Habit Reversal Therapy for Tics , FND, and BFRB

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  • HOME
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Teenager with Tourette Syndrome at high school practicing CBIT strategies for tics.

Tic Disorders and Tourette Syndrome

Tics are purposeless, involuntary, and repetitive movements and vocalizations. Common tics include head jerks, blinking, and throat clearing, They are often preceded by a nagging thought or feeling called a premonitory urge that demands a specific rapid action. Tics can be very simple and unnoticeable to others or involve multiple muscle groups and be extremely obvious. Tics can cause great frustration, embarrassment, and physical pain.  At times, tics also can make it difficult to communicate with others and complete daily tasks. Excessive attention to the tics from peers and family members often exaceerbates the tics. 

Tics initially develop one at a time, perhaps starting with blinking and then months or years later involving a neck movement or shoulder shrug or other movements or sounds.   Some people just have motor (movement) tics and some people just have vocal (sound) tics. The frequency and intensity varies from person to person, day to day, and over periods of time. Provisional Tic Disorder is common in young children and is defined as motor or vocal tics occurring for less than one year. After one year of motor or vocal tics, neurologists tend to make a diagnosis of Chronic Tic Disorder. People with both motor and vocal tics lasting for more than one year are typically diagnosed with Tourette Syndrome, aka Tourette's, Tourette Disorder, or TS. Many people who have Tourette's also have concerns related to anxiety, depression, Autism, OCD, ADHD, gender dysphoria, handwriting, and executive functioning. Some people with Tourette's also have Body Focussed Repetitive Behaviors (BFRB) such as skin picking or biting and hair pulling (trichotillomania).


People with tics also are known to be very bright and empathetic and to have amazing skills in areas including math, music, art, science, sports, medicine, and education. In fact, people with tics are often very driven to succeed and live highly productive and meaningful lives. 

Comprehensive Behavioral Intervention for Tics (CBIT)

CBIT is the leading intervention strategy for Tic Disorders and Tourette's. CBIT is provided by licensed and certified health professionals with extensive training in physical dysfunction, and mental health support. With CBIT Therapy our services include the following components:


  • Sensory training to become more aware of tics and internal signals that they are about to occur.
  • Physical techniques to block and reduce the frequency and intensity of future tics.
  • Lifestyle changes to reduce internal and external stressors.
  • Training in how to access accommodations at home, school, and on the job.
  • Referrals for related neurological, physical, and emotional concerns.
  • Patient and family education and support.
  • Consultation with medical and educational teams.
  • Advocacy.


Many children and adults are able to quickly reduce the intensity and frequency of their tics by practicing CBIT therapy strategies. Progress is dependent on motivation to manage tics, tic severity, and family support. Click here for a brief video about how CBIT helps to manage tics.

Living with Tourette's

Warning: 

This video is about Tourette Syndrome and viewing it may trigger tics in some people.

Neurology clinics specializing in Tics

UMass Tourette Clinic

MGB Tourette Syndrome Clinic

MGB Tourette Syndrome Clinic

Wissam Deeb, M.D.

Neurology Clinic, University Campus

55 Lake Avenue North

Worcester, MA 01655

Tel: 508-334-2527


MGB Tourette Syndrome Clinic

MGB Tourette Syndrome Clinic

MGB Tourette Syndrome Clinic

Marisela Dy-Hollins, E., M.D.

MGH Tourette Syndrome Clinic

Wang Ambulatory Care Center
15 Parkman Street, 7th Floor, Room 720
Boston, MA  02114
Tel: 617-724-9234

Boston Children's Hospital

MGB Tourette Syndrome Clinic

UVM Tourette / Tic Disorder Clinic

Kinga Tomczak, MD, PhD

Attending Physician in Neurology

Director, Tic Disorders and Tourette Syndrome Program

Department of Neurology

Boston Children’s Hospital

Harvard Medical School

Tel: 781-216-2525 (Waltham)​ 617-355-2063 (Boston)


UVM Tourette / Tic Disorder Clinic

UVM Tourette / Tic Disorder Clinic

UVM Tourette / Tic Disorder Clinic

UVM Tourette / Tics Clinic

University of Vermont
2 Colchester Avenue
Burlington, Vermont 05405
Tel: 802-656-2661


Community Neuroscience Services

UVM Tourette / Tic Disorder Clinic

Community Neuroscience Services

Christy Stine MD, PhD

Pediatric Neurology

33 Lyman St, Ste 400

Westborough, MA 01581

Tel: 508-898-0055

Fax: 508-898-0035


Resources for tics and Tourette's

Social Story about Tourette's

Social Story about Tourette's

Social Story about Tourette's

Young child with Tourette's reading about Tourette Syndrome and tics.

Explaining CBIT, tics, and Tourette Syndrome to a child and their friends is easier with the help of a social story.

Explaining TS to others

Social Story about Tourette's

Social Story about Tourette's

Card explaining tics and Tourette Syndrome.

Educate others about tics and Tourette Syndrome in a quick and effective way. Prepare an elevator pitch, email, text, or put your message on a business card. You can also click here for the TAA "I have TS" card.

Support Groups

Social Story about Tourette's

School Accommodations

Multiracial hands piled on top of each other for support

Join with others who have Tourette Syndrome and other tic disorders to make connections and new friends. Learn about CBIT, camps, social events and more resources on tics. Click here to contact a local chapter in Boston and other cities across America.

School Accommodations

School Accommodations

School Accommodations

Teenager in class

Practical strategies and accommodations are help for students with Tourette Syndrome and tics of all kinds to thrive in school settings. Learn more by contacting CBIT Therapy or  the Tourette Association of America.

Work Accommodations

School Accommodations

Work Accommodations

Electricians with hard hats

Know your rights. Reach out to the Job Accommodation Network (JAN) for free and confidential guidance on how to manage Tourette Syndrome and other conditions related related to tics while on the job and when seeking new work. Your skills are needed and valuable. 

CBIT Therapy

School Accommodations

Work Accommodations

Teens elbow touching while wearing masks.

Our name says it all. We specialize in CBIT therapy and are passionate about supporting our patients and their families so that they can better manage Tourette Syndrome and other conditions related to tics. Services are provided by a licensed occupational therapist certified in CBIT. 

Contact Us
Man with Tourette Syndrome blocking tics caused  by Tourette's.

blocking

Some people with Tourette Syndrome experience blocking phenomena, which is an inability to move.  Patients tend to get stuck in awkward and painful positions that can be highly debilitating.

Blocking Phenomena

What we know about blocking

Although some people with Tourette Syndrome experience brief times when their bodies are locked in awkward and debilitating positions, prolonged and highly agonizing periods of immobility also occur in some patients. Despite how emotionally and physically disabling this experience can be, research on the cause and treatment is highly limited.  


Blocking is thought to be related to tics, OCB/OCD or a Functional Neurological Disorder. People who suffer from blocking may also have more than one of these conditions. 


CBIT Therapy is developing strategies to prevent and interrupt freezing postures caused by blocking phenomena. Above all it is important to keep the patient safe. At times this may involve helping them to the floor so they do not fall. Tensing muscles more may help to release the body. Practicing tensing and relaxing during stable times is important. Slowly  gazing up and down when the rest of the muscles are stuck may also be useful to break the grip.


The most effective strategy for blocking seems to be managing preceding tics with CBIT.

Please contact us for more information about blocking phenomena, Tourette Syndrome, and tics.

Ice cubes representing Tourette blocking tics
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