Comprehensive Behavioral Intervention for Tics (CBIT)

The majority of children and teens with Tourette Syndrome (TS) and tic disorder will outgrow their tics by the time they reach their mid twenties, but life prior to that time can be painful and frustrating for everyone.  The Seattle Clinic offers the latest cognitive behavioral interventions designed to help children and teens suppress their tics using comprehensive behavioral intervention for tics (CBIT) as well as bullying prevention skills training.  

Although there is absolutely no doubt that tics are neurological in nature, tics are often also extremely sensitive to the behavioral and environmental factors. In this regard, TS is like diabetes. Diabetes is clearly a medical condition, but is highly influenced by behavioral factors such as consistent diet, exercise, and the ability to monitor blood sugar and take insulin. What CBIT attempts to do is to help children and adults figure out those factors in their environment that make their tics worse; teach these individuals how to create environments that are more stable, predictable and easily manageable; and learn skills to cope with environments that are stressful and tic-challenging.

CBIT consists of three important components:

·      training the patient to be more aware of tics

·      training patients to do competing behavior when they feel the urge to tic, and

·      making changes to day to day activities in ways that can be helpful in reducing tics

At the Seattle Clinic we are experts in CBIT. Dr. Andrew Fleming and Dr. Julia Hitch trained with and were directly supervised in CBIT by Dr. John Piacentini, a developer of CBIT.


Empirical Support

Specht, 2013 - Effects of tic suppression: Suppressibility, rebound, negative reinforcement, and habituation to the urge versus extinction learning.  

Piacentini, 2010 - Behavior therapy for children with Tourette Syndrome:  A randomized controlled trial.  

Woods, 2009 - A potential explanation for contextually-based variability in the symptoms of Tourette syndrome.  



Tourette Syndrome Association 
Tourette Syndrome Overview
American Academy of Pediatrics 
Children with Tourette Syndrome