An Overview of Comprehensive Behavioral Intervention for Tics (CBIT)
Comprehensive Behavioral Intervention for Tics (CBIT) is a behavioral intervention used to lessen the severity of tics. Individuals with tic disorders, including Tourette’s Disorder, often benefit from this non-pharmacological intervention which focuses on increasing an individual’s awareness of the tic, understanding factors that increase tics, and learning to perform a competing response when the urge to tic arises. Of note, research does not support the concern that new tics will emerge or existing tics will increase in severity due to participation in CBIT.
Core Components of CBIT
When meeting with an individual an assessment is completed to obtain information related to factors that may increase the prevalence of tics. This includes looking at antecedents, or events that occur before the tics, as well as consequences, or events that occur after a tic. Internal and external antecedents may exacerbate tics. An example of an internal antecedent is anxiety or excitement, while an external antecedent might include the setting the child is in (i.e. gym class, parties). An example of a consequence of the tic might be a parent allowing a child to take a break from their homework when the tics emerge. Increased attention from family members and peers, as well as bullying or teasing are also examples of consequences.
Awareness Training
During awareness training the individual describes the tic, factors that increase the prevalence of the tic, as well as the physical sensations and urges that accompany the tic. In discussing these physiological sensations the individual should come to identify the premonitory urge which tends to precede the occurrence of the tic.
Competing Response Training
A premonitory urge tends to precede the tic, and it is at the initial onset of the urge that the competing response should be used..A competing response is most often a behavior that is physically incompatible with the tic. For instance, an individual with a mouth grimace tic might purse their lips together when they experience the urge to tic. The competing response is held for 60 seconds or until the urge disappears, whichever is longer. The therapist and client will collaborate to determine the most appropriate competing response, and this response will be practiced in session. Within sessions the therapist and client will also discuss socially inconspicuous competing responses, and how the client can consistently practice the competing response in real life settings.
Social Support
For children and adolescents parents often assist in helping with the ‘homework’ that is completed outside of sessions, which includes the monitoring of tics and competing responses. Parents may provide prompts and reminders to use completing responses when tics are present. Additionally, it can be helpful at times to reward a child’s practice of skills outside of session (i.e. completing monitoring logs, using completing responses) to small incentives to increase a child’s willingness to practice skills and maintain motivation.