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What is OCDRelated Symptoms & ConditionsAre nervous tics a mental health problem?

Are nervous tics a mental health problem?

6 min read
Grant Stoddard

By Grant Stoddard

Reviewed by April Kilduff, MA, LCPC

Aug 31, 2023

Sweaty palms, a racing heartbeat, shallow breathing, gastrointestinal distress. The effects of nervousness on the body are numerous and, for the most part, incredibly unpleasant. But many people suffer an additional response when in an anxiety-provoking situation: tics. 

In this article, we’ll be taking a look at how feelings of nervousness can bring on tics. We’ll discover the sort of impacts tics can have on sufferers’ lives, and learn about how professionals determine whether these behaviors are indicative of an underlying mental health condition—plus how such a condition can be treated, often within a few months of specialized therapy.

What are tics? 

Tics are sudden, involuntary movements or vocalizations that occur repetitively and without apparent purpose. They can include repeated blinking, throat clearing, facial grimacing, head jerking, or making repetitive sounds. Tics often arise unexpectedly and can vary significantly in intensity and frequency. While the exact cause of tics is not fully understood, they’re believed to result from genetic, neurological, and environmental factors. 

Tics are more common in childhood and typically emerge between the ages of 5 and 10. And they’re surprisingly common: 10-20% of children experience tics, with boys being more prone to developing a tic disorder than girls. While many children outgrow these tics as they mature, a smaller percentage continue to experience them into adulthood. 

What are nervous tics? 

Tics disorders can be categorized into two types: transient tics, which are common in childhood and often diminish with age, and chronic tics, which persist over time and can be associated with conditions like Tourette’s syndrome

While they can be difficult to distinguish from other behaviors like “stims,” which may be healthy, tics of all kinds are considered a mental health issue. That’s why it’s especially important for these behaviors to be assessed accurately by a trained professional: self-stimulating actions can appear similar to tics—and are often done to regulate nervous feelings—but they are not a mental health issue whatsoever. On the other hand, when repetitive behaviors cause distress or negatively impact one’s day-to-day life, this is a sign that specialized treatment can help.

When we talk about “nervous tics,” we’re referring to tics that are triggered or exacerbated by stress and anxiety. “A nervous tic isn’t a type of tic disorder, nor is it a term used in a mental health setting,” says Dr. Nicholas Farrell, a licensed clinical psychologist and a Regional Clinical Director at NOCD. 

“However, nervousness bringing on tics is a common experience, so it’s easy to understand why people would refer to their tics as being of the nervous variety. Tics can indeed show up when a person is experiencing heightened emotional tension, which may temporarily worsen during times of stress. However, it’s just one feeling that can bring on tics, a few others being frustration, boredom, and excitement. So while all nervous tics can be classified as tics, not all tics are nervous tics.” 

The impact of nervous tics 

Whatever brings them on, the impact of tics on a person’s life can be profound, affecting various aspects of their well-being and daily functioning. Socially, people with tics might encounter challenges due to the involuntary and often conspicuous nature of their movements or vocalizations. Feelings of embarrassment, shame, and self-consciousness can arise, potentially leading to social isolation and strained relationships.

As we mentioned previously, tics of all kinds are seen most often in children and adolescents, and their presence can hinder concentration, productivity, and performance at school. 

Participating in hobbies, sports, or other leisure activities might also become more challenging as the physical limitations and stressors imposed by tics can disrupt enjoyment and engagement. 

The psychological toll of living with tics can also contribute to a cycle of diminished self-esteem and decreased overall quality of life. It’s common for people to develop avoidance behaviors, withdrawing from situations to escape potential embarrassment or judgment.

What’s more, these symptoms and their effects can contribute to a vicious cycle. The psychological toll of managing tics and coping with the associated stress can in turn lead to heightened anxiety, further exacerbating the tics themselves.

How are tics treated? 

As with many mental health conditions, pharmaceutical and non-pharmaceutical approaches can be taken when treating tics. However, given that medications—typically alpha-2 adrenergic agonists like clonidine and guanfacine or antipsychotic drugs—don’t offer long-term management of tics and may also come with side effects, a non-pharmaceutical intervention is typically the first approach to treatment. One non-pharmaceutical approach that has been shown to significantly reduce tic severity in both adults and children is a form of therapy called habit reversal training (HRT). 

What is Habit Reversal Training (HRT)?

HRT is a structured behavioral therapy that aims to help people gain control over unwanted habits or behaviors, including nervous tics. Psychologist Nathan Azrin developed the technique in the 1970s, and it has since been refined and adapted for various conditions, including tic disorders.

How Does Habit Reversal Training Work?

Habit reversal training consists of several key components:

Awareness training: The first step involves increasing people’s awareness of their tics. This includes recognizing the sensations, urges, or situations that precede the tic. Developing this awareness is crucial, as it forms the foundation for subsequent steps.

Competing Response: A central aspect of HRT is learning and practicing competing responses. These are voluntary behaviors that are physically incompatible with the tic. For example, if someone’s tic involves picking at their hands, a competing response might be to gently squeeze their hands into fists.

Practice and Replacement: The person practices the competing response whenever they feel 

the “premonitory urge” that typically precedes the tic. By repeatedly engaging in the competing response, the person begins to replace the tic with the new, less disruptive or harmful behavior.

Social Support: Working with a therapist or trained professional is essential in implementing HRT effectively. The therapist provides guidance, feedback, and support throughout the process, helping the person stay motivated and make necessary adjustments.

Effectiveness of HRT for tics:

Numerous studies have demonstrated the effectiveness of HRT in reducing the frequency and severity of tics. The technique’s success lies in interrupting the automatic cycle of tics by introducing intentional, controlled responses. This reduces the occurrence of tics and empowers people to regain a sense of control over their bodies.

Advantages of HRT:

HRT offers several advantages as a treatment option for tics:

Non-invasive: HRT is a non-pharmacological approach, making it a preferable choice for people who wish to avoid medication or want to complement medical interventions.

Empowerment: HRT empowers people to actively participate in their treatment, giving them a sense of agency over their condition.

Flexibility: HRT can be adapted to fit a person’s unique needs and circumstances. Competing responses can be tailored to be inconspicuous and easily integrated into their daily life.

Long-term benefits: Through consistent practice, people can experience lasting reductions in tic frequency and severity, contributing to improved quality of life.

It’s important to note that HRT is most effective when guided by a specially trained therapist who can provide guidance, encouragement, and adjustments as needed. For people seeking a non-invasive and empowering approach to managing tics, habit reversal training offers a path towards greater self-control and improved well-being.

Getting help for nervous tics

If you or someone you know is struggling with a tic disorder—including tics that are triggered by stress and anxiety—schedule a free call today with the NOCD Care Team to learn more about how a licensed therapist can help. 

All NOCD therapists specialize in treatment for both OCD and disorders related to the condition, receiving specialty training in both HRT for treating tic disorders and exposure and response prevention for OCD.

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