Online CBiT for Tic Disorders and Tourette Syndrome
Australia-Wide Telehealth Support
What is CBIT?
Comprehensive Behavioral Intervention for Tics (CBIT) is an evidence-based, non-pharmacological treatment for Tourette syndrome (TS) and other persistent tic disorders. CBiT is recommended as a first-line treatment before considering medication in Europe and Canada. It is a collaborative and individualised treatment which is tailored to each person. CBIT primarily combines Habit Reversal Therapy (HRT) with other behavioral strategies to help individuals manage their tics effectively.
Key Components of CBIT
CBIT typically consists of several core elements:
Habit Reversal Therapy (HRT)
Functional Analysis and Intervention
Relaxation Training
Psychoeducation
Habit Reversal Therapy (HRT)
HRT is the primary component of CBIT and includes two main elements
Awareness Training:
Helps patients identify premonitory urges and early tic signs.
Increases consciousness of how specific tics are expressed.
Competing Response Training:
Teaches patients to perform a physical response incompatible with the tic.
Involves contracting a group of muscles that make it impossible to do the tic simultaneously.
How Habit Reversal Therapy (HRT) works
You will work on becoming more aware of how a certain tic is expressed.
Then, you learn a competing response that uses muscles incompatible with the tic.
As soon as you feel the urge coming on, you need to do the competing response and keep doing it even after the urge passes.
Eventually, you learn to take control of the tic.
To enhance learning, strategies are used to increase the need for you to tic, making the urge as strong as possible. You then work at implementing a competing response to make it hard for your tic to breakthrough.
Important notes
This process can be hard work and may create an uncomfortable sensation to begin with, but with lots of practice, it gets easier.
The goal is to gain control over the tic, not to suppress it.
The five rules for competing responses in HRT are:
Can be done anywhere
Doesn't require props
Can be maintained for more than 1 minute
Must be incompatible with the tic
Should be more socially acceptable than the tic
Functional Analysis and Intervention For Tics
This component involves
Identifying environmental factors, situations, or internal states that exacerbate tics.
Developing strategies to manage these triggers and reduce tic severity.
Relaxation Training
Patients learn techniques such as progressive muscle relaxation and diaphragmatic breathing to manage stress and anxiety, which can worsen tics.
Psychoeducation about Tics
Understanding the neurobiology of tics is an important part of CBiT and your telehealth psychologist will go through this in more detail with you.
However, here is a summary of current research and what it suggests:
Tics result from a dysfunction in the central nervous system, particularly in the cortical basal ganglia and frontal cortex of the brain.
The basal ganglia normally inhibit neurons in the thalamus, preventing undesired movement-related signals from reaching the motor cortex.
In Tourette's syndrome, there may be a fault that results in the failure to stop unwanted signals from reaching the cortex, causing unwanted movements and/or sounds.
Abnormal activity in the basal ganglia is believed to be due to an excess of the neurotransmitter dopamine or a supersensitivity of dopamine receptors.
Dopamine, a reward chemical that makes us feel good, also transmits messages in our brain related to stopping, focusing, and concentrating.
Differences in dopamine levels or receptor sensitivity in individuals with Tourette's may affect these messages from happening smoothly.
Other neurotransmitters such as serotonin and GABA may also play a role, though research is ongoing.
Understanding these neurobiological factors may help you better comprehend yours or your child’s condition and the rationale behind CBIT techniques.
Other Treatment Approaches
While CBIT is a widely used and effective treatment for tics, some individuals may benefit from other approaches or a combination of techniques.
For example:
Exposure and Response Prevention (ERP): This method focuses on helping individuals tolerate the urge to tic without performing the tic itself. Some treatment plans may incorporate elements of ERP alongside CBiT techniques.
It's important to work with a qualified healthcare provider, such as a psychologist trained in CBiT to determine the most appropriate treatment approach for your individual needs.
Effectiveness of CBIT
Research has shown that CBIT can be highly effective:
HRT alone has been shown to reduce tics by up to 40% in some studies.
Up to 80% of clients experience a reduction in tic severity with CBIT.
