Written by Mary M. Moebius, MD, FAPA
Diplomat of the American Board of Psychiatry and Neurology in General and Child Psychiatry, Assistant Clinical Professor, UCLA Semel NPI, private practice Tarzana, California

Fleeting motor tics are quite common in childhood and may not even be noticed as such. However, a passing tic can be quite distressing, usually for parents more so than for the child. The range I have seen has been from what I call the “ticky picky” behaviors to cartwheels, vomiting tics, and one I’ll never forget,”Dr. Mary Dr.Mary Dr. Mary”!

Contrary to popular belief, most tics are not Tourettes Syndrome (TS). TS require a minimum of 6 months of both a motor tic and a vocal tic. The classical swearing vocalizations are rare though TS is often portrayed this way in the media.

Here are some “tic tips” I’d like to share from years of working with children, teens, and an occasional adult, with tics.

In the olden days, we thought medications that treated Attention Deficit Disorder (ADD) caused tics to develop. It turns out that tics are especially common in children with ADD and even more so in boys with the diagnosis. Because the brain has to develop to certain points before certain symptoms can present, the symptoms of ADD usually present in kids under the age of 7 while tics present around the age of 9, by which time many are already being giving medications for the ADD. If a child with ADD is not treated with medications, tics still may present. Lo and behold, the meds were not the culprit after all.

Now that that has been said, I do see tics seem to present, worsen, improve, and even disappear in individuals who receive ADD medications. Some present only to disappear about two months after starting medication. Tic “seasons” are recognized with theories as to why they occur so consistently. In the beginning of my private practice in 1991, I began to notice tics presenting at the end of November around Thanksgiving, with improvement by the end of January. Was it that a child’s schedule was defined by change from this holiday on to the next with holiday performances, celebrations, and fluctuations in school schedules?

As the years went on, it seemed that tics also came around May then left by the 4th of July or soon thereafter. Then another brief blip would present in September.

Some symptoms of manic depression and depression worsen in May and September (peak suicide seasons, contrary to popular lore that the holidays are). Neuroimmunology studies associate the almost world wide tree bloom with an abundance of pollen as the culprit of over stressing the immune system and tipping the depression “centers” over the edge. Almost certainly allergens provoke an immunological tic response. This is more clearly known in PANDAS which stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Strep where a child has a sudden on set of tics (or obsessive compulsive symptoms) around a bout of strep throat. The body’s immune system (that is fighting the germs) begins to fight itself and in this case sets off the movement centers of the brain. My experience is that any illness may bring out or worsen tics in the right person. Some of my families are able to tell when a child is becoming sick because the tics begin as a warning!

Another pearl about tics is that something frequently begets a tic. For example, the Santa Ana winds rise up, drying the air (releasing pollen too), lips become chapped and if one has the tic “seed” in the brain, lip licking ensues and “Clown Lips” appear from the repetitive tic lip licking (say that 3 times fast!). A throat clearing tic frequently starts after a cold or hay fever reaction as do eye blinking, sniffing, and coughing. Dr. Cesar Chavarria, a local pediatric pulmonologist, sees quite a few cough tics seasonally that are in a cycle as the cough irritates the breathing tubes which causes more coughing which irritates...

Tics also have a daytime rhythm. Usually when a child is well rested in the morning, then tics are quieter. The tics may be more under the person’s control during the day, at school, with others present, and while occupied. By the time the child gets home, is tired, and with the parent the tics may become so pronounced that the parent frets (understandably so) then stresses the child by scolding or highlighting the tic so that it worsens, becoming a family issue of contention.

What’s a parent to do?

First, relax. Take a few deep breaths, after all, how many adults have noticeable tics? With time, the cycles abate and your child will likely outgrow this. As family anxiety can heighten tics, lowering it can decrease the intensity. Both “good” stress and “bad” stress may exacerbate tics. Minimize the “bad” and roll with the good.

Treat hay fever with the guidance of your pediatrician, allergist, or ENT.

