In this blog series, Steve Pally, administrator of the TSFC Forum (www.tourettesyndrome.ca), explains the basics of CBIT, or Comprehensive Behavioral Intervention for Tics.
CBIT (pronounced see-bit) is a non-pharmacological treatment for Tourette Syndrome.
It combines six strategic therapeutic components in the form of a clinically proven, comprehensive therapy to help a person with Tourette Syndrome manage their tics, including:
- Psychoeducation: Examining what situations tend to make tics worse and what situations make tics better. A person can then use this knowledge to avoid the situations that exacerbate their tics or find ways to lessen their impact. They might also seek out situations that lessen tic activity.
- Self-awareness training: Learning to recognize signs that a tic is about to occur. Tics are usually preceded by a premonitory urge which is the key to knowing when a tic is about to be expressed.
- Relaxation training: Acquiring strategies for minimizing stress and managing tics. Examples include deep breathing, progressive muscle relaxation and guided imagery.
- Tic Analysis: Identifying a person’s most bothersome tic (Note: not the tic that bothers someone else,but rather the tic that causes individual the most discomfort, distress or difficulty). A CBIT therapist helps the individual to recognize any premonitory urge or urges that precede that particular tic. They then break down the tic into its components (i.e., the precise muscle movements involved in the tic from start to finish).
- Competing Response (CR)/Tic Blocker: Responding to the urge to perform a particular tic with an action that’s less conspicuous than the tic itself and can be performed without any external aids or devices. For example, if a person with TS has a tic that involves head rubbing, a new action might be for that person to place his or her hands on his or her knees, or to cross his or her arms so that the head rubbing cannot take place. Once a person identifies a CR for their bothersome tic, they perform the CR whenever they experience the urge to perform the bothersome tic, until the urge passes, usually in a minute or two.
- Social support: Getting encouragement and assistance from family, friends and educators. Parents may have to advocate on their child’s behalf at school to alert teachers about a child’s needs. Positive reinforcement at home is also important for children. When a child employs the correct CR, they should be praised. If they happen to miss using the CR and the tic emerges, parents need to remind the child about using the CR, not in a punitive tone, but in a supportive and encouraging one.
CBIT does not cure Tourette Syndrome or eradicate tics; rather, it provides strategies to help manage tic symptoms and lessen their impact.
About the blogger: Steve Pally was diagnosed with TS as an adult in his mid-forties. He has volunteered with TSFC for nearly three decades and currently co-administers the TSFC information and support Forum at www.TouretteSyndrome.ca. His interest in CBIT was sparked when he realized many of the strategies taught in a ten-week period in CBIT today were familiar to him, but took him decades on his own to discover them, as have many other adults with TS. That’s why he is eager to acquaint as many people as he can with CBIT so they can take advantage of recent developments for tic management.