Treatment for Tourette Syndrome (CBIT)

People with Tourette syndrome and other tic disorders can feel embarrassed, isolated, and limited by their tics. Historically, medication has been the only treatment for these disorders. Cognitive Behavioural Intervention for Tics (CBIT) is the first and only non-medication treatment proven to be effective in reducing tic severity. Dr. Brazeau offers CBIT at the Center for Pediatric Excellence.

Here are questions we are often asked about CBIT along with our answers.

What are Tourette Syndrome and tic disorders?

Tourette Syndrome is the most common tic disorder. It is a neurodevelopmental disorder: “neuro” meaning brain, and “developmental” meaning that it begins in childhood or adolescence, when the brain is still growing and developing. Tourette Syndrome and other tic disorders cause involuntary movements (motor tics) and/or vocalizations (phonic tics). A diagnosis of Tourette Syndrome requires the presence of tics for over one year and at least one phonic tic and two motor tics. For many children diagnosed with Tourette syndrome or other tic disorder, tics will decrease or go away completely with age; others will not experience any reduction in tic severity into adolescence and adulthood.

What is CBIT?

Comprehensive Behavioural Intervention for Tics (CBIT) is a non-medication treatment developed and proven effective to reduce tic severity by a branch of the Tourette Association. CBIT does not offer a cure to tics: it is a tool to help manage tics and reduce the negative influence of tics. CBIT takes the best ideas many people already use to reduce their tics and blends them with strategies that allow you to quickly learn the techniques.

What does the process of learning CBIT look like?

This is a highly structured therapy delivered by a clinician specially trained in CBIT. You and/or your child will learn CBIT in three steps:

1. Understanding your or their tics, the urge to tic, and what makes them better or worse

2. Learning to do a competing behaviour when you or they feel the urge to tic that makes the tic more difficult to do. Consistent and repeated practice of an appropriate competing behaviour done at the right time is critical for CBIT to be effective.

3. Identifying and making changes to situations that can make tics worse.

How is CBIT different from voluntary tic suppression?

Voluntary suppression takes an extraordinary amount of energy, is very stressful for the person trying to supress their tics and is ultimately, usually, ineffective in the long-term. CBIT will teach you and/or your child a set of specific skills to manage tic urges and behaviours. In contrast to voluntary suppression, the more you or your child practices using the competing behaviour in a calm and focused manner, the tic gets better, and you or your child will feel more in control, which further reduces the occurrence of tics.

Is there a chance of the competing behaviour becoming a new tic?

There are two main reasons why this is not a concern:

  1. Research tells us that people are less likely to tic when they are engaged in calm, focused activity. In CBIT, you and/or your child are taught to use the competing behaviour in a calm, focused way until the urge to tic goes away.

  2. Practicing the competing response typically leads to a decrease in the tic urge. Once the urge is gone, you or your child can stop using the competing response.

Will CBIT cure my or my child’s Tourette Syndrome?

CBIT is not a cure for Tourette Syndrome. Once you or your child learn(s) and practice(s) CBIT, it is a tool that can help manage tics. The results from large, national studies show that over half of people who complete CBIT therapy experience a significant decrease in tic severity. Everyone with tics can use CBIT skills, but not everyone will benefit.

Will CBIT help with my or my child’s tics or Tourette Syndrome?

Unfortunately, there is no way of knowing prior to trying the treatment. We do know that over half of people who complete CBIT report a significant decrease in tic severity, but we don’t know why these people benefit and why others do not. We know that untreated or not yet managed mental health and social problems that get in the way of participating in treatment likely will make CBIT more difficult. In your initial consultation, the psychologist may recommend you or your child have an evaluation and address any symptoms that would make it more difficult to learn or practice CBIT.

How can I support my child to reduce their tics with CBIT?

As a parent, you play a pivotal role in helping to create and maintain a positive environment for CBIT to be effective. Dr. Brazeau can provide suggestions that are specific to your child and their triggers. Here are some general guidelines:

What to do

Recognize how hard it may be for your child to learn CBIT: motivate your child to keep trying and help your child to keep their spirits up. If you display discouragement or frustration, your child will pick up on, and may internalize, those negative feelings. This will reduce the chances that CBIT will be successful in managing your child’s tics.

Reward and support your child for their efforts, not just their successes in practicing their competing response.

Work with your child and their psychologist to understand how to best encourage and reward your child so that they do not interpret your efforts as nagging.

Share in your child’s excitement when they begin to master the techniques and see a reduction in symptoms.

What to avoid

Scolding, raising your voice, or taking privileges away from your child for tics. This will likely result in psychological problems and/or worse tics.

Pressuring your child to do their CBIT exercises or punishing your child for not doing them. This often backfires and is likely to make your child more angry, nervous, or disheartened by therapy, which can lead to worse tics.

Rewarding your child for not having tics. Focusing rewards only on the lack of tics is shown to encourage voluntary suppression, which is not an effective long-term method to reduce or eliminate tics. This is different from rewarding your child for their efforts to use their competing responses and celebrating successes.

How much does CBIT cost?

CBIT costs $225 per 1-hour session. The standard treatment is eight sessions ($1,800). In consultation with you or you and your child, Dr. Brazeau will determine if additional or fewer sessions are needed.

Is CBIT covered by OHIP?

No. Many private insurance plans provide some degree of coverage. Check with your insurance provider to verify what they will cover.

Do I need a doctor’s referral?

No. CBIT is not covered by OHIP, so we do not require a referral from a physician. However, your insurance company may require a doctor’s referral in order to reimburse the costs where applicable.

How do I get started?