Common Misconceptions About CBIT

There has been a lot of conversation about behavioral therapies for Tourette Syndrome such as Comprehensive Behavioral Intervention for Tics, or CBIT. As psychologists who have witnessed many of our patients, both children and adults, benefit so greatly from behavioral therapy, we’re excited to hear such a vigorous conversation about this topic.

LET’S START WITH THE BASICS, WHAT IS CBIT?

CBIT is a 10-week behavior therapy program in which a person works with a trained provider to develop individualized skills they can use to effectively manage their tics. We know from multiple, large-scale, scientifically sound studies that CBIT is effective for teaching tic management skills, which in turn result in a decrease in tics and tic-related challenges for many (but not all) individuals. What we also know to be true about CBIT is, when delivered properly, it does not cause harmful side effects, such as those that can occur with various medication treatment options. Recently, the American Academy of Neurology recommended CBIT as the first line of treatment for people with TS, which is a tremendous step toward making sure that all TS patients will have the same experience no matter where they are treated. CBIT is not the only behavioral therapy that can be used to treat TS, but it has the strongest supporting research evidence, and it is the form of behavior therapy most commonly used in the United States. Of course, medications and other therapies may also be appropriate for many people in the community, and many individuals feel that pursuing no formal therapy or treatment at all is the best choice for them. Treatment for tics is only recommended when the person with tics finds that the tics are distressing, painful, or interfere with their quality of life or day-to-day functioning.

IF TOURETTE SYNDROME IS NEUROLOGICAL, WHY ARE WE USING BEHAVIORAL THERAPY TO TREAT TICS?

When people hear “behavioral therapy” as a first-line recommendation for tics, it is sometimes thought this means that tics are simply a behavioral problem, rather than a neurologically-based disorder. This is not the case. Tourette Syndrome is absolutely a neurological condition, and tics are never done “on purpose.” The word behavioral in, Comprehensive Behavioral Intervention for Tics, or CBIT, is instead intended to emphasize that it is a skills-based treatment designed to teach specific tic management behaviors, and to differentiate it from medical or invasive therapies such as medication. In other words, behavior therapy is an active learning experience that helps people develop strategies to manage tics when they want to. The approach is similar to how neurologists and other medical doctors recommend behavioral or skills-based interventions for other problems that are also clearly neurological or biological, such as migraine headaches, diabetes and autism. Decades of research shows that behavioral interventions help people manage these medical problems.

IS CBIT MOSTLY ABOUT SUPPRESSION OF TICS?

In CBIT, we will never tell a person that they must stop their tics. We work directly with children, adults, and families to fi nd collaborative and supportive approaches to tic management that do not cause shame, anxiety, or put stress on relationships. We never recommend punishing an individual for ticcing, or rewarding them for not ticcing. The focus is always on empowering the person with TS to manage tics in a way that supports their personal treatment and life goals. The idea is for providers and parents to act as coaches, not as bosses. In all of this, we understand that CBIT is not a cure for TS and that it is not expected, or intended, to eliminate tics; rather, our goal in CBIT is to teach strategies that allow people to have greater tools to manage tics, on their own terms. For many people, this experience can be very empowering.

WHAT’S NEXT FOR CBIT?

We know that, like any treatment for TS, CBIT does not work for everyone who tries it. We also realize that we have a long way to go in improving our efforts to provide accurate information about CBIT and making CBIT available to those who want it. We believe the way to making these advances is to put the voices of people impacted by TS first and foremost. To us, a key step is to begin creating equitable partnerships between people living with tics and CBIT researchers, which will help ensure that the needs, values, and challenges of people with TS are prioritized in future efforts to improve CBIT. An example of this approach is the TAA’s recent, first-of-its-kind, Treating Tourette Together Summit, in Minneapolis, MN. This event brought together close to 50 partners, including individuals with TS, healthcare providers, and researchers to collaboratively develop an agenda for conducting the next generation of research on CBIT. We had a fantastic dialogue across many aspects of the needs of people with TS, and specifically around the future of behavior therapy for TS. Within a couple of months, we will post a Research Agenda that lays out the key consensus areas for research that we identified at Treating Tourette Together. We hope you will check that out when we have it available, and then help continue the conversation by submitting your comments to us.

Authors

Dr. Matthew Capriotti, Assistant Professor of Psychology at San Jose State University, a licensed psychologist, and co-organizer of Treating Tourette Together Summit and Dr. Christine Conelea, Assistant Professor of Psychiatry & Behavioral Sciences at the University of Minnesota, a licensed psychologist, and team member of Treating Tourette Together Summit.