Comprehensive Behavioral Intervention for Tics (CBIT) is non-pharmacological intervention for tic management that consists of three critical components (1):
- Training the patient to be more aware of tics
- Training the patient to do competing behavior when they feel the urge to tic
- Making changes to day to day activities in ways that can be helpful in reducing tics
- The CBIT program is not teaching “suppression” of tics
- Tics are not replaced by new tics once the CBIT program has addressed and minimized a particular tic
- The CBIT program is only for patients who self-report that their tics interfere in daily activities
How Effective is the CBIT Program for Someone with Tourette Syndrome or a Tic Disorder?
The CBIT program has been shown to help 50-75% of patients who complete the program to manage their tics. Elimination of the tics can and has been seen before in the CBIT program, but it is not expected. The goal of the CBIT program is to minimize impact and interference during daily activities to allow more positive experiences throughout the day.
About Our Program at UF Health
The CBIT program consists of eight weekly sessions over ten weeks. Tics are managed by introduction of a “competing response” and environmental modifications to implement throughout the day. The focus will be to identify the tics and how they impact all daily activities. Then, alternating strategies and behavioral habit reversal training methods will be introduced to manage each individual tic. The goal of the program is to teach the person who is affected by tics how to manage tics throughout their life, as well as how to manage new tics if they were to arise as a result of Tourette Syndrome’s natural waxing and waning. At the conclusion of the ten week program, booster sessions for reinforcement and reminders are available.
Sessions last for 30-60 minutes, dependent on each person’s situation. Sessions are very interactive and need engagement from the tic patient. Our Occupational Therapists are trained and are willing to work with the person with tics to ensure engagement and commitment to the program. Success of the program can be directly correlated to the commitment of the person with tics to participate with the strategies in their home and daily life.
The CBIT program at UF Health is performed by Occupational Therapists. Therefore, sessions are largely covered. Follow up with your insurance company to find out details on coverage for your particular situation. CBIT must be performed under a physician’s referral.
What is Expected of the Person Participating in the Program
- Complete home exercise/activity program regularly and consistently
- Attend all sessions, every week
- Be willing to discuss tics and how they interfere in daily activities
- Visit an example demonstration of the CBIT program here
Who performs the CBIT Program
Heather Simpson, OTD, MOT, OTR/L
Heather Simpson graduated with a B.S. in Exercise and Sport Science with a minor in Early Education from the University of Florida in 2007. Following her Bachelor’s degree, Heather received a Master’s in Occupational Therapy, in 2009, from the University of Florida as well as a Doctorate in Occupational Therapy from the University of St. Augustine for Health Sciences. Since completion of graduate school, she has worked in a variety of settings including outpatient neurology, inpatient physical rehabilitation and pediatric rehab. Currently, Heather serves as the Coordinator for the Tourette Syndrome Association Southeast Regional Center of Excellence. Her clinic location is at UF Center for Movement Disorders and Neurorestoration.
Heather provides occupational therapy evaluations and treatment for patients with a variety of conditions with a focus on Tourette Syndrome and the comorbid conditions of ADHD, OCD and anxiety through the Comprehensive Behavioral Intervention for Tics (CBIT) program.
Heather is a recognized provider of the CBIT program through the Behavior Therapy Institute (BTI) and TAA.
Laura Frahm, MOT, OTR/L
Laura graduated from the University of Florida with a Master’s degree in Occupational Therapy and a Bachelor’s degree in Health Science. She currently is specializing in pediatric occupational therapy with an emphasis on the treatment of sensory processing disorder, autism spectrum disorders, developmental delays and fine motor delays. She currently works at UF Health Rehab Center for Kids at Magnolia Parke, where she has been working since January 2010.
Laura has completed continuing education courses in therapeutic listening, Wilbarger Therapressure protocol for sensory defensiveness, Handwriting without Tears, building blocks of sensory integration and Comprehensive Behavioral Intervention for Tics (CBIT).
Laura is a recognized provider of the CBIT program through the Behavior Therapy Institute (BTI) and TAA. Laura completes the CBIT program at the UF Health Affiliate Clinic at Magnolia Parke.
Naomi Steel, MOT, OTR/L
Locating CBIT Providers in Your Area
The Tourette Association of America, along with the Behavior Therapy Institute (BTI-TS) are working hard to disseminate the training for CBIT across the county. For those families that do not live locally, you can locate a CBIT provider at the Find A Provider Search Link. In order to ensure that you find a provider who has completed the training, please make sure that “Comprehensive Behavioral Intervention for Tics” option is clicked under the “Clinical Expertise” dropbox.
Virtual CBIT Opportunities
For some, finding a professional trained in CBIT closer to home is difficult. Recently, an interactive online treatment program based on the CBIT program has been shown to be a viable option. Click here for more information on the TicHelper Program.
Becoming a CBIT Provider
If you are interested on becoming a certified provider of CBIT, visit the Tourette Association CBIT for Practitioner Page for more details.
Demonstration of CBIT Program
For video demonstrations and further information, visit the Tourette Association of America’s YouTube playlist here.
(1) Tourette Syndrome Association (2010). Comprehensive Behavioral Intervention for Tics. Bayside, NY. Woods D, Piacentini J and Walkup J.