a presentation by - spectrum learning · spectrum of life (sol) integrative wellness centre...
TRANSCRIPT
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A presentation by:
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Hiro KooPsychologist & Licensed Clinical HypnotherapistSpectrum Of Life Integrative Wellness CentreBSocSc(Hons) PsychologyMSc Clinical PsychologyDiploma 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)
of 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 CentrePractitioners 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.
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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/
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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
8At present, no specific agent or event has been identified
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Intervention: EEG Biofeedback
• Pharmaceutical intervention: Neurochemical or 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 antiseizuremedication 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 SMRMarch 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
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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 sessionMonth 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.
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FindingsPresenting 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
occasionally interrupted what he was trying to do or
say nowadays.
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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
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FindingsPresenting 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
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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 SMRFebruary 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
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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 or
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.
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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.