Understanding Tics and Tourette’s: Why They Happen and How Therapy Can Help

Tics and Tourette’s syndrome are an area of therapy I particularly enjoy working with. I find it incredibly rewarding, not least because there are effective treatments available, but because of the difference that understanding and support can make to someone who may have spent years feeling embarrassed or misunderstood.

Living with tics can be difficult, particularly when there is a constant awareness of how other people might react. Children may worry about making noises in the classroom, teenagers may become increasingly self-conscious around their peers, and adults can spend years trying to disguise their tics in professional or social situations. There can be a great deal of shame associated with something that is largely outside a person's control. One thing I want people to know is that there are treatments that can help.

What's actually happening in the brain?

Tics are sudden, repetitive movements or sounds. They might involve blinking, facial movements, head jerking, sniffing or throat clearing, although some tics are considerably more complex. Tourette's syndrome is a neurodevelopmental condition involving both motor and vocal tics, beginning in childhood and continuing for at least a year, you can experience tics without meeting criteria for Tourette's.

We know that tics involve differences in the way the brain regulates movement, particularly within networks connecting the basal ganglia and frontal areas of the brain. Throughout the day, our brains generate enormous numbers of signals relating to potential movements and actions. Normally, these networks help select the movements we want to make while inhibiting those that aren't needed.

In people with tic disorders, this filtering process appears to work differently. Some movement signals are not inhibited as effectively, allowing movements or sounds to occur that would ordinarily have been suppressed. It's a useful way of understanding why tics happen, although the underlying neuroscience is more complex than a simple filtering problem.

Many people also experience what we call a premonitory urge, an uncomfortable sensation or feeling of pressure that builds before a tic. Performing the tic can briefly relieve this feeling, but the relief is temporary and the urge may return. This creates a cycle of negative reinforcement, where the relief following a tic can help maintain the pattern.

Tics can also be influenced by positive reinforcement. For example, attention or a change in demands following a tic may sometimes influence how often it occurs. I want to be clear that tics are not a choice, but their frequency and expression can be influenced by the environment and the responses of others.

Tics also naturally fluctuate. Stress, tiredness, excitement and changes in routine can make them more noticeable, although these factors don't cause Tourette's syndrome. Tics can also be more prevalent in the teen years due to development shifts., emotional triggers and social triggers.

Tourette's, ADHD and OCD

ADHD and obsessive-compulsive disorder (OCD) are particularly common alongside tic disorders and the three are sometimes described as a triad. Autism and more generalised anxiety are also frequently seen. There can be an interesting overlap between tics and OCD, particularly when someone experiences a need to repeat a movement until it feels "just right". Sometimes this is driven by a physical urge, while at other times it may be connected to an obsession or a sense that something is incomplete. Understanding the difference is important, as it helps us decide which treatment approach is most appropriate.

In my work, I always want to understand the wider picture. Sometimes the ADHD, anxiety or OCD is having a greater impact on someone's day-to-day life than the tics themselves. Supporting someone effectively means recognising how these difficulties interact rather than focusing on one diagnosis in isolation.

How can therapy help?

There are two behavioural approaches I use when working with tics: Comprehensive Behavioural Intervention for Tics (CBIT) and Exposure and Response Prevention (ERP).

CBIT involves developing an understanding of someone's tics, identifying the sensations that come before them and learning a competing response. This is an alternative movement or action that makes it more difficult to perform the tic. We also consider the circumstances in which tics occur and whether changes to the environment might help.

ERP works slightly differently. Rather than focusing on an alternative response to an individual tic, we practise gradually tolerating the uncomfortable sensations that precede tics without immediately responding to them. With practice, this can help people become more comfortable with the urge and develop greater control over their responses.

Both approaches are structured and involve practice between sessions. Importantly, they are not about telling someone to stop tics or expecting them to suppress their tics throughout the day. We work collaboratively, at a pace that feels manageable, and focus on the difficulties the person actually wants help with.

What can you expect from treatment?

I think it's important to be realistic about what therapy can achieve. There is no cure for Tourette's syndrome, and behavioural therapy doesn't guarantee that tics will disappear. However, research shows that treatments such as CBIT and ERP can lead to meaningful reductions in tic severity and the disruption they cause.

Treatment often takes place over approximately 8–12 sessions, although this depends on individual circumstances. Some people notice considerable changes in their tics, while others find that particular movements or sounds become easier to manage.

When working with children, I often involve parents and, where appropriate, schools. It's important that the adults around a child understand tics and know how to offer support without constantly drawing attention to them. For teenagers and adults, therapy may also involve addressing anxiety, avoidance or the impact that years of feeling self-conscious have had on confidence.

Success isn't always measured by how many tics someone has. Sometimes it is about being able to concentrate at school, feel more comfortable with friends, participate in activities or simply spend less time worrying about what other people think.

Why this work matters to me

One of the things I enjoy most about working with tics is helping people understand something that may have felt confusing or uncontrollable for a long time. There is often a real sense of relief in discovering why tics happen and that there are practical approaches that may help.

I also think it's important to acknowledge that not everyone with tics needs or wants treatment. Tics are part of a person's neurodevelopmental profile, and the decision to work on reducing them should be theirs, rather than something driven by other people's discomfort.

For those who do want support, my hope is that therapy offers both practical skills and a greater sense of confidence. Living with tics can be challenging, but it shouldn't have to mean living with shame.

At Kate Camps Therapy, I work with children, teenagers and adults experiencing tics and Tourette's syndrome, offering CBIT and ERP through a collaborative, neuro-affirming approach.