Beyond the Clinic: Making CBIT Work in Everyday Life

Completing CBIT (Comprehensive Behavioral Intervention for Tics) sessions is a big step forward, but the real challenge-and opportunity-comes when you take those strategies beyond the clinic. The magic of CBIT lies in using the tools you’ve learned in the moments that matter most: at home, school, work, and in the community. Here’s how to make CBIT skills part of everyday life so they stick and truly work for you.

Keep Practicing, Even Without Tics

It’s tempting to only use competing responses when tics appear, but daily practice-especially during calm moments-builds automaticity. A few minutes each day of practicing your competing responses can make them more effective when tics do show up.

Identify and Plan for Triggers

One of CBIT’s core elements is functional intervention-understanding what situations or feelings make tics more likely. Keep a log of when tics appear and what’s happening around you. Once you spot patterns, you can proactively use strategies before tics escalate.

Involve Your Support Network

The people around you can be powerful allies. Share your CBIT strategies with family, friends, teachers, or coworkers so they know how to support you. Sometimes that means giving you space to use a competing response; other times it means helping reduce environmental triggers.

Make Adjustments for Real-Life Settings

The version of a competing response that works in a therapy room might not feel as natural in a classroom, office, or crowded place. Work with your therapist to develop subtle or modified versions that fit the setting, so you feel confident using them anywhere.

Handle Plateaus and Setbacks

It’s normal for progress to level off or for tics to flare during stress, illness, or big life changes. This doesn’t mean CBIT has stopped working-it’s a sign to revisit strategies, fine-tune competing responses, or add stress-management tools.

Celebrate Small Wins

Tic management is a journey, and progress isn’t always measured in tic counts alone. Maybe you used a competing response faster, felt less anxious in a trigger situation, or remembered to practice every day for a week. Recognizing these victories keeps motivation high.

Final Thoughts

CBIT isn’t just a therapy-it’s a set of life skills. By weaving them into your daily routines, you give yourself the best chance for lasting results. With practice, planning, and the right support, CBIT can become second nature, helping you manage tics with confidence wherever life takes you.

Choosing Between CoPs, CBIT, or a Blend: Finding the Right Path for Tic Management

When you or your child is navigating life with tics, finding the right treatment approach can feel overwhelming. Two evidence-based options often come up in conversations with healthcare providers: Comprehensive Behavioral Intervention for Tics (CBIT) and Cognitive Psychophysiological Therapy (CoPs). While both target tic reduction and improved quality of life, they differ in focus, structure, and underlying strategies. For some, a combination of the two may be the most effective approach. Here’s a closer look to help you make an informed decision.

What is CBIT?

CBIT is a behavioral therapy specifically designed for managing tics. It combines three core elements:

• Habit Reversal Training (HRT) to build competing responses that replace tic behaviors.

• Functional intervention to identify and modify situations that make tics worse.

• Relaxation and self-awareness training to improve overall regulation.

CBIT is often recommended as a first-line behavioral intervention and has strong research support for reducing tic frequency and severity.

What is CoPs?

Cognitive Psychophysiological Therapy (CoPs) addresses tics through a slightly different lens. It focuses on understanding the cognitive, emotional, and physiological processes that trigger or maintain tics, helping individuals identify underlying stress patterns, perfectionism, or sensory sensitivities. CoPs often incorporates psychoeducation, stress management, and body-focused awareness exercises.

This approach is newer, and has less large-scale research compared to CBIT, but it may resonate with individuals whose tics are strongly linked to anxiety, sensory overload, or cognitive patterns.

Deciding Between CBIT, CoPs, or a Blend

When deciding on a treatment path, consider the following factors:

1. **Your primary challenges** -If your main concern is reducing the physical occurrence of tics, CBIT may be a strong starting point. If underlying stress, perfectionism, or anxiety feel like major drivers, CoPs might better address root causes.

2. **Your learning style** -CBIT is more structured and skills-based, while CoPs is more exploratory and reflective.

3. **Access to trained providers** -CBIT-trained therapists are increasingly available, especially via telehealth. CoPs-trained clinicians are more limited and may require remote sessions with international providers.

4. **Personal preference** -Some people respond best to the clear, step-by-step tools in CBIT; others find relief in the insight-driven, mind-body focus of CoPs.

5. **Potential for blending** -In many cases, elements of both can be used together. For example, CBIT can directly target tics while CoPs addresses the stress or thought patterns that contribute to them.

Final Thoughts

Choosing between CBIT, CoPs, or a blend doesn’t have to be permanent-many individuals try one approach, then adapt or combine strategies over time. The best choice is the one that fits your unique needs, preferences, and access to skilled providers. A conversation with a clinician familiar with both methods can help you chart the most effective path forward.

