Health Care

All About CBIT: Effective, Alternative Relief From Tic Disorders is Here

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Living with a tic or movement disorder such as Tourette syndrome is stressful and exhausting. It can impact quality of life for patients young and old. But there is hope for relief in a treatment called CBIT. We want you to know that we offer this leading-edge therapy at AdventHealth Sports Med and Rehab at our North Orlando Avenue location.

We’re here with our expert, occupational therapist Jessica Trio, OTD, OTR/L, to tell us all about CBIT, how it can help your tic disorder, and our program. Read on to learn more.

What is CBIT?

Dr. Trio: Comprehensive Behavioral Intervention for Tics, or CBIT pronounced ‘see-bit’, is an evidence-based, non-drug treatment that trains people to be more aware of their tics. It provides training in “competing responses,” done when the urge to tic is felt. It also teaches patients how to make daily adaptations that are helpful in reducing tic severity.

Occupational therapists certified in CBIT provide intervention with a unique perspective on how tics impact the ability to participate in meaningful life activities, such as completing schoolwork, job functioning, engaging in social relationships and getting enough rest and sleep.

What conditions does CBIT treat, and how does it help them?

Dr. Trio: CBIT is for individuals diagnosed with a tic disorder. These include Tourette syndrome, transient tic disorder and chronic tic disorder.

Those diagnosed with tic disorders may also have co-occurring conditions, such as attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety, and depression. These directly impact tic occurrence.

We also work with patients who have a tic disorder in addition to other medical diagnoses, such as Huntington's disease, Down syndrome, autism and cancer. Everyone is unique, so we work closely with our neurologists to ensure that the use of CBIT will be an effective course of treatment.

What methods are typically used in this type of therapy?

Dr. Trio: CBIT consists of three components:

1. Self-awareness: training individuals to be more aware of their tics and the urge to tic

2. Habit reversal training: training individuals to do competing behaviors when they feel the urge to tic

3. Tic reduction techniques: teaching patients how to make changes to day-to-day activities in helpful ways to reduce tics, such as square breathing, guided muscle relaxation, and other techniques to decrease stress, anxiety and manage co-occurring conditions.

What age groups can be helped by your CBIT program?

Dr. Trio: We’re currently working with patients ages that range from 7 to 71 years old, but any age, young or old, can benefit from this treatment. My youngest patient to experience successful CBIT treatment was 4 years old.

The key to successful CBIT is an individual's motivation to stop their tics, their awareness of tics and when the urge to tic is felt.

It’s also very important that they are cognitively able to engage in therapy and have a good support person. A support person's role is to provide calm support as their child, spouse, significant other or friend goes through CBIT. That solid support can be one of the driving forces for success.

What kinds of improvements do patients see during and after CBIT treatment?

Dr. Trio: Response to treatment varies. Learning to be more aware of one's tics as well as how to manage them can be challenging. But with solid support, they can feel a sense of accomplishment. Clients can feel 10-20% relief from their tics within the first few visits. After CBIT, research has shown it can give some individuals 50% relief. In some cases, I have seen 75 to 90% relief; again, the response to treatment varies for everyone.

Most people can immediately use coping strategies such as square breathing to reduce anxiety and stress. Stress is a big factor that can increase tics. If breathing techniques are not effective, we work together to find strategies that do. This can have an immediate effect not just on tic occurrence, but on overall quality of life. Learning how to manage emotions is a life skill that can be used well after CBIT ends.

Finally, since CBIT is a behavioral approach, success in decreasing tics is grounded in the individual's ability and motivation to continue using the competing responses in addition to managing stress and anxiety. Also, rewards for completing the home programs, which tie into the behavioral therapy components of CBIT, provide meaningful acknowledgment of the individual's work and effort on the techniques. We focus on relapse prevention before discharge and offer booster sessions if an individual needs support months or even years later.

What would you like readers to know about your CBIT program?

Dr. Trio: This program was designed to build awareness in our community and for physicians to know that there is an effective alternative treatment for tics provided by certified occupational therapists.

For patients who don’t want to take medications for various reasons, some neurologists report CBIT as a first line of treatment. However, if physicians are not aware of the benefits of CBIT, individuals cannot benefit from this therapy.

Help for Your Tics and Hope for the Future

Thank you to Dr. Jessica Trio for sharing her expertise, and for taking the time to educate us about this wonderful program.

If you or someone you know and love is suffering from a tic disorder who may benefit from CBIT, visit us here to learn more about this option for relief, and discuss it with your neurologist or primary care provider for a referral to our program.

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