What is Comprehensive Behavioural Intervention for Tic Disorders?
What is a tic?
Let's start by looking at what a tic is. The media often portrays tic disorders with an emphasis on the repetition of obscene words (coprolalia). However, this is just one example of a tic and a relatively uncommon one.
A tic is a sudden, recurrent and involuntary motor movement (motor tic) or sound (vocal tic). Below are examples of some common tics.
Motor Tics:
Shoulder shrug
Taking a skip backwards with feet, while walking
Eye blinking
Touching objects
Neck jerk
Vocal Tics:
Clearing throat
Making 'Mmm' noises
Repeating a certain word or phrase e.g. sorry or yup
Snorting
How to respond to someone experiencing a tic?
If you notice someone having a tic, it is best not to draw attention to the tic. Drawing undue attention will likely make the tic worse. Furthermore, telling someone to 'stop' the tic can be very distressing for the individual, due to their involuntary nature.
What are the treatment options?
Comprehensive Behavioural Intervention for Tic Disorders (CBIT) is an evidence-based non-pharmacological treatment for tic disorders.
CBIT aims to support the individual in managing the severity of their symptoms. In this blog post, we will provide a brief overview of the key components of CBIT.
Education:
A foundational component of CBIT is empowering individuals and their families with a comprehensive understanding of tics and tic disorders.
Education components include:
DSM-5 criteria for tic disorders
Brain-based understanding of tics
Behavioural model of tic disorders
Education for responding to tics
The nature of tics
Common triggers
Environmental factors and environmental reinforcers
Education plays a powerful role in intervention. In fact, for some individuals, it may be sufficient alone as an intervention. This is because education helps to normalise tics, address anxiety associated with tics, and offer guidance on how to respond to tics on a day-to-day basis.
While others may experience significant pain, distress, or functional impact from the tic, and report a preference to complete additional CBIT components.
Awareness Training:
Awareness training consists of enhancing self-awareness of the tic in great detail from commencement through to the end of the tic. This includes the identification of any premonitory urges or signals that a tic is about to occur.
By identifying these cues, individuals can develop strategies to intercept before the tic occurs. This is one reason why awareness training is required before competing response training.
Competing Response Training:
Competing response training involves the development of an alternative and physically incompatible behaviour which is utilised in response to the premonitory urge or commencement of a tic. Consistent practice of the chosen competing response is required.
Environmental Modifications:
This component of CBIT involves functional intervention. This is because certain environments may trigger tics. A functional intervention can help to identify triggers and develop appropriate environmental modifications.
Social Support and Coping Strategies:
It is important to note the role of a supportive environment. This can include identifying support people to assist with CBIT and the development of strategies for individuals to navigate challenging social situations.
By combining education, awareness training, competing response techniques, environmental-based interventions, and social support, CBIT provides a comprehensive approach to symptom management. However, tic disorders can co-occur with other presentations such as self-esteem concerns, anxiety, and obsessive-compulsive disorder. When additional difficulties are present, treatment targeting these difficulties may be required. For example, the use of Cognitive Behaviour Therapy for the treatment of anxiety.
Life Balance Clinical Psychology offers Comprehensive Behavioural Intervention for Tic Disorders (CBIT) to individuals aged 16 and over. If you are interested in booking an appointment please complete the contact form on our booking page.
Further information is available on tics from the Tourette Syndrome Association of Australia.