Self-Hypnosis Shows Promise for Tourette Patients
Medpage Today
July 13, 2010

Note that the findings are based on self-reported improvement in only a small group of patients.

About 80% of patients with Tourette syndrome had improved tic control after 10 weeks of video-assisted training in self-hypnosis, results of a small clinical trial showed.

Almost half of the responders achieved tic control after two sessions, and only one required more than three sessions to attain control, according to a report in the July issue of the Journal of Developmental and Behavioral Pediatrics.

"This reinforces [previously reported] observations of at least a short-term decrease in tics following practice of self-hypnosis in four sessions or less," Jeffrey Lazarus, MD, and Susan K. Klein, MD, PhD, of Case Western Reserve University and University Hospitals in Cleveland, wrote.

"Our series suggests that self-hypnosis might be able to be taught effectively in fewer sessions than habit reversal," they continued, noting that whether it will be more cost-effective is still an open question.

Self-hypnosis has been used infrequently in the treatment of tic disorders, the authors noted. All told, about a dozen case series have been reported, most of which were based on retrospective analyses, had limited observation, and used imprecise methods to assess the impact on tics.

The largest case series published to date involved just four patients and was published more than 20 years ago (Am J Clin Hypn 1987; 29: 227-237).

In an effort to add to the clinical data, Lazarus and Klein did a pilot study to evaluate the effectiveness of self-hypnosis for treating tics in patients with Tourette syndrome and to examine the use of video training on the effectiveness of self-hypnosis.

They evaluated a sample of children and adolescents referred during 2000 through 2007 for instruction in self-hypnosis for treatment of tic disorders. The sample consisted of 33 patients -- 27 of them boys -- whose age averaged 13 and whose mean duration of tic disorders averaged 6.4 years.

All of the patients had motor tics, and three also had vocal tics.

The self-hypnosis protocol consisted of relaxation mental imagery techniques, augmented by suggestion tailored to each patient.

The study participants also had homework assignments consisting of questions designed to increase awareness about tics and the patient's feelings and emotions about their own tics.

Each patient completed two 90-minute sessions. During the second session, study participants viewed a video that illustrated a patient before, during, and after self-hypnosis training. After viewing the video, patients received their initial training in self-hypnosis technique.

Additional 60-minute training sessions were scheduled on an as-needed basis. Patients were instructed to perform self-hypnosis exercises three times a day at home.

Participants monitored tic activity by means of a self-maintained calendar. Clinical response was defined as a self-reported decrease in tic activity associated with the introduction of self-hypnosis.

The authors did not use any standardized measures of tic frequency or severity to assess the outcome.

After 10 weeks of treatment and follow-up, 79% (26) of the patients met the subjective criteria for response. The authors reported that 12 of the 26 responders met response criteria after the second training session, and 25 of 26 responded after three sessions.

The 26 responders included 12 children younger than 10. One patient achieved tic control and returned nine months later after re-emergence of a new tic. The patient achieved control of the new tic after a "booster" training session.

"Our data suggest that videotape training made self-hypnosis more accessible to younger children," the authors concluded.

"Viewing a series of videotapes of a patient before, during, and after treatment gives patients the reassurance that they are not the only ones in the world with this problem," they added. "Furthermore, it gives them the hope and the motivation that if this child can take control over his body and life challenges, then they can, as well."