If your child’s tics began or worsen during or after a streptococcal infection, tell your doctor so you can have labs done, and begin appropriate antibiotic treatment if P.A.N.D.A.S. is present. (Pediatric Autoimmune Disorders Associated with Strep)

Prevent chapped lips, cuticles, scabs, dry eyes, prolonged coughs before a cycle of licking, picking, blinking, and coughing begins. Sunglasses help eye blinking. Hypnotherapy is my favorite active treatment when the above mentioned steps are not effective enough or the social stigma becomes a problem. Children and teens tend to be able to learn the self-hypnosis techniques taught to them by the hypnotherapists quite easily. Many times, a patient of mine will stop ticking the first time they are in a hypnotic state! Hypnosis is a “tool” one may use for life. Please be reassured that people don’t really do bizarre things under hypnosis when in with a trained professional.

Cognitive Behavior Therapy has also been shown to be effective. This is another “tool” one can take with them where ever they go, for life. Both hypnosis and CBT manage accompanying anxiety.

In only the most severe situations, do I recommend medications for the management of tics because the side effects and potential risks may outweigh the benefits? With that said, under supervision, these may be minimized and allow the opportunity for the less aggressive treatments to “kick in” when used together.

Clonidine and Tenex may be the first medication your doctor would use. Usually given in pill form, it may be taken once at night or up to three times a day, starting at low doses, increasing based on effects. Sometimes a child may feel sleepy at first but that usually goes away. Originally used to control high blood pressure, these medications were found to help the hyperactive component of ADHD as well as insomnia in medicated and non-medicated people with ADHD. An EKG may be done before starting these medications and about 6 weeks in to treatment. Monitoring for depression and weight gain is important too.

Catapress is the patch form of Clonidine.

Medications called Neuroleptics have been used for quite awhile to treat tics especially of the Tourettes Syndrome nature. Because of sedation, they frequently are given at night. Weight gain, Metabolic Syndrome (having labs such as fasting blood sugar, cholesterol, other lipids), abnormal body movements (not the tic itself) must be monitored closely. Other potential side effects should be explained by your doc. If a tic has a more obsessive compulsive quality to it a Selective Serotonin Reuptake Inhibitor may be tried. It’s almost hard to explain how to differentiate between some OCD behaviors and tics. It becomes a "gut" feeling so I recommend having a detailed discussion with your pediatric psychiatrist, neurologist or pediatrician.

Some nicotine and nicotine-like agents have been used but I have not felt comfortable trying them for fear of it becoming a “gateway” to cigarettes. However, if it works for your child, it may be worth trying it with a doctor experienced in its use.

I hope this article will help children, parents, siblings, and grandparents have a little more understanding as how best to ride the storm of the ever-changing weather pattern of tics.

You can achieve your full potential by using both your body and your mind. You might have noticed when two athletes have comparable body types and abilities and one excels at kicking a ball past the goal with amazing precision or swim faster, always defeating their competition. Have you ever noticed how a seemingly average athlete can exceed his or her potential while the athlete with more ability never reaches their goal? It is true that physical training is essential but consider how important mental training is as well. You can improve your performance, not by increasing your workouts or resorting to drugs. The most powerful tool you have is the grey matter located between your ears. Your mind is your greatest friend. Working physically and mentally are tools to help you work smarter not harder.

Mental training and imagery can help you achieve your full potential. If you want to get more out of your workouts or if you experience stress or anxiety in competition, learn how to control it and reframe it to your advantage. We all have worry and anxiety but there is a functional and dysfunctional type. There are positive parts of anxiety, the kind that prepares us for competition or when you are learning a new skill or getting “up” for a performance. Eliminate toxic worry! Worrying and stress weakens the athlete physically, spiritually and emotionally. Learn how to redefine the moderate levels of worry and anxiety.

You can learn to be a better athlete by eliminating the “stinkin thinkin,” by allowing your body to do what it was trained to do. Stop over thinking every movement and detail. Don’t become overwhelmed by the moment, your body knows what to do. Start letting go of your analytical, left brain side and allow your right side, the creative, visual side to take over.

In 2002 Johan Hedberg, the goal tender for the Pittsburgh Penguins used hypnosis and imagery to improve the mental side of his game. He was quoted as saying, “I think back on last year and I feel shame. I feel sick, I didn’t just want to work out my body to get rid of it. I wanted to work out my head as well. But Hedberg wasn’t just sick over losing – he was losing his composure.” 1

In an article written by George Smelch in Nine called “Baseball’s Mental Game,” he states that “about one-third of the players interviewed said they visualize before games. Visualization or what many sports psychologists alternatively refer to as imagery or mental rehearsal, is used to create and concentrate on the mental images of a physical act before doing it.”

