At a glance
Comprehensive behavioral intervention for tics (CBIT) is a type of behavioral therapy that can help people with tics and tic disorders manage their tics better. CBIT can be effective for many people with tic disorders, including Tourette syndrome.
Background
For many years, medication was the only real treatment option for children and adults with TS. Medication can help control tics, but it doesn't always work. Medication can also cause side effects that make people feel bad and can lead to other health problems. Researchers working with the Tourette Association of America began developing and testing a promising treatment option12 that does not use medication, called comprehensive behavioral intervention for tics, or CBIT (pronounced see-bit).
The first large study of CBIT in children was published in 2010.1 Since then, work to learn more about this treatment, and to make it more widely available, has continued.
About comprehensive behavioral interventions for tics
CBIT is a type of behavioral therapy that is very systematic and carefully planned according to a person's specific needs and symptoms, and typically takes place in a therapist's office. During CBIT, the therapist helps individuals with tics learn to
- Become more aware of their tics and the urge to tic.
- Carefully choose and practice a new behavior instead of the tic. This "new behavior" (competing response) helps reduce and, in some cases, even eliminate the tic.
- Identify situations that can make tics worse and find ways to change them.
- Learn ways to prevent or cope with stress.
An effective treatment option
"It's the first therapy I try," said Dr. Leon Dure, a pediatric neurologist from the University of Alabama at Birmingham. "It has been very effective."
Linda Rowland, mother of Lucas, 15, who has Tourette syndrome, shared her experience: "Over 4 years, we tried medication, which was a negative experience, and diets, and neuro-feedback, with no lasting improvement. Two days after Lucas started CBIT the first tic was gone. Now he is basically tic-free for the first time since third grade. If we had CBIT 4 years ago, it would have made the past 4 years so much better. One thing I really like about CBIT is that Lucas is learning how to address tics, so if new ones come up, he'll be able to manage them on his own."
When this behavioral treatment was first developed, health professionals were concerned that it could cause more misunderstandings about tics. Just because tics can be managed by changing behavior doesn't mean that tics are done by choice. Dr. Doug Woods, a clinical psychologist from Texas A&M University and one of the leading experts in CBIT, compared behavior therapy for tics to rehabilitation after a stroke. "If people with Tourette syndrome learn new skills, they can overcome many of the problems caused by their neurological disorder."
During the past decade, there has been increasing evidence that CBIT can be effective for many people with Tourette. Experts now suggest using it as the first approach to treatment because its effectiveness is similar to medications but with fewer side effects.3 But the evidence also shows that CBIT is not a "cure" for Tourette syndrome and does not help everybody; rather, CBIT is a tool that, when used appropriately, can help many people with Tourette syndrome manage their tics better and reduce the impact that tics may have on their lives. Researchers continue to learn more about how and for whom this treatment is most effective.
Education and outreach
Because CBIT is still a relatively new and specific treatment for tics, healthcare providers need training so that they can offer this treatment. People with Tourette syndrome and their families need to be informed that it is available and how to find a practitioner who could help them. CDC partners with the Tourette Association of America to provide CBIT training for health professionals and educational programs about CBIT for people who have Tourette syndrome and their families. In the past decade, the partnership has supported 120 CBIT programs with about 3,700 attendees. The Tourette Association of America has also supported 33 training institutes for CBIT, with close to 300 practitioners becoming licensed to provide CBIT to their patients.
With limited options for direct access to training and treatment in the current environment, there is more need than ever to find ways to use telehealth approaches. The Tourette Association of America has worked with experts to identify ways to provide teletraining to professionals who want to learn about CBIT. They also assist professionals who have been trained on CBIT so that they can learn to provide the therapy to their clients via telehealth. In the long term, telehealth can help families who live in rural areas, who have difficulty finding time to visit with a provider, or who have trouble finding a trained provider by giving them options for accessing treatment.
Tourette Association of America CBIT training is part of the Tourette Health and Education program, a CDC-TAA partnership to provide information, training, and support for those who have Tourette syndrome, their families, healthcare providers, educators, and the general public. Since the start of the partnership in 2004, TAA has conducted more than 1,175 education programs throughout the nation.
- Piacentini, J., Woods, D. W., Scahill, L., Wilhelm, S., Peterson, A. L., Chang, S., Ginsburg, G.S., Deckersbach, T., Dziura, J., Levi-Pearl, S., Walkup, J. T. (2010). Behavior therapy for children with Tourette disorder: a randomized controlled trial. JAMA, 303(19), 1929-1937.
- Wilhelm, S., Peterson, A. L., Piacentini, J., Woods, D. W., Deckersbach, T., Sukhodolsky, D. G., Chang, S., Liu, H., Dziura, J., Walkup, J. T., Scahill, L. (2012). Randomized trial of behavior therapy for adults with Tourette syndrome. Arch Gen Psychiatry, 69(8), 795-803.
- Pringsheim, T., Holler-Managan, Y., Okun, M. S., Jankovic, J., Piacentini, J., Cavanna, A. E., et al. (2019). Comprehensive systematic review summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology, 92(19), 907–915. doi:10.1212/WNL.0000000000007467.https://n.neurology.org/content/92/19/896