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Question 85: I was one of the fortunate 500 that sat in the audience at Horton High School in Greenwich and witnessed the magic that is you!! I am a....college prof and grief therapist. I have a question regarding one of the techniques I was taught as a graduate student re: behaviors that needed to be performed in access of 30 times a day. The technique involved the paradox of asking the client to increase the behaviors and hence they would be unable to perform, say handwashing, at all. Can you share your understanding of how this works? Or possibly you don't support this approach. It was lovely to be in your presence. Regards, S.S., NS, Canada.

Evening S.S.!

Your words were most kind....WIth regards to your question, I've heard of this technique too (called Massed Practice). To me it smacks of behavioural modification ('if we make him hate the tic enough, he'll be motivated to stop' -- kind of like the dad that forces the son to smoke the entire pack of cigarettes in one sitting). In addition to being aversive for the child, it is hypothesized that Massed Practice will fatigue the muscles enough to reduce the tics. The former reasoning (b-mod) seems to miss the point (i.e. it is not that TS'ers don't already have plenty of justification for stopping) and the latter reasoning seems to 'throw the baby out with the bathwater' (i.e. if I was so exhausted that I couldn't tic, I can't imagine I would accomplish much else either).

My Child Clinician's Handbook (Kronenberger & Meyer, 1996) tells me that "despite early widespread use of this technique, outcome studies question its effectiveness" (read: it doesn't work!). Based on the neuropsychological learning model of tic formation I created for my Ph.D. thesis (the Incidental Associations Model), this technique is enormously stupid -- it would create that many more connections between the tic movements and other day-to-day movements (read: it could make tics that much worse).

Hope this helps! Take good care,
Dr. Dunc.

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