Why Do My Tics Get Worse
When I Think About Them?

This is one of the weirder things about having tics: you can be going about your day, not really noticing them, and then someone mentions your tics and suddenly you're doing them constantly. Parents see this too. Your kid seems to be having a quiet tic day, you say, “Hey, your tics seem better today,” and then the tic immediately shows up six times.

So did talking about it make the tics worse? Sort of—but probably not for the reason you think.

Paying Attention Changes What You Notice

A lot of people with tics have some kind of sensation before the tic happens. We call this a premonitory urge, which is a fancy name for the feeling of needing to tic. It might feel like pressure, tension, an itch, something being “off,” or simply a strong need to make a particular movement or sound.

If you don't have tics, try becoming aware of your blinking right now. You were blinking perfectly well without thinking about it. Now you're probably aware of your eyelids and when you're going to blink next. Tics aren't the same thing as blinking, obviously, but attention can work similarly. Once you're thinking about a tic, you notice the urge, then the tic, then whether another one might be coming.

That can make tics feel more frequent or intense. What it doesn't mean is that you're making yourself tic.

“But They Weren't Doing It Until We Talked About It.”

Tics are confusing because people often have some ability to suppress them. A kid might hold their tics back at school and then tic like crazy when they get home. Someone might barely tic while completely absorbed in a video game and start again when they're finished. None of this means they're doing it intentionally.

Think about having an itch you're not allowed to scratch. You can probably resist for a while, but you're going to be very fucking aware of that itch. Suppressing a tic can be similar. Someone may be able to stop the movement or sound temporarily without making the urge disappear. For some kids, home is simply the place where they finally don't have to work so hard at controlling it.

So Why Does CBIT Teach People to Notice Their Tics?

Comprehensive Behavioral Intervention for Tics (CBIT) includes awareness training, which sounds a little contradictory. The difference is that we're paying attention for a reason. CBIT teaches someone to recognize the tic and the urge that comes before it so they can use a competing response. We're not trying to create someone who spends all day thinking, Am I going to tic? How about now?

The goal is more control when you want it—and ultimately, less of your life being organized around your tics, not more.

Parents, You Don't Have to Monitor Every Tic

If your child's tics aren't hurting them, interfering with something they want to do, or particularly bothering them, you don't necessarily need to do anything about them. You don't need to announce a good tic day, point out every new tic, or ask whether they used their CBIT strategy every time you hear one. And you definitely don't need to give them the look. You know the one.

Sometimes the most useful thing everyone else can do is stop making the tics such a big fucking deal. If they're painful, disruptive, socially difficult, or bothering the person who has them, that's different. That's when treatment like CBIT can be really useful.

Tics Can Be Weird

Tics wax and wane and don't always behave in ways that make intuitive sense. Thinking about them can make them more noticeable. Stress can increase them, but so can excitement. Sometimes you'll know exactly why they've gotten worse and sometimes you won't. You don't have to solve that mystery every time.