21 Jun Comprehensive Behavioural Intervention for Tics

Bye Bye Annoying Tics: Introducing Comprehensive Behavioural Intervention for Tics (CBIT)

What is CBIT?

Comprehensive Behavioural Intervention for Tics (CBIT) is a non-drug powerful behavioural treatment that helps patients to (1) become more aware of tics and early signs a tic is about to occur, (2) use competing responses (voluntary behaviours that are designed to be physically incompatible with tics thereby disrupting the tic cycle), and (3) change their environment in ways that can help reduce tics.

CBIT is more than basic supportive therapy and education. CBIT is a highly structured and specialized treatment, provided by a therapist who is trained and certified in CBIT. CBIT is generally delivered over 8 sessions (although the length depends on the child and family’s needs).

In CBIT, Jonny learned that before his neck cracking tic, he feels a pressure build up in his neck. Instead of doing the tic, he began tilting his head slightly forward when he felt that pressure, so that he could not crack his neck at the same time. After a week of using his competing response consistently, the pressure began decreasing and he no longer felt the urge to do this tic. He was super happy since this tic was causing him pain and teasing from other boys at school. In CBIT, Jonny also learned that he tics more in church so he began using his breathing and competing response strategies on the way to church. Moreover, his parents learned about how they should react to Jonny’s tics and were provided with information that might be useful for Jonny’s school to know. Even though Jonny only met with his therapist 8 times and addressed 2 of his tics, he and his parents felt that he left treatment with a toolbox of strategies and techniques that he could use for any new and bothersome tics!

Does CBIT work?

Yes! A study published in 2010 found that children and teens who participated in CBIT demonstrated a decrease in tic severity that was comparable to the decrease seen with medications. Furthermore, nearly 90% of the participants who received CBIT continued to show gains 6 months after treatment ended.

Compared to medications, CBIT (1) has no negative side effects, (2) can empower children to learn strategies to manage their tics, and by doing so, may enhance their self-esteem, and (3) can be applied to a specific tic (i.e., children can address the tics that are most bothersome and ignore the tics that are less distressing). In contrast, pills (medications) don’t teach skills, cannot be used to target specific bothersome, impairing, and/or painful tics, and often are unable to entirely eliminate tics.

CBIT is currently recommended as a front-line treatment for people distressed by tics according to 2011 European guidelines, 2012 Canadian guidelines, and 2013 American guidelines.

Is CBIT right for me?

Are you bothered by your tics? Do you have some insight into tic symptoms and/or urges? Are you motivated to participate in treatment? If you have ADHD, are your symptoms well-controlled? If you are a child, do you have parents who will be involved in treatment?

If the answers to these questions are yes, CBIT may be a good treatment for you!

Where can I find a CBIT treatment provider?

Unfortunately finding therapists trained in CBIT in Canada is extremely difficult. At The Possibilities Clinic we are fortunate to have child psychologists trained and certified in CBIT by the Tourette Syndrome Behavior Training Institute. If you are interested in learning more, please contact the clinic at 416-482-5558.