A presentation by: Hiro Koo Psychologist & Licensed Clinical - - PowerPoint PPT Presentation

A presentation by:

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Hiro Koo Psychologist & Licensed Clinical Hypnotherapist Spectrum Of Life Integrative Wellness Centre

BSocSc(Hons) Psychology MSc Clinical Psychology Diploma in Clinical Hypnosis (Lond.) Certified Neurotherapist (Singapore)

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• Member of American Psychological

Association (APA) Division 30 - The Society of Psychological Hypnosis (Membership #: 59610305)

• Licensed Hypnotherapist (13-PM-041)
• f The Association of Hypnotherapy

Practitioners, Malaysia (AHPM) – Traditional and complementary medicine department – Ministry of Health Malaysia

• Committee Member of AHPM

(2016/2017)

• Full member (B288/14) of Malaysian

Psychological Association (PSIMA)

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Spectrum of Life (SOL) Integrative Wellness Centre

Practitioners include integrative medical doctor, child psychologist, neurotherapist, chinese physician, nutritional therapist, naturopath and physiotherapist. We offer non-pharmacological, natural and complementary medicine modalities for common health issues.

Goal of the day

• Introduction: What is Tic Disorder and

Tourette Syndrome

• Intervention: How to deal with it by using the

technique of EEG biofeedback and Neuro- hypnotherapy

• Case study

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Tic disorder?

Tic Disorder

Tourette Syndrome 2 motor tics and at least 1 vocal/phonic tics & more than 1 year Chronic Tic Disorder Either motor tics or vocal/phonic tics but more than 1 year Provisional Tic Disorder Either motor tics or vocal/phonic tics but less than 1 year

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Picture soucre: http://www.metrokids.com/MetroKids/May- 2015/Understanding-Tourettes-Syndrome/

Co-occuring condition

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(Start) 5- 7 years old (More severe) 8-12 years old

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The Causes?

Tic Disorder

Genetics

developmental

Other factors

Environmental

8 At present, no specific agent or event has been identified

Intervention: EEG Biofeedback

• Pharmaceutical intervention: Neurochemical
• r brain structure components
• EEG biofeedback intervention: Electrical

components in the brain

• Regulate the part of the brain which is related

to motor movement regulation

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Intervention for Tic

P/S: There is no cure but symptom management

• Psychotherapy
• Deep brain

stimulation

• EEG

biofeedback

• ADHD or

antiseizure medication etc Neurochemical component Electrical component Other Brain structure component

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EEG Biofeedback Intervention (Central Sulcus)

• Certain abnormalities within the brain which related to motor

movement regulation (Bronfeld M & Bar-Gad I., 2013)

• Primary motor area controls the voluntary movements of

skeletal muscles and fine motor movements, including the lips, mouth, hands, and face.

• Issuing motor plans for movement that is generated

subconsciously

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EEG Biofeedback (Frontal Lobe)

• The area which responsible for the initiation and

construction plan for primary cortex motor movement.

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EEG Biofeedback (SMR brainwaves)

• The Sensorimotor Rhythm (SMR; 12–15 Hz) is linked with

brain and body functions. It is known to increase when motor movement is inhibited.

• Motor movement or mental imagery related to motor task

can cause SMR brainwaves to change as well (Shanbao Tong & Nitish Vyomesh Thakor, 2009).

• SMR brainwave is commonly measured and trained above the

central sulcus related area. EEG biofeedback training on the central sulcus appears promising for Tic Disorder because training on this part of the brain has been related to motor movement regulation.

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EEG Biofeedback (Theta brainwave)

• Research study has found excess theta wave activity in the TS

patient's frontal lobes (Messerotti Benvenuti S, Buodo G, Leone V & Palomba D., 2011).

• Interestingly, excess theta wave activity in the brain’s frontal

lobe is also a common feature of ADHD patient.

• Inhibit theta brainwaves on the frontal lobes to alleviate the

symptoms of the Tic Disorder.

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Intervention: Neuro-hypnotherapy

Neuro-Hypnotherapy

Clinical Hypnotherapy Neuro- therapy/EEG biofeedback Psychotherapy

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Psychoeducation Functional intervention

• Triggers

Habit reversal therapy (HRT)

• premonitory urge

Hypno-desensitization

• - An intentional

movement to replace urge Cognitive behavioral Hypnotherapy

• Comorbid symtoms

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Patient A

• Gender: Male
• Age: 25
• Diagnosis: Chronic Motor Tic Disorder

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EEG biofeedback session

Month Session Treatment Protocol February Session 1 – Session 3 C3-C4 SMR, T4 SMR, P4 SMR March Session 4 – Session 6 April Session 7 – Session 10 Total sessions 10 *** T4 & P4 SMR is done by using simultaneous protocol, the reason of doing this is: Tics triggered by anxious feeling or

performance related anxiety.

