What is CBIT-- And Can it Help You?

Gardiner Comfort, an actor with Tourette Syndrome, talks about his experience with CBIT for the Tourette Association of America. You can watch the video here.

Having full control of your body is something we often take for granted; it only seems natural to most people. But to some, such as those with tics, it’s not. Tics are involuntary, repetitive, and sudden movements and vocalizations. With tics, you can feel out of control of your own body, doing things or making noises that you don’t  intend. Tics are more common than you may expect, affecting 1 in 50 individuals, meaning that for 2% of the population, having full control of their body is something that can feel well outside their grasp. This is where Comprehensive Behavioral Intervention for Tics (CBIT) comes into play. CBIT is a psychotherapy designed to teach individuals strategies to manage tics without use of medicine.

How was CBIT started?

In 2001, following a long-overdue increase in awareness of tics, the Tourette Association of America (TAA) raised  the need at the Behavioral Sciences Consortium for a non-pharmacological treatment for Tourette Syndrome. With many great minds working together, the first framework for CBIT was formed and was soon put to the test in multiple studies, which found CBIT to be effective. This data was later used to help create the first Treatment Guidelines for Tourette Syndrome and Tic Disorders, published by the American Academy of Neurology in 2019, with CBIT being promoted as the first-line treatment for tics. 

The Main Components of CBIT

So what exactly is CBIT, and can it help you? CBIT consists of four main components: Psychoeducation; Relaxation training; Functional intervention; and Habit Reversal Training (HRT).

• Psychoeducation

Psychoeducation involves learning about Tourette Syndrome and tic disorders, what tics are, and what you can expect from life with Tourette Syndrome or other tic disorders. The goal of psychoeducation is to give you a better understanding of your diagnosis. The hope is that understanding of your diagnosis will help give context for the work being done in treatment. Additionally, knowing more about what’s being done can increase motivation to complete therapy.

• Relaxation Training

Tics are often exacerbated by big emotions. Lots of excitement, lots of stress, or similar emotions can greatly increase tics. In this part of treatment, you learn different techniques to relax. This may include breathing methods or muscle relaxation exercises. The goal of this is to give you tools to manage your emotions. Having better control of your emotions gives you more control over your tics. These relaxation techniques also can help with the skills we teach in HRT.

• Functional Intervention

Functional intervention focuses on identifying what in the environment might make your tics worse. This can be different situations, emotions, other people’s reactions to your tics, and more. There are many different factors that can worsen or trigger your tics. An important part of functional intervention is identifying and lessening or modifying those factors in your life. We will discuss how we can modify your environment to best accommodate you and your tics. 

• Habit Reversal Therapy

Habit reversal therapy focuses on learning strategies to directly decrease intensity and frequency of tics. HRT consists of 3 components: Awareness training; Competing Response (CR) development; and Competing Response practice.

Seventy percent of people with tics report having a premonitory urge before having a tic. A premonitory urge is like a pressure or an itch that people feel, which tells them to tic. These premonitory urges generally have some specific action they are trying to accomplish. In the awareness component, we identify premonitory urges. We do this to increase awareness of when you’re going to tic.

Next, we focus on competing responses. Competing responses are behaviors we put in place when you get the urge for certain tics. Competing responses have three criteria: They should be

1. Incompatible with the tic

2. Able to be done anytime anywhere, and

3. Less noticeable than the tic.

The goal of using a CR is to learn that engaging in the tic is not the only way to get rid of the uncomfortable premonitory urge. In fact, if you  use a CR to ride out the urge, the urge will actually go away on its own. We know this can sound impossible when just reading about it, but it makes sense when practiced. An example may be if the tic is to raise your arm, you would hold your arm down against your sides. The longer a competing response is in use, the less frequent the tic will become. Ideally, the tic will disappear completely after enough practice.

How is CBIT Administered?

The standard format is eight sessions over 10 weeks– in the most ideal cases. Typically, the actual amount of time that a client needs can depend on a number of factors, including the client’s awareness of their premonitory urge; their motivation to do homework; and their ability to complete the homework on a weekly basis. Sessions are usually spent-one on-one in a therapist’s office. However, there has been recent research in support of the efficacy of teleCBIT, a virtual form of CBIT, and we at Central Therapy offer both in-person and online CBIT to accommodate your availability.

The Bottom Line

As we stated above, CBIT is the most effective treatment for developing strategies to manage your tics and give you more control over your body, and can be done without medication. One of the wonderful things about CBIT is that it can be self-led after completing treatment with a trained therapist. The knowledge about your tics and preferences are things that can be remembered and put into use at any time. You will be able to understand your tics more, recognize your own urges, and create competing responses for any tics you may experience after treatment. 

Our CBIT team at Central Therapy is headed by Dr. Jeremy Lichtman, an expert in tics and Tourette's for over a decade, and a certified CBIT provider. He trains, supervises, and oversees all of our CBIT therapists.

After reading all this, you may be wondering: Can this help me? If you or your child have tics and are interested in finding out whether CBIT will work for you, contact us today!