Comprehensive Behavioural Intervention for TICS (CBIT)
Clinicians at Possibilities are trained in CBIT and provide this intervention to children and teens. Here are questions we are asked about tics and CBIT, along with our answers.
Comprehensive Behavioural Intervention for Tics (CBIT) is an exciting, drug-free treatment that helps individuals with Tic Disorders like Tourette Syndrome learn to manage and decrease tics. This therapy has strong scientific support and is recommended as the first approach for helping individuals take charge!
Tics are repetitive, involuntary movements or vocalizations such as blinking, nose twitching, sniffing, or throat clearing. Tics are the major symptom of Tic Disorders, like Tourette Syndrome. Some people think that tics are all about swearing, but swearing, as a tic, is rare.
Tics typically emerge around 5 to 7 years of age and become more frequent and intense up to ages 10 to 11 years. During this time, tics can wax and wane, which means they can come and go. The severity of tics tends to decrease into adulthood.
Tic Disorders, like Tourette Syndrome, are classified as neurodevelopmental conditions, meaning there is a brain difference. All brains store sequences of movements that can be called upon to help us move smoothly in the world. To produce targeted, intentional movements, the brain must launch some sequences while stopping others. In Tic Disorders, specific circuits in the brain—called the cortico-striatal-thalamo-cortical (CSTC) circuits—have difficulty stopping sequences of movements that aren’t necessary for our functioning in the moment, so tics escape.
No. Tics, by definition, are involuntary. Some children and teens may have some control over their tics, but they can’t suppress them all the time. Suppression is difficult, exhausting, not always possible, and not an effective long-term strategy. Saying “stop!” or offering rewards to suppress tics won’t work either. In fact, the more people talk about tics or point them out, the more likely the tics will get worse!
CBIT is a short-term therapy with three main goals. First, clients learn to become more aware of their tics and the urge to tic. Next, clients learn to perform a Competing Response—or CR—when they feel the urge to tic, to prevent the tic from happening or to make the tic harder to do. Thirdly, clients are taught to think about what circumstances and feelings make their tics worse, so they can make adjustments in their daily life, and practice relaxation, so tics are less likely to happen.
No, and that’s what’s really exciting about CBIT! Suppression doesn’t work, but mobilizing a Competing Response (CR) can be a powerful tool for reducing tics over time.
People with Tic Disorders often feel an urge to tic a split second before the tic happens. This urge can feel like tension that must be relieved, or like a tickle or an itch that must be scratched. When the tic escapes, it relieves the tension—or scratches the tic. But the urge comes back again, and the tic happens again to gain momentary relief. This cycle of urge—tic—urge—tic will continue unless it’s broken. The Competing Response (CR) is designed to break this cycle. When a client feels the urge to tic, the CR for that tic is mobilized and held until the urge shrinks. When the urge disappears, the client ends the CR, and doesn’t feel the need to tic. When the urge happens again, the CR is mobilized and held until the urge shrinks again. Eventually, when the CR is applied over and over again at the first warning signs, the urge to perform a specific tic weakens until, over time, it stops emerging altogether.
No, the Competing Response does not become a new tic. In fact, the ultimate goal is to stop mobilizing the CR because the urge to express specific tics decreases and disappears. No urge means no temptation for the tic—and that means no need to do the CR at all! If the urge comes back in future—since tics can wax and wane—mobilizing past CRs can work well to banish those urges more quickly than they disappeared the first time.
Yes. Large-scale studies show that CBIT can result in significant reductions in tic severity in over half the clients who undergo this drug-free treatment. CBIT is not a cure for Tic Disorders or Tourette Syndrome, but it can create remarkable improvements in those who respond well to the treatment.
Yes. A recent study showed that 87% of people who responded well to CBIT continued to show a good response six months after treatment. In CBIT, clients learn strategies they can continue to practise over a lifetime, like becoming more aware of new tics that emerge, and mobilizing Competing Responses to reduce them.
Some clients with Tic Disorders may benefit from medication. With that being said, because CBIT can be incredibly effective in reducing tics in many clients, this drug-free approach is typically recommended as a first-line treatment before medication for tics is considered.
People with Tic Disorders need to be aware of their tics and frustrated by them in order to be good candidates for CBIT. This frustration means they are willing to learn Competing Responses for their tics, and to practice the CR when they feel the urge to tic in between sessions with the clinician. Clients are also asked to collect data between CBIT sessions to help track how often tics are happening and how successful the CR has been to reduce them. A parent or partner offering support to clients between sessions is important for CBIT success.
The number of sessions can vary depending on how many distinct tics a client hopes to reduce. Generally, there are 8 CBIT sessions that happen over 10 weeks, plus 3 monthly booster sessions that begin a month after the last CBIT session.
Yes! We see clients across Ontario through secure video sessions. Our health professionals who offer CBIT are licensed in the province of Ontario. You must be physically present in Ontario for all therapy sessions.
CBIT can be an effective treatment for children, teens, and adults with Tic Disorders. Children as young as 8 or 9 years of age can benefit from this approach, if they are motivated to reduce tics and mobilize Competing Responses between therapy sessions with parent support. Currently, our clinicians provide CBIT services to children and teens. We will update this information if CBIT services for adults become available.
CBIT at Possibilities is provided by non-medical health professionals such as psychologists. As such, these services are not covered by OHIP. Your private insurance plan may cover CBIT services as a non-medication treatment for tics.
Yes! You do not need a referral to start CBIT with one of our clinicians.
For more information about CBIT, please contact us at firstname.lastname@example.org or call 1-833-482-5558. You can also get started right away by completing our Child and Adolescent Intake Form. Once this form is received, our Care Coordinator will review your needs, match you to an appropriate clinician, and get back to you with booking options.