Manage motor and vocal tics with CBIT therapy

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CBIT Therapy is a specialized occupational therapy practice supporting children, teens, and adults with a wide range of tic disorders. Tics are sudden and involuntary twitches, movements, or sounds done repeatedly over a period of time. Tics occur anywhere in the body and can be highly noticeable or completely hidden from view. Tics are often distracting, annoying, embarrassing, and painful. They are rarely funny or a source of enjoyment. Preceding tic onset, many individuals report an urge to move or make a vocalization that is difficult for them to resist. With extreme effort, tics can sometimes be suppressed temporarily. Training in Comprehensive Behavioral Intervention for Tics (CBIT) often makes tics more manageable and less frequent and intense. One of the primary components of CBIT is using and holding specific competing responses to prevent tics from occurring. For example, the competing response for a tic that involves hitting may involve crossing arms behind the back and then pulling elbows towards each other while counting breaths for 60 seconds. This position is incompatible with the tic movement.

Tics are the primary symptom of three childhood-onset neurological conditions known as Tic Disorders, classified by the type of tics and length they have been present. Tourette Syndrome (TS) is more common in males and involves both motor and vocal/phonic tics present for greater than one year. Persistent Tic Disorder involves motor or vocal/phonic tics for more than one year. Provisional Tic Disorder  involves motor or vocal/phonic tics lasting less than a year.

It is also common for tics to be caused by extreme emotional dysregulation instead of a neurological condition. Instability, loss, fear, and anxiety caused by the COVID-19 pandemic is the current leading cause of this type of tics, often called "functional" and related to a Functional Neurological Disorder or FND. These functional tics are an outward expression of inner distress.

Both types of tics are suggestive in a way similar to how yawns are contagious. Tics are sometimes picked up during in person encounters, as well as while on Zoom calls and when watching videos. People with neurological tic disorders, such as Tourette's, briefly mirror the tics of others. However, people with FND may have vocalizations and movements for months or even years. Repetitive viewing of TikTok and YouTube videos with erroneous tic content has been directly linked to sudden and dramatic onsets of tics in some tweens and teens who previously did not have tics. This form of FND, which is most common in females, is sometimes called TikTokTics and can be extremely disabling. The condition is  often misdiagnosed leading to further complications related to medications and recovery.

The symptoms in both neurological and emotionally based tic disorders are real and require support to address underlying causes and to develop coping mechanisms. Understanding sensory and motor components of each tic is critical. CBIT Therapy  occupational therapists are all certified in Comprehensive Behavioral Intervention for Tics (CBIT) and have extensive training in anatomy, physical dysfunction, sensory integration, and mental health. Telehealth enables our patients to safely and conveniently participate in treatment sessions and to identify triggers and resources. With our approach, tic management strategies are immediately put into practice at home and in the community. CBIT Therapy is based near Boston and licensed to practice throughout Massachusetts, New Hampshire, and Vermont. 

CBIT Therapy is part of Online OTs LLC and collaborates with clinicians at UMass, MGH, Boston Children's Hospital, and many practices throughout New England. We request that all patients consult a neurologist prior to receiving therapy to determine the cause of their tics and to ensure proper medical care. A HIPPA compliant Google Suite platform is used for video calls. Allways Health Partners, Blue Cross Blue Shield, and private pay are accepted. Mass Health recipients are eligible for financial assistance.