Health Library

Tics: Comprehensive Behavioral Intervention (CBIT)

Tourette syndrome is a neurological condition beginning in childhood where people have tics that change over time. Tics are a kind of repeating movement and / or sound.

CBIT is an established therapy that teaches people to change their behavior over time and tic less. Research on CBIT has been done with children and adults with Tourette syndrome.

CBIT is based on three simple observations about tics:

1. Tics can get better and worse on their own.
2. Tics are often done in response to a feeling or urge.
3. Tics can often be stopped, at least for a short time.

What Is Involved in CBIT?

For CBIT to be successful, the child or adult needs to:

• Work with a therapist
• Do homework
• Attend therapy training sessions

How Does CBIT Work?

CBIT is based on these simple actions, which teach people to tic less:

Action	What To Do	Homework
Change the situation	Notice situations where tics are better / worse.	Change the situation to reduce tics.
Watch the tic	Break the tic down into each step. Watch for any urge inside you that may occur before the tic starts.	Watch each step of your tic and know the steps of the urge / tic.
Refuse to give in to the urge / tic	Talk about the steps to fight back against the urge / tic and to put off doing the urge / tic.	Relax and fight back the urge and put off doing the tic.
Change the bad tics	Make up and practice “Competing Responses” (a movement that is the reverse of the tic). For example, in place of your hand coming up you push it down.	When the tics occur, remember to do the competing responses that you made up in therapy.

Who Can Teach CBIT?

Any person who has had CBIT training can perform this treatment, such as a doctor, nurse, social worker, or psychologist / counselor. The number of visits can be different for each person.

Where Can I Get This Treatment?

The Cincinnati Children's Tourette Syndrome and Tic Disorder Clinic offers CBIT. The doctor or nurse seeing your child will help decide if this treatment is right for your child. It may also be available in your area by other providers.

To Get More Information about CBIT Therapy at Cincinnati Children’s

• If you have never been seen at Cincinnati Children’s for tics, call 513-636-4222, option No. 1 and ask for a new patient appointment in the Movement Disorder Clinic. You will need to be seen in clinic first for an exam so that we can decide if CBIT would be helpful.
• If you are a current patient at Cincinnati Children’s and have been seen in the Movement Disorder Clinic for tics, call 513-636-4222 and ask for the movement disorder nurse or email us at tics@cchmc.org.

Additional Resources for CBIT

• Visit the National Tourette Syndrome Association website
• Managing Tourette Syndrome: A Behavioral Intervention Workbook, Parent Workbook. Douglas W. Woods, John Piacentini, Susanna Chang, Thilo Deckersbach, Golda Ginsburg, Alan Peterson, Lawrence D. Scahill, John T. Walkup, Sabine Wilhelm. Oxford University Press.

  Available on Amazon.

• Nix Your Tics! Eliminate Unwanted Tic Symptoms: A How-To Guide For Young People. B. Duncan McKinley, PhD. Life’s A Twitch! Publishing.

  Available on the TSA website.