I'm a psych trained in CBIT and have been using it for around.... 12-13 years now? (I'm getting so old!) I often hear or read about other people's experiences with CBIT and a lot of confusion about what CBIT is and how it works. On the one hand, I don't want to provide a long history lesson of CBIT and its roots (I think it's interesting, but don't expect others will feel the same); on the other hand, I do want to provide some information to help other people understand how it works, what it can do, and the importance of their choice in the process.

First: I'm sorry and disappointed if you have tried CBIT and had a bad experience. It is meant to be a tool that you can use to potentially get some relief and reduction in tics or their impact on your life. It should not feel mandatory.

Ok, well, I guess let me offer a bit of info that is hopefully helpful. I would truly be happy to help clarify things, help make CBIT actually useful for you (and others), and even just help you (and others!) understand tics and the neurology underlying them a bit more.

Competing Responses

CBIT uses competing responses instead of suppression. We had decades of researchers trying to develop suppression-based therapies for tics and they never worked. CBIT can work because it doesn't use suppression. Suppression is "specifically not doing something" whereas a competing response is "specifically doing something that interferes with the tic."

Tics basically run in an automatic reinforcement cycle. The brain creates "the problem" - actually just a "sensation" (a premonitory urge) that it registers as a problem. The sensation may not be detected clearly or it may even feel like a very specific sensory sensation. It's actually just activity in the brain that gets interpreted as "sensation-like thing." I like to describe it as this: The brain has no external input to tie it to, so it "doesn't make sense" and when brains detect something that "doesn't make sense" then the brain says, "IT'S A PROBLEM!"

Tics are a Fix

Tics are the "fix" for the problem. They have managed to get wired up (there are a few hypotheses about how this happens) and connected to the temporary reduction in that sensation (the "urge") and thus the brain says, "Well, I had the sensation, then I did this behavior, then the sensation stopped. So that behavior fixed it. That's what I'll do every time." This may be part of why tics basically have to be done "the right way" in order to feel right. If not, then it just "doesn't feel right" and we're usually stuck doing it again.

The CR (Competing Response) in CBIT... I didn't use that word before in this article did I? Well, the CR is a behavior that (oh I did, I see it now) interferes with the tic by giving the brain something active to do during the sensation and that behavior is (as much as possible) incompatible with the tic. Suppression is "not behavior" while a CR is "actively incompatible behavior" and that's an important difference. I can do something but it's very hard to "not do" something.

Gradual Improvement

Over time, the brain learns the way the brain does - by experience. Talking about and understanding a thing doesn't really get the brain to change (other than getting it to use different words). Doing the CR interferes with the automatic reinforcement mentioned before (breaking the connection between "tic and sensation reduction"), gives the person some sense of relief and reduced stress (feeling like we are helpless before the tic), and perhaps most importantly, allows the brain to experience that the sensation (aka "urge") actually will go away on its own. Kind of like you're getting your brain to stop being superstitious or something.

All of that said (and I always say a lot I fear), CBIT isn't the only behavioral treatment for tics. It has been very well studied and shown to be pretty effective with no side-effects (CR's tend to not become new tics because they have a different origin), but I think officially they tend to say it's effective for about 40% of people. That's pretty good as a treatment, but still would leave a LOT of people without help. In my experience, I've found that it can reduce the severity, frequency, intensity, or impact of tics for the vast majority of people I've worked with. Often times we'll get some tics to go away completely, which is great. However, most of the time there are still one or two tics that seem to respond very little. In my work, we do use CBIT and try to get reduction, but we also look at all of the other things that are extremely common in TS and work on whatever is important to the individual - what they want to get out of our work together. That matters more than just tics.