Understanding Comprehensive Behavioural Intervention for Tics (CBiT)

Tics and Tourette's Syndrome can significantly impact an individual's daily life, affecting their social interactions, academic performance, and overall well-being. Comprehensive Behavioral Intervention for Tics (CBiT) is a non-medical treatment approach designed to reduce the frequency, intensity, and impact of tics. This blog will delve into what CBiT is, its components, effectiveness, and how it can be accessed through telehealth services.

What is CBiT?

CBiT is a structured, evidence-based therapy that helps individuals manage tics and Tourette's Syndrome. Unlike some treatments that focus on suppressing tics, CBiT aims to reduce their severity and impact through a combination of behavioural techniques. It is recommended as a first-line treatment before considering medication in Europe and Canada.

Components of CBiT

CBiT encompasses several components, each tailored to the needs and goals of the client. These components include:

1. Psychoeducation: Educating the client and their support system about tics, their nature, and the principles behind CBiT. Understanding the condition is crucial for effective management.

2. Functional Analysis: Identifying the situations and triggers that exacerbate tics. This involves detailed observation and recording of tic occurrences to understand their patterns.

3. Relaxation Training: Teaching relaxation techniques to help reduce overall stress and anxiety, which can often worsen tics. Techniques may include deep breathing exercises, progressive muscle relaxation, and mindfulness practices.

4. Awareness Training: Helping the client become more aware of their tics and the premonitory urges that precede them. This heightened awareness is the first step in learning to manage tics.

5. Competing Response Training: Developing and practicing behaviours that are physically incompatible with the tic. For example, if a tic involves head jerking, a competing response might be gently tensing the neck muscles.

6. Social Support: Involving family members or close friends in the treatment process to provide encouragement and assistance. For adults and older teenagers, the use of a support person is optional but can be beneficial.

Effectiveness of CBiT

Several randomised control trials (RCTs) have demonstrated the effectiveness of CBiT in reducing tic severity in both adults and children/adolescents with tic disorders. Habit Reversal Training (HRT), the core component of CBiT, has been shown to significantly decrease the frequency and intensity of tics. The collaborative and individualized nature of CBiT ensures that each intervention is tailored to the specific needs of the client, enhancing its effectiveness.

The Role of Habit Reversal Training (HRT)

HRT is a critical element of CBiT and involves several steps:

1. Awareness Training: The client learns to recognize the early signs of a tic, such as the premonitory urge that often precedes it.

2. Competing Response Training: The client is taught to perform a behaviour that is incompatible with the tic. This response must meet five criteria: it must be incompatible with the tic, not involve a prop, be sustainable for more than one minute, be performable anywhere, and be more socially acceptable.

3. Motivation: The client is encouraged to stay motivated by understanding the benefits of reducing tics and receiving positive reinforcement from their support system.

4. Generalisation Training: The client practices the competing response in various settings to ensure it becomes a natural and automatic reaction to the premonitory urge.

Accessing CBiT Through Telehealth

Telehealth has made it easier for individuals to access CBiT, regardless of their location. Graciously You psychologist, Natasha Kiemel-Incorvaia, offers CBiT via telehealth to individuals anywhere in Australia. This approach provides flexibility and convenience, allowing you to receive treatment from the comfort of your own homes.

Steps to Access CBiT via Telehealth

1. Initial Consultation: Schedule an initial consultation with a trained psychologist like Natasha to assess your needs and determine if CBiT is suitable for you.

2. Psychoeducation: Receive detailed information about tics, Tourette's Syndrome, and the principles of CBiT to understand the treatment process.

3. Functional Analysis: Work with the psychologist to identify triggers and patterns of your tics, possibly by keeping a tic diary.

4. Training Sessions: Learn and practice relaxation techniques, awareness training, and competing response training with regular feedback to ensure effectiveness.

5. Social Support (optional for adults): Involve family members or close friends in the treatment process for encouragement and assistance, if beneficial. Note this step is not always required for adults.

Benefits of Telehealth for CBiT

Telehealth offers several advantages for individuals seeking CBiT:

1. Convenience: Clients can receive treatment from the comfort of their own homes, eliminating the need for travel and reducing the time commitment.

2. Accessibility: Telehealth makes CBiT accessible to individuals in remote or underserved areas who may not have access to trained CBiT psychologists locally.

3. Flexibility: Telehealth appointments can often be scheduled at times that are convenient for the client, accommodating busy schedules and reducing barriers to treatment.

4. Comfort: Receiving treatment in a familiar environment can help clients feel more relaxed and open during sessions, enhancing the effectiveness of the therapy.

Conclusion

Comprehensive Behavioural Intervention for Tics (CBiT) is a highly effective, non-medical treatment for managing tics and Tourette's Syndrome. By combining psychoeducation, functional analysis, relaxation training, awareness training, competing response training, and social support, CBiT can help individuals reduce the frequency, intensity, and impact of their tics. Telehealth services, such as those offered by Graciously You, make CBiT accessible to individuals across Australia, providing a convenient and flexible option for receiving this life-changing treatment.

If you or someone you know is struggling with tics or Tourette Syndrome, you may want to consider exploring CBiT as a treatment option. To book an appointment, visit this link HERE or call Graciously You’s admin team for more information on 0457 427 876.

References

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Piacentini, J., Woods, D. W., Scahill, L., Wilhelm, S., Peterson, A. L., Chang, 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., ... & Scahill, L. (2012). Randomized trial of behavior therapy for adults with Tourette syndrome. Archives of general psychiatry, 69(8), 795-803.

Pringsheim, T., Holler-Managan, Y., Okun, M. S., Jankovic, J., Piacentini, J., Cavanna, A. E., ... & Oskoui, M. (2019). Comprehensive systematic review summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology, 92(19), 907-915.

Verdellen, C., van de Griendt, J., Hartmann, A., Murphy, T., & ESSTS Guidelines Group. (2011). European clinical guidelines for Tourette syndrome and other tic disorders. Part III: behavioural and psychosocial interventions. European child & adolescent psychiatry, 20(4), 197-207

McGuire, J. F., Piacentini, J., Brennan, E. A., Lewin, A. B., Murphy, T. K., Small, B. J., & Storch, E. A. (2014). A meta-analysis of behavior therapy for Tourette syndrome. Journal of psychiatric research, 50, 106-112.