CBIT is the common way we refer to Comprehensive Behavioral Intervention for Tics (because it is much shorter and easier to say – sounds like “see bit”). It is the primary recommended approach to treating Tourette's and Tic Disorders (TS/Tics) - it has a strong background of evidence supporting it and is typically effective at reducing tic frequency or severity in a relatively short period of time (typically 9 to 12 weeks). To be clear though, it is not the only way to work with TS/Tics and it does not focus as much on the other challenges that are often present.

I’ve been a clinician who was trained in and have been providing CBIT for around 12 years now as well as a person who has lived with TS for around 43 years. I’ve also been a parent of a child with TS for around 5 years. I frequently receive questions from people about CBIT, what it is, how it works, and what to expect from it. There’s a lot of misunderstanding about CBIT and it is typically hard to find a clinician who can provide it (and people often don’t know who can provide CBIT). Hopefully this article will provide some quick and easy-to-reference answers for some of these things and help people get connected with a CBIT-trained professional if they are looking for that!

What is CBIT?

• Is CBIT just suppression training? How is it any different? Many people express doubt or skepticism about CBIT and think it is just another form of suppression training. CBIT is different from suppression training in one overly-simplified way: It is not suppressing a tic, it is instead actively engaging in a behavior that disrupts or prevents the tic from occurring at the same time. It is more the difference between trying to get your brain to not do something and giving it something to actively do instead.
• How does CBIT work? There are multiple parts to CBIT, including a lot of focus on the contexts in which tics occur and factors that seem to contribute to tic symptoms (such as stress, fatigue, hunger…). The core component, though, is Competing Response Practice. Competing Responses (CRs) are the “incompatible behaviors” mentioned above. We try to analyze how a tic operates (movements, sensations…) and then design a behavior the individual can do and maintain (and that is not going to call attention to them) that will interfere with that tic. Then we work on practicing it, ideally before the tic occurs (when the “urge” is detected).
• How often does CBIT help? I usually describe it as: “CBIT works most of the time for most tics for most people.” In my experience, it usually produces a significant reduction in many tics; may eliminate some; and leaves others still present but less bothersome than they used to be. However, it usually does not eliminate all tics.

Who can provide CBIT?

Currently most CBIT-trained providers are either Mental/Behavioral Health Clinicians or Occupational Therapists. What is most critical in finding a qualified CBIT provider is ensuring they have completed formal training in CBIT. The Tourette Association of America maintains a searchable directory of CBIT providers here: TAA Provider Directory

• Does CBIT have to be in-person? No! CBIT can be provided remotely (via telehealth). Studies were conducted specifically to determine if CBIT could still be effective if done remotely. However, for some individuals and for some tics, it may be more effective to do CBIT in-person. The best thing is to meet with the CBIT provider and discuss this with them. They can advise if they think they will be able to provide effective treatment remotely or not.
• How much time does CBIT take? Naturally this varies and depends on things like: how much of an impact the tics are having, how often they occur, the individual’s emotional and physical health otherwise, how much time a person can devote to doing the practice, and so on… Originally the protocol outlined CBIT as 12 sessions to complete. The protocol has continued to be refined and improved. It is now a more flexible protocol: often around 9 sessions, but sometimes longer or sometimes shorter - it really depends on the individual and their tics. Sessions are ideally 90 minutes, but often providers adapt it to the 60 minute session limitations put in place by insurance companies.
• Is CBIT covered by insurance? Yes, insurance companies generally cover CBIT as a form of behavioral healthcare. Naturally you should always confirm this with your own insurance provider, but CBIT is a clearly evidence-based and recommended treatment for TS/Tics and, as such, is generally well-covered. The biggest barrier is usually finding a trained provider who has availability.