: format, BBc

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          • #20
            Re: Professional CBIT Training

            Thank you for your kind words, Journey!

            Originally posted by Journey
            How do you see trauma and complex trauma playing a role in TD?
            I'm afraid your question is beyond my understanding and knowledge. Perhaps others may have insights to offer.

            Are you asking about the possible effects of trauma in earlier life as a possible triggering factor for tic symptoms? PTSD as a tic trigger?
            Steve

            Dum spiro spero....While I breathe, I hope

            Tourette Canada Homepage
            If you enjoy the TC Forum, please consider a Tourette Canada membership
            Please visit our sister Forum: Psychlinks Psychology and Mental Health Support Forum

            Comment


            • #21
              Re: Professional CBIT Training

              I was more asking how to assist with tics that are triggered by trauma memories? Maybe it is similar to a mental tic?

              Comment


              • #22
                Re: Professional CBIT Training

                Originally posted by Journey View Post
                I was more asking how to assist with tics that are triggered by trauma memories? Maybe it is similar to a mental tic?
                According to to my understanding, Tourette tics are restricted to involuntary muscle movement, thought to originate in a dysfunctional CSTC circuit within the basal ganglia.

                Associated disorders like OCD and ADHD are thought to share similar origins within the brain The Johns Hopkins Psychiatry Newsletter | Tourette's, OCD, ADHD: Closer Together Than We Thought | Marco Grados MD

                So called mental tics might have more to do with compulsions and intrusive, looping thoughts and might better benefit with therapeutic strategies aimed at managing compulsive behavior.

                Looping thoughts may have a closer relationship to OCD symptoms that Tourette, but as we know, the relationship between Tourette, OCD and ADHD is closer than once thought as all three disorders are thought to occur in the same region of the brain.

                Looping thoughts may be triggered by a particular situation or event where the mind becomes stuck on a phrase, word, scenario that repeats like a broken record (if you are old enough to appreciate the broken record metaphor...

                Treatments might include cognitive behavior therapy to identify the trigger(s) and to learn strategies to abort or redirect that kind of thought process.

                Some Ideas to Help Stop Obsessing | World of Psychology

                Also:
                How to Eliminate Intrusive Thoughts

                While Tourette tics are neurological and involuntary, tics tend to be influenced by environmental factors, both internal and external.

                Examples of internal factors would include anxiety, fatigue, stress, excitement. External factors would include people, places or situations that tend to exacerbate tics in a predictable way. The environment does not cause tics, as Tourette tics are involuntary, but the environment can influence tics, both positively and negatively.

                There is no universal standard for what factors trigger tics for any given individual, so the therapist would interview and assess each individual's particular tic triggers in order to provide strategies to address those triggers. What might increase tics for one person with Tourette, may not affect another's tics, while the same factor may lessen yet another's tics. (Silva et al 1995)

                Strategies to manage internal factors would include such things as learning relaxation techniques, improvement of sleep hygiene, dietary modifications such as reduction in caffeine and sugars. External factors can be managed by mitigating those situations either by avoiding them, finding ways to lessen their influence through education, awareness etc, or learning ways to lessen their impact.

                These strategies can be learned with the assistance and counseling of a behavior therapist, especially one who is trained and experienced in treating Tourette Syndrome.
                Steve

                Dum spiro spero....While I breathe, I hope

                Tourette Canada Homepage
                If you enjoy the TC Forum, please consider a Tourette Canada membership
                Please visit our sister Forum: Psychlinks Psychology and Mental Health Support Forum

                Comment


                • #23
                  Re: Professional CBIT Training

                  Hi Journey, I just discovered that I misunderstood your original question:

                  Can you think of a competing response for a sniffing outward or snorting out tic? The adult client gets embarrassed as people constantly offer her a tissue, and the snorting out gets loud.
                  When I read that, I imagined your client was getting offered a tissue by the same people over an over again, and so I was imagining something like an office or other working environment. But then you wrote:

                  at times explaining it to a clerk in a store is not helpful
                  And now I understand better. If I imagine myself in your client's shoes, and it's a stranger offering the tissue, then a polite response might be to get out a tissue of my own from my pocket, dab it at my nose, and say something vague like, "I'm sorry, it's my fall/spring allergies" or "It's this dry winter air."

                  For your other question

                  how to assist with tics that are triggered by trauma memories? Maybe it is similar to a mental tic?
                  I would suggest that you look into Exposure and Response Prevention. The International OCD Foundation provides training to therapists in this treatment technique.

                  This technique can be used for intrusive thoughts.

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