EDITOR’S NOTE: This multipart series first appeared in the March 2010 edition of the Journal of Clinical Psychology Practice and also can be found on Life’s A Twitch, a website run by Canadian psychologist Dr. B. Duncan McKinlay.
Deep breathing techniques are mobile, inconspicuous and decrease my ticcing through stress reduction. A slow, mindful and deep intake of air can smother (or at least partially mute) a swelling premonitory urge. I imagine the breath enveloping and drawing that urge from my body as I exhale.
By the completion of the out-breath, vestiges of the urge have re-kindled and I find myself back on the precipice. Brief refractory period or not, the exercise still bought me time enough to again smother the flames with my next in-breath. In this way, simple breathing techniques also serve as exposure and response prevention (ERP) exercises, further severing the incidental associations bonding me to my tics.
Exposure exercises can be taken further into the realm of mindfulness training. I spend 45 minutes motionless, aware and present of each passing moment, meditating on body sensations. I note a premonitory urge, and watch it with detached interest. Squirming and twisting within, it tempts me to complete the pattern. To lull me into automaticity. I leave all thinking behind to just be, no longer tied to what my brain tells me must occur next. My attention wanders, and before long I return to note the urge has vanished. A half-smile spreads across my face.
Anything to shore up my flagging frontal lobes is likely a good plan in the battle to contain tics, as Bradley Peterson’s work so eloquently suggested. For a few years now I have taken large daily doses of Omega-3 and wonder if this has helped. Certainly it has not had any direct impact on tic levels, but I suspect it may have moderated my ability to successfully utilize behavioural treatments.
Of more obvious benefit has been an optimized dosage of controlled-release methylphenidate. Within 20 minutes of my first treatment I became aware of an altered state of being. Initially I felt almost outside myself – an alien, persistent, altered state of consciousness difficult to categorize and best described as an artificial distancing of what I was doing from what I was thinking.
I was tempted to call this novel disconnect “extraordinary” until I realized that this phenomenon was likely not “extra” at all. It is, in fact, completely ordinary to insert a beat between action and thought, and this is precisely what decreased impulsivity requires. This vague sense of light-headedness (which I had habituated to by the second day) wasn’t a side-effect at all – it was merely the more normal brain functioning I was as yet unaccustomed to.
In the past I had been closer to the action in a cognitive sense: observing, cataloguing and paying for all my spontaneity only after it had ensued. My success at remediation or at demonstrating changed behaviour the next time was limited because I was already immersed in the next moment.
An ability to “put on the brakes” more effectively has improved many things in my life – not the least of which is my success with HRT. Good intentions, good demystification and good efforts simply weren’t enough to compensate for a lack of deliberativeness; the methylphenidate helped with that.
Lastly, and most recently, I learned a myopic preoccupation with my own “leaky brakes” had blinded me to the still very-much wounded individual behind the wheel. Failing brakes certainly require attention, but so does an impaired driver taxing those brakes by continually steering into hazards. I still possessed a shame-based identity, largely created from having undiagnosed and untreated symptoms for many years.
A great deal of judgement, developmental trauma, and discrimination had led to a denial of healthy instincts, a devaluing and martyring of myself, a lack of self-trust and compassion, an ambivalent attachment style, and a profoundly co-dependent nature. Much exploitation and boundary violation resulted, breeding entitlement, conflict and abandonment. Addressing those issues impacted symptoms in unexpected ways.
Resolving internal conflicts and making better choices provided less unhealthy fodder for my dysregulation to perseverate upon, or to impulsively react negatively towards. Behavioural treatments succeeded in turning down my neurologically-based amplification of self. But it took plain old good therapy to change the actual tune being played.