Jamestown Expos pitcher Mark Larosa learned to visualize from his girlfriend’s father who is a psychiatrist and who uses hypnosis and imagery in his practice: While they are announcing the line-ups, I sit in the corner of the dugout by myself, and breathe deeply and try to relax, and I see myself on the mound going through the motions, delivering the pitch. I don’t see the batter’s face or anything, just my arm action and my ball action. Once I think I have it down, that’s it. It doesn’t take long, just three to five minutes.”

How does imagery work in sports performance? Imagery is seeing something in the back of your mind’s eye (in the back of the eyelids) but it uses sensory recruitment as well. This includes using all of the senses; sight, sound, smell, taste, touch and emotions. By training physically and mentally you will enhance your performance. Words create images and the brain learns through images. There are two hemispheres of the brain, the right and the left side. We use both hemispheres all of the time but often times, one side is dominant. The left side is the logical analytical side. The right side is responsible for imagination and making pictures. By using both hemispheres of the brain you are using all of the mental tools available to the athlete. Imagery allows you to mentally rehearse your athletic performance, enables you to connect with your own inner resources and affects you physiologically. When you are in hypnosis you are in homeostasis, your mind and body are in balance. Your body doesn’t discriminate between real and imagined events. So you are actually practicing and pre-training for your sport, you are rehearsing for your physical activity.

Mental training and imagery allows the athlete to merge the physical and the mental side of the game. If you want to get more out of your workouts, learn to control and conquer your fear and enhance your performance during competition, learn the tools and strategies to help you be the best you can be. The athlete cannot rely solely on physical training. Enhance your sports performance by unlocking your potential and tapping into the body and the mind.

1 ESPN.com Wednesday, August 28, 2002

At times, everyone of us has experienced insomnia. Too often these days, we settle into bed with our smartphones, tablets and laptops. Poor sleep is near epic proportions because people are oblivious to before sleep behaviors. Not only can our electronics undermine sleep, but it is also about our before sleep behavior. There is an estimated 60 million people who struggle with insomnia.

Listed below are some suggestions for improving your sleep:

. Seek help for conditions that require medical attention or professional counseling such as alcohol and chemical dependency, depression, snoring and sleep apnea.

. Limit your screen usage.

. Learn tools and strategies to help your body adapt to stress, such as hypnosis, guided imagery, and breath work.

. Limit or eliminate the use of stimulants by stopping caffeine and cigarette consumption by noon. Caffeine can remain in your system for up to 8 hours. If you feel a little lull in the afternoon, take a break and get 20-30 minutes of sun

. Eliminate naps, even a five minute nap can sabotage your sleep.

. Come up with a bedtime routine. Not only is it good to have a routine for children but it is helpful for adults too. Having a regular schedule can give our body physiological responses which cues our body to feel sleepier. Plan five to six nighttime rituals prior to going to sleep, the last one being turning off the lights and ceasing all of your activities.

One of the most common reasons people seek hypnotherapy is for a fear or phobia. Typically fears are rational, have their origin in childhood and are based on a real experience that you have had. A typical example might be a fear of dogs. Perhaps when you were a child you actually got bit by a dog and this fear would be a logical and realistic response. A fear can result in a fight/flight response and in physiological changes such as a change in breathing, trembling or shaking and perspiration. In contrast a phobia can have an unknown cause, be irrational, and most often start in adulthood. Some physical responses might be muscle tension, hyperventilation and tightening in the throat.

Fears and phobias can be life changing and cause people to alter how they live their lives. There is stress and anxiety around concealing these fears from others and can result in problems with friends and family, school situations and maintaining jobs.

Research by Web MD states, "Alcoholics can be up to 10 times more likely to suffer from a phobia than those who are not alcoholics. And phobic individuals can be twice as likely to be addicted to alcohol as those who have never been phobic."

Some common fears or phobias are:
Fear of flying, fear of public speaking, fear of animals, social phobias, fear of open spaces (agoraphobia) and fear of water.

What is pain?

