Tics are sudden, quick, and repetitive movements or sounds that an individual performs involuntarily. These actions, which can be either motor (like blinking or shoulder shrugging) or vocal (such as throat clearing or sniffing), may occur in any part of the body. While often mild and temporary, tics can sometimes become more frequent or severe, potentially interfering with a person’s daily life. Comprehensive Behavioral Intervention for Tics (CBIT) provides a non-pharmacological, evidence-based approach for managing these movements and sounds.
Understanding Comprehensive Behavioral Intervention for Tics
CBIT is a specialized therapeutic approach for individuals experiencing tic disorders. The goal of CBIT is to help individuals gain control over their tics without medication. This therapy observes that tics, while neurological, are often preceded by sensations or urges and can be influenced by environmental factors. People can often temporarily postpone or stop tics, suggesting a behavioral component can be addressed.
CBIT is a structured therapy delivered over eight weekly sessions spanning ten weeks. A trained therapist guides the individual through techniques, focusing on breaking the urge-tic-relief cycle. This systematic approach teaches skills, empowering individuals to manage tic urges and behaviors, fostering self-awareness and confidence.
Core Components of CBIT
CBIT integrates several techniques to help individuals manage tics.
Habit Reversal Training (HRT) is a core part of this intervention, comprising two main phases.
Awareness training is the first phase, where individuals learn to identify their tics and the premonitory urges that precede them. These urges are described as an unpleasant sensation that builds until relieved by the tic, similar to an itch.
Following awareness training, competing response training teaches individuals to perform a voluntary movement incompatible with the tic whenever they feel an urge or notice a tic. For instance, if a person has a shoulder shrugging tic, they might learn to press their hands down on their lap or cross their arms. For a vocal tic like throat clearing, a competing response might involve quiet diaphragmatic breathing or making a subtle mouth movement. These new responses aim to be less noticeable or physically block the tic.
Psychoeducation is another component, involving the individual and their family learning about tic disorders, their causes, and how CBIT functions. This educational aspect aims to demystify tics, reduce misconceptions, and create a supportive environment by helping families understand how their reactions might influence tic expression. Understanding tics can also reduce stress and increase self-confidence, which can decrease tic severity.
Functional analysis helps therapists identify environmental factors or situations that worsen an individual’s tics. This involves observing antecedents (what happens before a tic) and consequences (what happens after a tic) to understand patterns and triggers. By recognizing these exacerbating factors, strategies can be developed to avoid or modify those situations, creating an environment that is less likely to provoke tics.
Relaxation training is also incorporated into CBIT to help manage stress and anxiety, which are known to intensify tics. Techniques such as diaphragmatic breathing or progressive muscle relaxation are taught to help individuals calm their nervous system. Learning to manage internal states of tension can indirectly reduce tic frequency and intensity, as stress often acts as a significant trigger for tic expression.
Who Can Benefit from CBIT?
CBIT is a treatment option for individuals experiencing tic disorders across age groups. Children, adolescents, and adults with diagnoses such as Tourette Syndrome, chronic motor or vocal tic disorder, or provisional tic disorder can find benefit from this approach. The therapy helps those whose tics interfere with daily functioning or activities.
Individuals who prefer non-medication interventions, or for whom medications have been ineffective or caused side effects, are also good candidates for CBIT. While the therapy does not require complete control over tics, a willingness to engage in the learning process and practice the techniques is important for successful outcomes. The ability to recognize premonitory urges that precede tics is also beneficial.
Expected Outcomes and Efficacy of CBIT
Research indicates that CBIT can significantly reduce tic severity and associated impairment for many individuals. Large, multi-site studies funded by the National Institutes of Health have shown that over half of individuals who undergo CBIT experience notable reductions in tic severity. While CBIT does not eliminate all tics, it provides individuals with practical skills to manage their symptoms more effectively.
Patients often report decreased tic frequency and intensity, leading to improved daily functioning and quality of life. The long-term benefits of CBIT include reduced self-consciousness, increased self-efficacy, and greater control over their condition. Consistent practice of learned techniques between sessions is a significant factor in achieving and maintaining positive outcomes.