Comprehensive behavioural intervention for tics

Domain II · Behavioural & cognitive · Woods, Piacentini, Chang · 2008

What it is

Comprehensive Behavioural Intervention for Tics (CBIT) is a short, skills-based outpatient behaviour therapy for Tourette syndrome and persistent (chronic) motor or vocal tic disorder. At its core is habit reversal training (HRT; Azrin & Nunn, 1973), with function-based assessment and intervention,…

Format

• Format. Individual outpatient therapy. Children attend with a parent or caregiver who sits in on sessions; adolescents may be seen alone with the family brought in as needed; adults need only minor changes. The protocol was designed for ages 9 and up and was tested in children aged 9–17 and in…
• Dose. 8 sessions over 10 weeks: sessions 1–6 weekly, then sessions 7 and 8 every other week. In the child trial, responders also had 3 monthly booster sessions. Some clinicians report about 10 sessions in routine practice, and the length depends on how many tics bother the client.

Who practises it, and how they are trained or regulated

• Session sequence (manual structure, as reported in training slides citing Woods et al. 2008):
• Response detection and early-warning training continue until the client detects about 4 of 5 tics or urges.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Skills dropping off as tics decrease. Working: gains maintained at follow-up.
• Dependence on the therapist to design CRs. Working: the client designs a workable CR independently.
• Pain from tensing in tic-affected muscles. Use gentler tension there. Working: the client can relax on cue.
• Over-breathing or dizziness (slow down). Use as avoidance. Working: the client reports feeling calmer in trigger situations.
• Clients who report no inconvenience for a tic. Consider whether it should be targeted at all. Working: the client links practice to things they value.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.