The International Association for the Study of Pain defines pain as, "An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." It is common to see people withdraw from their daily activities as a way to protect, repair and heal the body. Good pain is there to tell you there is an issue; for example if you are a runner and you have pain in a leg that has a bad knee, this is an indication that you need to seek medical treatment whereas bad pain serves no purpose. In 2007, after a review of 13 studies, "The International Journal of Clinical Hypnosis found evidence for the efficacy of hypnosis in the reduction of chronic pain in many conditions." Hypnosis and imagery can be helpful for headaches, back pain, cancer pain, fibromyalgia, surgery, labor and childbirth, and dental pain.

What is the difference between acute and chronic pain?

Acute pain comes on suddenly without warning in emergency situations and may be the result of an accident or situation such as broken bones, cuts, burns, childbirth or dental issues. Chronic pain is ongoing whereby you have it now and quite possibly will have it in the future. Chronic pain can be the result of cancer, back pain, arthritis, headaches, fibromyalgia or neurogenic pain.

How can hypnotherapy help?

Hypnosis can help lower the threshold of pain, and manage the pain that you have to help you have a healthier lifestyle which can result in a dramatic change in one's life.

Note: Some medical conditions require a doctors referral.

Hypnosis can be a powerful tool prior to surgery, during surgery as well as the post operative phases. Before surgery, hypnosis can help to reduce stress, anxiety and fears by helping to achieve a more positive, comfortable state. Prior to surgery, it is important to maintain the health and well being of your physical and emotional body by working on healthy eating habits, smoking cessation, getting enough exercise and sleep. During surgery, hypnosis can be effective for reducing the amount of anesthesia, infections, bleeding, and complications and thus a quicker recovery. After surgery and In the recovery period hypnosis is helpful for wound healing, reducing discomfort from anesthesia and post operative procedures.

How does hypnosis give you the mental edge in sports performance?

You can achieve a better performance by merging both the body and the mind to achieve harmony and help you reach your sports goals. Of course your physical workouts are vital but what gives you the advantage is using the three pounds of grey matter between your two ears. You can learn to conquer your fear, anxiety and improve your confidence by incorporating the tools and strategies to be the best athlete you can be.

What is the greatest challenge most athletes have?

Perhaps you have experienced what is known as, "Analysis paralysis" whereby you become overwhelmed with the task at hand and are overthinking each piece of your game. Sound familiar? Certified hypnotherapist Shelley Halpern can teach you to stop the, "Stinkin' thinkin' " and let your body do the job it was trained to do. Your body already knows what to do and by using the mental side of the game it can enhance the physical side.

How can imagery and visualization improve your sports performance?

By using imagery, you not only are able to see behind the mind's eye but you are able to use what is called, "Sensory recruitment" whereby you integrate all of your senses. It makes the experience much more rich and vivid and allows you to tap into the right hemisphere of the brain, the creative, intuitive side rather than being stuck in that left brain side of logic and analysis. Imagery allows you to link the two hemispheres of the brain thus enhancing your performance. By actually doing image rehearsal, you practice and condition your body to reduce the stress and anxiety, to increase concentration and put your body into homeostasis (balance).

How can parents best support their children in sports?

It is important that we allow children to keep the joy in their sport by not making practices and workouts seem like punishments. Allow your child to be well rounded and have them schedule time and activities away from their sport. Avoid over training which can result in injuries and emotional burnout. Parents, keep in mind that you can be your child's best ally or you can end up sabotaging their progress. Your children look to you and emulate your behavior. Keep things positive and support them in whatever way they need.

How can an athlete maintain a winning attitude? “If You do what you’ve always done you get what you’ve always gotten.” ~ Tony Robbins

Don't be afraid of making changes, don't get stuck in a rut. Change helps us grow and improve our performance. Focus more on improving yourself and your sport rather than on winning because what you focus on will follow. Remember, create a plan and make your goals attainable and stay positive because your mental attitude is 50% of your game!

Hypnosis is a state of deep relaxation where you are able to access your subconscious mind to help you create your path toward success. In hypnosis, you are completely open to positive thoughts and suggestions that allow you to replace old behaviors and habits with new ones you desire. Hypnosis is a deeply relaxed state in which you access the most powerful part of your mind, the subconscious. A wonderful metaphor for the conscious and the subconscious is the image of an iceberg which is about 88% below the surface (subconscious) and 12% is above the surface (conscious).

Hypnosis attracts thousands of people each year from all ages and all walks of life. They all come seeking the unique services that hypnotherapy provides.