Benefits are often maintained for months or years after treatment.
CBIT has been found to be as effective as medication for tic reduction in many cases
What to Expect in CBIT Sessions
Typically 8-10 weekly sessions, each lasting 50-90 minutes. Please know we understand some clients will not be able to financially afford 90 minute sessions. We are more than happy upon request to provide 50 minute sessions. Other clients may find 90 minute sessions hard to attend to due to attention difficulties. Our telehealth psychologist Natasha will always tailor treatment length to your needs.
May include additional booster sessions to maintain gains.
Sessions involve learning and practicing tic management techniques.
Homework assignments to reinforce skills learned in therapy.
Initially, techniques may feel uncomfortable or challenging, but they become easier with practice.
Significant practice and time commitment are required for effectiveness.
Benefits of Telehealth CBiT
Telehealth Comprehensive Behavioral Intervention for Tics (CBiT) offers several advantages for both clients and psychologists
Improved Accessibility
Telehealth CBiT removes geographical barriers, making evidence-based treatment available to clients in rural or underserved areas. This is particularly crucial given the shortage of trained CBiT trained psychologists and practitioners.
Comparable Effectiveness
Studies have shown that telehealth CBiT demonstrates effectiveness comparable to in-person treatment for both pediatric and adult clients.
This includes significant reductions in tic severity and improved global functioning.
Convenience and Flexibility
Remote sessions allow clients to receive treatment from the comfort of their homes, reducing travel time and costs.
This flexibility can lead to improved treatment adherence and client satisfaction.
Continuity of Care
Telehealth CBiT ensures uninterrupted treatment delivery, even during public health crises like the COVID-19 pandemic.
Enhanced Client Engagement
Digital platforms can incorporate interactive elements, such as video demonstrations and progress tracking tools, potentially increasing client engagement and treatment adherence.
Cost-Effective
By reducing travel and associated costs, telehealth CBiT can be a more cost-effective option for many clients.
Expanded Reach
Telehealth allows healthcare providers to serve a wider client base, potentially reducing wait times for treatment.
Family Involvement
Remote sessions can facilitate easier involvement of family members in the treatment process, which is particularly beneficial for paediatric clients.
While telehealth CBiT shows great promise, it's important to note that its effectiveness may vary depending on individual factors such as client motivation, cognitive ability, and technological proficiency. However, for many clients, telehealth CBiT represents a valuable option for accessing this evidence-based treatment for tic disorders.
Is CBiT Right for You?
CBiT may be a good option if:
You're looking for a non-medication approach to managing tics.
You're willing to actively participate in treatment and practice techniques at home.
Your tics are causing significant distress or impairment in daily life.
Remember: While CBiT is highly effective for many individuals, it's not a cure for tic disorders. The goal is to provide tools for managing tics and improving quality of life.
Helpful further learning and support
Tourette Syndrome Association of Australia Inc
Brain Foundation - Tourette Syndrome
References
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.
Andrén, P., Aspvall, K., Fernández de la Cruz, L., Wiktor, P., Romano, S., Andersson, E., ... & Mataix-Cols, D. (2019). Therapist-guided and parent-guided internet-delivered behaviour therapy for paediatric Tourette's disorder: a pilot randomised controlled trial with long-term follow-up. BMJ Open, 9(2), e024685.
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.
Pringsheim, T., Okun, M. S., Müller-Vahl, K., Martino, D., Jankovic, J., Cavanna, A. E., ... & Oskoui, M. (2019). Practice guideline recommendations summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology, 92(19), 896-906.
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.
Woods, D. W., Piacentini, J. C., Chang, S. W., Deckersbach, T., Ginsburg, G. S., Peterson, A. L., ... & Wilhelm, S. (2008). Managing Tourette syndrome: A behavioral intervention for children and adults therapist guide. Oxford University Press.
Capriotti, M. R., Himle, M. B., & Woods, D. W. (2014). Behavioral treatments for Tourette syndrome. Journal of Obsessive-Compulsive and Related Disorders, 3(4), 415-420.