CBIT for Tic Disorders

What are Tics and is there a treatment for them?

If you have Tourette Syndrome or another neurological Tic Disorder, you are most likely familiar with the sudden, involuntary movements or sounds your body makes. These tics can be mild, moderate, or severe and may even be debilitating in some cases. People of all ages can be affected by Tic Disorders with onset usually occurring between the ages of 5 to 7. Symptoms tend to increase in severity and frequency around the ages of 8 to 12 with most people seeing improvement or a complete decrease in tics in adolescence and early adulthood. However, sometimes tics stick around and become persistent later in life. Usually, adults with tics notice they are worse during times of increased stress, anxiety, excitement, fatigue, or illness.

Is there a treatment for Tics?

The first line, non-pharmaceutical treatment for Tic disorders is Comprehensive Behavioural Intervention for Tics (CBIT). This treatment can be modified for clients of all ages and is usually conducted in 8-11 sessions. CBIT consists of three key components:

  • Training the client to be more aware of their tics and urge to tic.
  • Training the client to use a competing behaviour when they feel the urge to tic.
  • Making changes to daily activities in ways that can be helpful in reducing tics (this may include relaxation training and emotional regulation).

Studies have shown that CBIT reduces tic severity and improved ability to function in daily life for more than half of those who engage in treatment. While CBIT may not be a “cure” for tics, it may reduce symptoms to the point where they are unnoticeable. Even if tics do not fully disappear, CBIT teaches tools for managing them so that quality of life can be improved.

How does treatment work?

A counsellor who is trained in CBIT will walk you through the process. First, time will be spent listing and ordering your tics from most to least severe. You may spend time together recognizing tics and becoming aware of the sensations in your body that happen right beforehand. With your counsellor, you will decide on what is called a “competing response” which you can use when you feel that sensation. This is part of Habit Reversal Training and helps to decrease tic severity and frequency. Throughout treatment, you will work up your hierarchy of tics and practice a competing response for each of them. You will also explore environments or emotions that tend to make your tics worse and brainstorm changes that could be made. Clients are also asked to complete brief homework assignments between sessions so they can report back on how things have been going.

Won’t focusing on my tics make them worse?

This is a very common concern for those starting CBIT treatment. While talking about tics may increase them in the short term, there is no evidence to support that increasing attention on tics within the context of treatment has detrimental effects.

Won’t I just be replacing an old tic with a new one?

Another common belief is that using a competing response means you have only replaced an old tic with a new one. Research on behaviour therapy does not support this, with no new tics noted due to engaging in treatment.

If you are experiencing tics and would like to try CBIT, please reach out to us. If you are looking for CBIT in British Columbia (virtually), CBIT in Nanaimo, and/or CBT in Port Alberni we have counsellors trained in this method who would be more than happy to work with you. Reach out for a free 15-minute consultation to learn more.

Written by Cat Zydyk


Tourette Association of America. (n.d.). Comprehensive Behavioral Intervention for Tics (CBIT): Overview. https://tourette.org/research-medical/cbit-overview/

Woods, D.W., Piacentini, J.C., Chang, S.W., Deckersbach, T., Ginsburg, G.S., Peterson, A.L., Scahill, L.D., Walkup, J.T., & Wilhelm, S. (2008). Managing Tourette Syndrome: A behavioral intervention for children and adults: Therapist guide. Oxford University Press.