Comprehensive Behavioral Intervention for tics Therapy

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CBIT Therapy is a specialized and private occupational therapy practice supporting children, teens, and adults with a wide range of tic disorders. We are certified in Comprehensive Behavioral Intervention for Tics (CBIT) and affiliated with the Tourette Association of America. Our practice runs completely online via telehealth to enable our patients to receive services in the most effective, convenient, and safe way during the COVID-19 pandemic. Therapy is currently available in Massacusetts, New Hampshire, Maine, and Vermont.

Tics are sudden, involuntary, and rapid movements done repeatedly over an extended period of time. They can occur anywhere in the body and be highly noticeable or hidden from the view of others. Tics are often distracting, annoying, embarrassing, and painful. The severity of a tic can only truly be judged by the person experiencing it.

Tics are classified as motor (movement tics) or phonic (sound tics).  In fact, all tics involve movement, so it is important to examine the exact muscle or muscle groups involved with each tic in order to decrease the frequency of occurrence.

Preceding tic onset, there is often a a slight physical sensation or thought that signals that a tic is coming. This is called a premonitory urge. The urge may differ from one tic to another.  One of the primary components of CBIT involves recognizing urges and then using them as a tool to activate competing responses to inhibit the tics. Competing  responses are very specific actions and restrictions of action to prevent tics from occurring. For example, the competing response for hitting the chest may involve crossing one's arms behind the back, lacing fingers together, and then silently counting 30 slow breaths. This competing response is incompatible with hitting oneself.

Tics often are thought to be 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. 

The most well known tic-related neurological condition is Tourette Syndrome, also referred to as Tourette Disorder, Tourette's or TS. Tourette's is more common in males than females and involves both motor and phonic tics present for over one year. Age of onset is typically prior to or during early elementary school. Peope with Tourette's tend to have co-occuring conditions such as ADHD and OCD, and average to above average intelligence.

Persistent Tic Disorder is a condition that involves only motor or phonic tics for more than one year. 

Provisional Tic Disorder involves motor or phonic tics lasting less than a year. 

It is also very common for tics and tic-like symptoms to be caused by emotional dysregulation, instead of a neurological condition. These type of tics are often called functional tics or anxiety tics are related to having a Functional Neurological Disorder or FND. These tics are an outward expression of inner distress. Functional tics often have a sudden onset and are much more extreme in appearance and number than someone who has a neurologically based tic disorder. People with functional tics often find their tics to be funny, this is rarely the case with people with neurologically based tics.

Viewing of TikTok, YouTube, and other social media with tic and tic-like content has been linked to a sudden and dramatic onset of functional tics during the pandemic. This form of FND, which is most common in female teenagers, is now known as TikTok Tics, In 2020 the Calgary Tic Disorders Clinical Registry labeled this disorder Functional Tic-Like Behaviors (FTLBs) and is tracking cases closely. The condition can be extremely disabling and is even associated with suicide attempts. Sudden onset tic-like behaviors are 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 situational factors 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 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.