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Extra info for Disordered Media
Anytime the competing response is done, it should be held for at least 1 min or until the premonitory urge fades away—whichever is longer. In this manual, the CR is implemented in three phases: 1. Selecting a CR 2. Demonstrating the CR and its correct implementation 3. Practicing the correct implementation of the CR Selecting the Competing Response CR training is done to teach the patient to engage in another behavior (called the competing response, or CR) for 1 min or until the urge to tic goes away (whichever is longer), contingent on the occurrence of the tic or a signal to tic.
Bedtime Tics 32 1. Establish a speciﬁc bedtime routine that is adhered to regularly. 2. , turn off TV and have homework completed). 3. Have the child engage in relaxation practice 15 min before bed. In-Car Tics 1. , middle of the back seat). 2. Remind the child that the car is a good place to practice her CR exercises. 3. Car trips should be scheduled during times of day when tics are less likely to happen. Consequence Interventions If Social Attention Is Endorsed 1. Parents/siblings/teachers/peers/coaches should no longer tell the child to stop the target tic.
The CR should be socially inconspicuous (or at least, less conspicuous than the tic) and easily compatible with normal ongoing activities. 4. Feedback from the patient as to what CR would work the best is crucial. Work with the patient in a collaborative fashion to select the CR. Using these guidelines, it is clear that various CRs exist for the different topographies of tics. 1 lists common CRs for use with different motor tics. , hair twirl, head rubbing) Flicking toes, curling toes Head nodding, head jerking Jaw clicking or thrusting Knuckle cracking Leg lift or ankle twist Leg tensing Licking Lips Mouth opening Neck roll Nose twitching Nostril ﬂaring Picking lips Shaking head side-to-side Shaking head up and down Shoulder popping or shrugging Spitting Tensing arm or ﬂailing arm Tongue clicking Wrist twisting 46 Cross arms Press all toes ﬂat on ground Tense neck muscles gently, ﬁxate eyes Straighten and tense neck while lowering and tensing shoulders Let jaw hang loosely while doing relaxed breathing, holding breath for 2–3 s prior to exhale Close mouth and tense jaw Cross arms Fold hands Push heels into ﬂoor Hold knees together tightly Tense buttocks Clench jaw softly, pressure lips together Purse lips, push teeth together, and push tongue up to roof of mouth Tense neck muscles with chin down slightly Breathe in and out through mouth while tensing nose and eyebrows Purse lips and tense nose Clench jaw and pressure lips together Place hands on leg, squeezing if needed Tense neck in place, push chin toward chest and deep breathe Hold chin down to chest and deep breathe Tense neck muscles Push hand down on thigh and push elbow toward hip Tense shoulders in downward position, keep arms at sides Purse lips and use diaphragmatic breathing Interlock ﬁngers, push shoulders down, and push arms into side If standing up, push arms into side and push shoulders down Push tongue to roof of mouth, close mouth, and breathe Hand on leg, squeeze leg if needed For vocal tics, a “controlled” breathing CR should be implemented.