Behavioral Therapy/CBIT Clinic

Many patients do not require treatment for their tics. For those that do, behavioral therapy is a popular choice. Behavioral therapy is not a cure but it can help to reduce the number, severity or impact of tics. It is important to note that even though behavioral therapy can help, this does not imply that tics are completely under voluntary control. Tic disorders are a neuro-biologic condition. Though individuals may have some voluntary control – tics are not produced purposefully.

Behavioral Therapy/CBIT Clinic

In Comprehensive Behavioral Intervention for Tics (CBIT) sessions, a therapist work with a child (and his/her parents) or and adult to better understand the patients’ tics and the situations in which they occur. Changes to surroundings will be made if possible and the individual with tics will also learn a new behavior (competing response) to do instead of the tic. Practice and support for the individual with tics is an important part of success of this technique. A typical course of CBIT consists of 11 hour-long sessions spread over several months, though some patients may require far fewer. Occasionally, there are additional sessions. Read more about CBIT below.

At our Clinic, Gail Reiner, D.N.P., FNP-C, and Anna Carrion-Gelabert, a Tourette Syndrome Association-trained CBIT practitioner, provides this therapy. We can also provide referrals to providers in the community if our location is not convenient for you. A referral to the CBIT Clinic can be made by any of our neurologists, though it is most often recommended after evaluation in our Tic/Tourette Center.

Behavioral Therapy/Parent Training

Parent training may be helpful for parents to better understand tics and associated behavioral issues. This training may enable parents to identify situations that may trigger tics and help them to alter the environment and/or interactions in a way that may benefit their child’s tics. Training may help parents to learn skills specific to their child’s problems including the use of positive reinforcement and/or discipline. Parent training may be recommended as part of your child’s plan of care. We offer this training through our CBIT clinic.

Definitions

Comprehensive Behavioral Intervention for Tics (CBIT) is an evidence-based therapy that combines Habit Reversal Therapy (see below) with other strategies, including education about tics and relaxation techniques. CBIT has been shown to be effective at reducing tics and tic related symptoms in children and has shown promising results in adults.

Habit Reversal Therapy (HRT) was pioneered by Dr. Greg Nunn (see our Team page) and Dr. Nathan Azrin in the 1970s. HRT consists of two main components: awareness training and competing response training. In awareness training, people identify each tic and associated urge. In competing response training, people learn to do a new behavior that is incompatible with the tic. For example, if the tic is to turn the head to the right, the competing response might be to tense the muscles to turn the head to the left.

Helpful CBIT Resources

On the Resources page under “Tic/Tourette Syndrome,” “Books,” please see “Managing Tourette Syndrome: A Behavioral Intervention Workbook” and “Nix Your Tics.”