Comprehensive Behavioral Intervention for tics

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CBIT Therapy is a specialized 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.

Tics are sudden and involuntary twitches, movements, or sounds done repeatedly over a period of time. They can occur anywhere in the body and 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 a slight physical sensation or thought that signals that a tic is coming. This premonitory urge nags patients to move or make a vocalization. It is extremely difficult to resist action. Tics can sometimes be suppressed temporarily, however, research shows that it is more beneficial to gain training in Comprehensive Behavioral Intervention for Tics (CBIT) to decrease the  frequency and intensity of tics. 

One of the primary components of CBIT involves 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 and tic-like symptoms to be caused by extreme emotional dysregulation instead of a neurological condition. Instability, loss, depression, fear, and anxiety caused by the COVID-19 pandemic are the current leading causes 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, 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.