Behavioural therapy makes use of the fact that tics are not entirely disconnected from free will. Children with tics can sometimes feel a kind of tension right before the tic occurs. These feelings are referred to as premonitory urges. In other words, the tic announces its arrival.
Two behavioural therapeutic methods have been developed: exposure with response prevention and habit reversal. Exposure with response prevention works as follows: the child feels the sensation that leads to the subsequent tic. This is the premonitory urge. The child is taught to expose him or herself to this premonitory urge for longer than usual. Normally, the tic follows the urge. Now, however, the child is taught to consciously suppress or delay all tics for increasingly longer periods of time. Holding back the tic is the ‘response prevention’. In this way, children may learn to control their tics.
Another behavioural therapy technique is habit reversal. This involves teaching the child a counter movement for each separate tic. The tic cannot be performed at the same time as this movement. In simple and concrete terms, the child feels that the tic is about to happen and performs a counter movement at the moment it expects the tic. This negates the tic.
There are clear indications that both methods can be effective. There does not appear to be a great difference between the effectiveness of both methods. What’s more, there is evidence that this kind of behavioural therapy for tics is also effective in the long term, up to months after concluding the treatment.
An advantage of behavioural therapy over medication is that it teaches the children how to at least temporarily suppress their tics. This can be very important to them in a number of social situations (with friends or at school). However, as behavioural therapy is an intensive form of treatment, the children must be motivated to participate.