CBIT

Comprehensive Behavioural Intervention for tics

Comprehensive Behavioral Intervention for Tics, commonly abbreviated as CBIT (pronounced SEE-bit), is an evidence-based treatment specifically designed to help individuals with motor and vocal tics, including those with Tourette’s Syndrome. CBIT is widely recognized and supported by leading international health organizations, including the Tourette Association of America and the American Academy of Neurology, which recommends it as a first-line treatment for tic disorders.

CBIT has been rigorously studied and shown to be effective in reducing tic severity in both children and adults. Numerous research studies have demonstrated its success, with many participants experiencing a 30-50% reduction in tics after completing CBIT therapy. Studies have shown that around 60-70% of individuals who undergo CBIT experience significant improvement in their tic symptoms. In some cases, participants achieve reductions in tic severity even beyond these averages, particularly when they engage consistently with the therapy.

Importantly, CBIT is a non-pharmacological intervention, making it a valuable alternative or complement to medication. It is particularly effective for individuals whose tics interfere with their daily functioning, and it can be used with people across a range of ages, from young children to adults.

What is involved?

CBIT involves a structured therapeutic process designed to help participants become more aware of their tics and learn specific strategies to manage them. It typically requires six to twelve sessions, depending on the severity of the tics. Here’s what participants can expect:

1. Awareness Training: In the initial sessions, participants are taught to recognize the early signs of a tic, which often include premonitory urges or sensations just before the tic occurs. This awareness is the foundation of CBIT.

2. Competing Response Training: Once individuals can identify when a tic is about to happen, they are taught to engage in a competing response—a behavior that is physically incompatible with the tic. For example, if a person’s tic involves head jerking, they might be instructed to gently tense their neck muscles instead.

3. Relaxation and Stress Management: Because stress and anxiety can worsen tics, CBIT also includes relaxation techniques and lifestyle adjustments to reduce tic triggers. This part of the therapy focuses on stress reduction and building a supportive routine.

4. Generalization Training: The final component of CBIT helps participants apply the strategies they’ve learned across different settings, such as at home, school, or work. This ensures that the skills become part of daily life and that participants can manage tics in a variety of situations.

CBIT is a practical and interactive therapy, requiring the active involvement of participants in identifying and practicing the strategies between sessions. For children, parents are often involved in the process to reinforce these strategies at home.

  • CBIT is effective for both children and adults who have motor or vocal tics, including those diagnosed with Tourette’s syndrome. It works well for individuals who want to reduce their tics and are willing to engage actively in therapy.

  • CBIT teaches participants to become aware of their tics and develop competing responses (actions that prevent the tic) to help manage or reduce the tics. It also includes relaxation techniques and strategies for reducing triggers like stress.

  • Research shows that around 60-70% of people who complete CBIT therapy experience a 50% or greater reduction in the frequency and severity of their tics. Many individuals maintain long-term improvements after completing the program.

  • Intervention typically involves 6 to 12 sessions, depending on the severity of the tics and how well the participant responds. Mild cases may need fewer sessions, while more severe cases could require the full 12 sessions.

  • CBIT is not a cure, but it significantly reduces tic severity for many people, allowing them to manage their symptoms better and improve their quality of life. Tic reduction is typically long-lasting when skills learned during therapy are consistently applied.

  • No, CBIT is a behavioral therapy that does not involve the use of medication. It focuses on teaching skills and strategies to reduce tics without relying on pharmacological interventions.

  • Yes, CBIT can be used in conjunction with medications prescribed for tic disorders. Many individuals find that combining behavioural therapy with medication offers even better control over their symptoms.

  • CBIT is based on Habit Reversal Therapy (HRT) but expands on it by including other components like relaxation training and lifestyle changes. While HRT focuses on competing responses, CBIT also addresses factors that exacerbate tics, such as stress and anxiety.

  • In a typical CBIT session, participants are first taught awareness training to recognize the signs before a tic occurs. Then, they practice competing responses (Ivan prefers the term 'Tic Blocker') to block the tic and learn strategies to reduce stress and improve their overall tic management.

  • The benefits of CBIT can last for a long time, especially if the participant continues to apply the strategies learned in therapy. Many people experience sustained improvements in tic severity after completing the program.

  • Yes. In fact, Ivan prefers that parents attend at least the first three appointments, even in the cases of teenagers. Parents play an important role in supporting their child through CBIT, especially when practising strategies outside of therapy sessions.

  • In Australia, CBIT (Comprehensive Behavioral Intervention for Tics) can be covered under Medicare through the Better Access to Mental Health Care initiative. This allows individuals to receive rebates for psychological services, including CBIT, when referred by a GP, psychiatrist, or pediatrician under a Mental Health Treatment Plan.

    Medicare provides a rebate for a certain number of sessions per year (up to 10 sessions), but the total cost of CBIT therapy exceeds the rebate amount. The current rebate paid by Medicare is $141.85 per session.