CBIT Therapy for Tics: What Parents Need to Know

Comprehensive Guide • 12 min read

If your child has been diagnosed with Tourette Syndrome or another tic disorder, you've probably heard about CBIT. It's increasingly recommended as a first-line treatment, sometimes before or alongside medication.

What Is CBIT?

CBIT stands for Comprehensive Behavioral Intervention for Tics. It's a structured behavioral therapy specifically designed to reduce tic severity and improve quality of life. CBIT was developed through NIH-funded research and is now considered one of the most effective non-medication treatments for tics.

What CBIT is NOT:

• Not about stopping tics through willpower—CBIT doesn't ask people to simply suppress tics
• Not a cure—CBIT reduces severity and improves management
• Not just for children—CBIT works for adults too

How CBIT Works

CBIT has three main components:

1. Awareness Training

Before you can change a behavior, you need to be fully aware of it. Awareness training teaches recognition of premonitory urges (the uncomfortable sensation before a tic), early warning signs, and high-risk situations.

2. Competing Response Training

This is the core of CBIT. For each target tic, the therapist helps develop a "competing response" that is physically incompatible with the tic, sustainable for at least a minute, and socially inconspicuous.

Example: For a head-jerking tic, a competing response might be tensing the neck muscles while keeping the head still. When the person feels the premonitory urge, they perform the competing response instead. Over time, this weakens the connection between urge and tic.

3. Function-Based Assessment

CBIT identifies what happens before tics (triggers) and after tics (consequences), then modifies these patterns. If stress triggers tics, stress management becomes part of treatment.

What to Expect From Treatment

A typical CBIT protocol involves 8 sessions over 10 weeks, with sessions lasting 60-90 minutes. Expect daily homework practicing techniques.

Does CBIT Work?

Multiple randomized controlled trials have demonstrated CBIT's effectiveness. The Yale Study (2010) found 53% of children receiving CBIT were rated as "much improved" compared to 19% in the control group.

CBIT typically reduces tic severity by 30-50%, improves ability to manage tics in difficult situations, and builds confidence and sense of control.

CBIT vs. Medication

Advantages of CBIT:

• No side effects
• Long-lasting—skills continue working after treatment ends
• Empowering—gives the person tools they control
• Can be combined with medication for added benefit

Most expert guidelines now recommend CBIT or medication as first-line treatments, with combination therapy for moderate to severe cases.

Finding a CBIT Provider

This is often the biggest challenge. Look for providers through:

• TAA Provider Database: tourette.org maintains a directory
• Psychology Today Directory: Search for tics or habit reversal training
• University Clinics: Academic medical centers often have specialists
• Telehealth: CBIT can be delivered effectively via video

How Tracking Supports CBIT

Tic tracking is essential to CBIT. It helps establish baseline tic levels, identify patterns for targeting, monitor progress weekly, and maintain gains after treatment. Many CBIT therapists recommend tracking apps to make this process easier.

Supporting Your Child Through CBIT

Do: Encourage practice, praise effort, be patient, communicate with the therapist.

Don't: Point out tics, expect perfection, do the work for them, give up too early.

The Bottom Line

CBIT is a proven, effective treatment that puts control in the hands of the person with tics. It requires effort and commitment, but the skills learned last a lifetime.

If you're considering CBIT, start by finding a trained provider. The Tourette Association of America (tourette.org) maintains a provider directory.