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Findings

Presenting Problem Outcome  Throwing the head back as if to get hair out of the eyes in public area (involuntary and rapid head jerk).  Touching the chest with his jaw in public area (involuntary).  Moving his ear purposeless  Poor concentration  Able to control his head jerks/movements. No more throwing his head back or touching his chest with his jaw in public area.  His motor tics reduce significantly according to his friends, family members, and himself. Now motor tics will only happen in his bedroom before he sleeps.  Better concentration 19

Patient B

• Gender: Male
• Age: 14
• Diagnosis: Tourette Syndrome
• Co-occuring: Obsessive Compulsive Behavior

according to caregiver.

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EEG biofeedback and Neuro- hypnotherapy session

Month Session Treatment Protocol November Session 1 – Session 3 C3 SMR, C4 SMR, Fz Delta, Neuro-hypnotherapy December Session 4 – Session 8 January February Session 9 – Session 10 Session 11 – Session 13 March Session 14 – Session 15 April Session 16 – Session 20 Total sessions 20 *** Neuro-hypnotherapy was conducted for 6 sessions in total. Fz Delta to deal with his Obsessive Compulsive Behaviour. 21

Findings

Presenting Problem Outcome  Eye blinking  Looking to one side for a brief period of time as if he heard noise  Nose twitching  Throwing the head back  Shrugging the shoulder  Shaking his legs  Tensing his buttocks  Obscene hand gestures  Vocal tic symptoms include coughing, throat clearing, animal or barking noises, rude or obscene words, repeating what someone else said, and sudden changes in pitch.  When his phonic/vocal tics became worst, tics were presented virtually all the time. Tic-free intervals were difficult to identify and did not last longer than 5-10 minutes. Basically, his phonic/vocal tics frequently disrupted what he was trying to do or say.  No more looking to one side motor tic symptom  No more nose twitching  No more throwing the head back  No more shrugging the shoulder  No more shaking his legs  No more tensing his buttocks  His vocal tics reduced significantly according to his teacher, principal, friends, family members, and

• himself. Now vocal tics happened occasionally when

he was watching an exciting movie.  His phonic/vocal tics only became worse occasionally. Tic-free intervals as long as 3 hours were not uncommon now. Basically, his phonic/vocal tics only

• ccasionally interrupted what he was trying to do or

say nowadays. 22

Patient C

• Gender: Male
• Age: 16
• Symptoms: Vocal Tic Disorder

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EEG biofeedback session

Month Session Treatment Protocol February Session 1 – Session 3 C3 SMR, C4 SMR, F3 SMR, F4 SMR. March Session 4 – Session 6 April Session 7 – Session 10 Total sessions 10 24

Findings

Presenting Problem Outcome High pitched hiccup and speech problem such as sudden changes in volume or pitch. High pitched hiccup sound occurred frequently whenever he was focusing on task.  His caregiver found that his high pitched hiccup sound reduced about 50-80% after 10 sessions.  High pitched hiccup sound only occurred occasionally nowadays.  Better concentration 25

Patient D

• Gender: Male
• Age: 11
• Diagnosis: Tourette Syndrome
• Co-occuring: ADHD

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EEG biofeedback session

Month Session Treatment Protocol January Session 1 C3 SMR, F3 Hibeta, C4-T4 SMR February Session 2 – Session 6 March April Session 7 – Session 9 Session 10 – Session 12 May Session 13 – Session 15 June Session 16 – Session 18 Total sessions 18 C4-T4 to deal with his ADHD symptoms 27

Findings

Presenting Problem Outcome  Negative thinking such as suicidal thoughts  Motor tics include eye blinking, holding funny expressions, nose twitching, touching the shoulder with the chin or lifting the chin up, throwing his head back, quickly flexing the arms or extending them, and touching objects for no purpose  Vocal tic symptoms include coughing, throat clearing, rude or obscene words, and sudden changes in pitch  Stop schooling  ADHD symptoms such as difficulty in focusing and hyperactivity  Positive mood and became happier  All vocal tic symptoms nearly diminished

• r
• disappeared. His vocal tics reduced significantly

according to his teacher, principal, friends, family members, and himself.  His motor tics was still noticeable but seldom interrupted what he was trying to do or say nowadays.  Back to school and his teachers were impressed by his change  Focus and attention span had improved according to caregiver. 28

Conclusion

EEG biofeedback and Neuro-hypnotherapy could be a promising new treatment option for Tics disoder and Tourette Syndrome. More Clinical Trials and Studies are needed.