Comprehensive Behaviour Intervention for Tics – CBiT

The main thrust of treatment for Tics (particularly in patients with PANDAS or PANS) is the use of antibiotics, anti-inflammatory and psychotropic drugs. However, Thenemann et al (2107) noted that “while underlying infectious and inflammatory processes in PANS and PANDAS patients are treated, psychiatric and behavioural symptoms need simultaneous treatment to decrease suffering and improve adherence to therapeutic intervention. Psychological, behavioural, and psychopharmacological interventions tailored to each child’s presentation can provide symptom improvement and improve functioning during both acute and chronic stages of illness” Thienemann and colleagues (JCAP 2017)

CBiT is a therapy that is used to teach people with Tic’s ways to manage them. It is not a cure for tics, but it has been proven to help reduce the number, severity and impact of tics.

The success of CBIT comes from the comprehensive combination of therapies used within treatment, these consist of Psychoeducation, Self-awareness training, Relaxation training, Establishing a tic hierarchy, selecting a target tic and reverse engineering it, Formulating a competing response to the target tic using habit reversal techniques, and Social support.

CBIT is recommended as a first line intervention for tics by the American Association of Neurology.

The main component of CBiT is Habit Reversal Therapy (HRT). HRT is the most researched validated behavioural therapy for Tics to date, the research stems back to the 1970’s. HRT treats tics individually unlike other behavioural therapies used to treat Tics. You will work on becoming more aware of how a certain tic is expressed, then you learn to do a competing response. You do this by contracting a group of muscles that make it impossible to do the tic at the same time, 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.

There can be an uncomfortable sensation to begin with but with lots of practice it gets easier.

To learn how to do this, strategies are used to increase the need for you to tic, making the urge as strong as possible and then you will work at implementing a competing response to make it hard for your tic to break through.

HRT is hard work and takes time and lots of practice however HRT has been proven to reduce tics by up to 40%

There are 5 rules when considering competing responses. The competing response must be able to be done anywhere, be done with no props, can be actioned for more than 1 minute, it must be incompatible with the tic and should be more socially acceptable.

A second method is called Exposure Response Prevention (ERP).  The main aim of ERP is for you to learn to tolerate the urge that comes before a tic, by learning to tolerate the urge you are learning to suppress the tic.​ This can also be hard work, and an uncomfortable sensation to begin with but with lots of practice it gets easier. By exposing your tics, you practice resisting the urge for longer and longer periods of time, until you can stop it in most situations for a period of time. Evidence suggests that ERP is as effective as Habit Reversal Therapy. ERP is best suited to individuals who have a range of troublesome tics or are young. Tic reduction is the result.
You can book either a single CBiT session or a package of 10 sessions with our CBiT therapist Sarah Sharp by using our online booking site.

Authored by: Sarah Sharp

Edited by: Dr Tim Ubhi

Published: 12th April 2020

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