One of the most popular uses for hypnotherapy is for studying and test taking. Often clients relay having challenges with the stress and anxiety of taking exams and most often, forgetting the material that they know and have studied during the exam. Learn how to relax and concentrate at the same time. Change your old habits and replace and create positive changes and build new strategies for learning. If you would like to increase your focus, concentration, attention and recall and maximize your success at test taking, call Shelley Halpern, Certified Hypnotherapist in Los Angeles for more information.

LSAT, MCAT, SAT, ACT, MFT boards and much more

Stop smoking is one of the most common reasons people seek hypnotherapy. There are two main types of smokers: the identification and replacement smoker. The identification smoker begins smoking because his or her friends smoked and they want to be part of this group. If they continue to identify with this group, smoking will become a deeply ingrained habit. The replacement smoker uses cigarettes to replace a habit such as eating, confidence, stress or anxiety and gets oral gratification from the cigarette. They receive pleasure from the ritual of smoking as well.

The steps I go through with clients to assist them to quit smoking include contacting them by phone and spending about 15 minutes discussing whether they are ready to stop smoking. If you are not ready (you are doing this for your doctor or spouse), it won't be effective. If that is the case, then we can work on motivation and when you are ready, then work on stop smoking. There are some people who aren't addicted and can stop smoking more easily. For others, it will require multiple sessions. Smoking is a chemical and psychological issue. People continue to have cravings because it's not just a physical addiction but a psychological issue. With hypnosis, we work on replacing and changing the habitual pattern.

Smoking is harmful to both the smoker and nonsmoker alike by causing various types of cancer. There are over 7,000 harmful chemicals in tobacco that can include hydrogen cyanide, carbon monoxide, ammonia, formaldehyde and much more.

When you quit smoking, you can experience some of the following positive changes in your body:

• Within 20 minutes of your last cigarette blood pressure adjusts to natural levels, pulse rate adjusts to a normal level and the body temperature of the hands and feet increase to normal.
• In 8 Hours carbon monoxide level drops to normal.
• In 24 Hours chance of a heart attack is significantly decreased.
• 48 Hours nerve endings start to re-grow, the ability to smell and taste improves.
• 72 Hours bronchial tubes begin relaxing and lung capacity begins to increase.
• 2 Weeks to 3 months circulation in the body improves, walking becomes easier, lung function increases up to 30%.
• 1 to 9 Months coughing, sinus congestion, fatigue, shortness of breath decreases. Cilia regrows in the lungs, increasing ability to handle mucus, cleans the lungs and reduces infection.
• 5 Years lung cancer death rate for the average smoker (one pack per day), decreases from 137 per 100,000 people to 72 per 100,000 people (after - 10 years, rate drops to 12 deaths per 100,000) or almost the rate of a person who never smoked.
• 10 Years Pre-cancerous cilia are replaced. Other cancer such as those of the mouth, larynx, esophagus, kidney and pancreas decreases.

ALL OF THESE BENEFITS ARE LOST...IF ONE CIGARETTE A DAY IS SMOKED!
Make a firm promise and commitment to yourself and choose to live your life healthy, strong, vital, vibrant and powerfully alive by freeing yourself from the bonds of cigarettes.

Call or email Shelley Halpern, Los Angeles Hypnotherapist today to start the process of change. 818-205-7271
In person or phone sessions available.

Everyone of us experience stress or anxiety. In fact, it is a normal human response that we all go through in our lives. We can look at stress in a positive, functional way; it gets us up for a speech or performance or it can by dysfunctional and toxic and can affect us physically, spiritually and emotionally and intellectually.

David Spiegel, Stanford University's associate chair of psychiatry and behavioral sciences explains the difference between stress and anxiety as follows: "While there is definite overlap between stress and anxiety, ultimately the two emotions come from two different places. With stress, we know what’s worrying us but with anxiety you become less aware of what you’re anxious about [in the moment] and the reaction becomes the problem. You start to feel anxious about being anxious. The key difference [between the two] is the sense of helplessness. When it comes to stress, you can deal with things and master them. By rolling up your sleeves and tackling that stress, you can feel less helpless.”

How can hypnosis and imagery help? Shelley Halpern can teach you tools and strategies to help lower the stress and anxiety such as self hypnosis, mindfulness skills such as breathing, de-sensitization and EFT.