Maximizing CBIT Success: Tips, Tricks, and Real-Life Strategies

Comprehensive Behavioral Intervention for Tics (CBIT) is a proven approach to help individuals reduce tic frequency and improve daily functioning. While the therapy itself is powerful, success depends on preparation, consistent practice, and support beyond the therapy room. Here are practical strategies to help you or your child get the most out of CBIT.

1. Prepare for CBIT

Before starting CBIT, take time to set realistic goals and gather background information. Keep a tic diary for one to two weeks to identify common triggers, times of day when tics are worse, and situations where tics interfere with daily life. Discuss these patterns with your CBIT provider so sessions can be tailored to your unique needs. Preparation also includes managing expectations-CBIT is a skill-building process, not an overnight solution.

2. Reinforce Skills at Home

CBIT works best when practiced daily outside of therapy sessions. Set aside a few minutes each day to rehearse competing responses and relaxation strategies. Pair practice with existing routines-such as after brushing teeth or before bedtime-to build consistency. Parents can offer gentle reminders, but avoid pressuring the child, as stress can increase tics.

3. Involve School or Workplace Supports

Teachers, school counselors, and employers can play a crucial role in CBIT success. Share information about the therapy and strategies being used so they can support practice during the day. In schools, this may include providing discreet opportunities for the student to step out and use a competing response or adjusting seating to reduce distractions. In the workplace, flexibility in break times or workspace arrangement can make practice easier.

4. Handle Plateaus in Progress

It’s normal for tic improvement to level off at times. Plateaus are part of the learning process and not a sign of failure. If progress slows, review your tic diary to see if new triggers have emerged, or if certain competing responses need adjusting. Stay in communication with your CBIT provider-they can introduce new strategies or tweak existing ones to reignite progress.

Bottom Line

CBIT can be a highly effective tool for managing tics, but it works best when approached with preparation, consistent practice, and a strong support system. Whether you’re a parent, teacher, or individual with tics, your active involvement can make a significant difference in long-term success.

Can CBIT Help My Child's Tics? A Practical Guide for Parents

If your child has motor or vocal tics, you’re not alone.

Tics can come and go, grow more intense with stress, and disrupt everything from morning routines to classroom focus. You may be wondering:
- Do they need medication?
- Will they outgrow this?
- Is there anything I can do to help right now?

The good news is-there is something you can do. It’s called CBIT (Comprehensive Behavioral Intervention for Tics), and as a CBIT-trained occupational therapist, I help children (and adults) manage their tics without medication-using evidence-based strategies that support the whole person.

What Is CBIT?

CBIT is a structured, behavioral approach that helps individuals:
- Recognize when a tic is about to happen
- Use a competing response to prevent the tic
- Identify and reduce triggers like stress or excitement

Research shows that CBIT is effective for many individuals with Tourette Syndrome and persistent tic disorders, often reducing tic severity and improving daily functioning.

How Occupational Therapy Enhances CBIT

Occupational therapists are uniquely trained to look at how tics impact:
- Routines at school, home, and in the community
- Social participation and self-esteem
- Transitions, regulation, and emotional well-being

By combining CBIT with an OT lens, we create custom strategies that work in your child’s real world-supporting their strengths and empowering independence.

What Happens in a CBIT Session?

CBIT sessions are collaborative and playful, especially for younger children. We:
1. Build awareness of tic sensations and patterns
2. Practice competing responses in fun, functional ways
3. Address family routines and school success
4. Coach parents and caregivers so strategies stick

CBIT works best when practiced regularly at home, so part of my role is to support you, the parent, with realistic tools and encouragement.

Available Virtually Across New York State

I offer virtual CBIT sessions for families anywhere in New York State and in-person appointments in the Greater Rochester, NY area.

All sessions are one-on-one, and tailored to your child’s:
- Temperament
- Learning style
- Occupational needs

Is CBIT Right for Your Child?

CBIT may be a good fit if:
- Your child has been diagnosed with a tic disorder or Tourette Syndrome
- You want to try a non-medication treatment
- You’re ready to take a proactive, skill-building approach
- Your child is school-age or older and able to engage in learning new strategies

Let's Talk

Curious if CBIT is right for your child?

📞 Contact me for a free consultation to learn more about how CBIT can support your child’s confidence and daily function.

CBIT for Adults with Tics: Breaking Free from Tic Interference

Tics don’t only affect children-many adults continue to experience them well into their 20s, 30s, 40s, and beyond. For some, tics may have started in childhood and persisted, while for others, they may return after years of improvement. Regardless of when or how tics present in adulthood, they can interfere with daily routines, work performance, social comfort, and overall well-being.

What is CBIT?

Comprehensive Behavioral Intervention for Tics (CBIT) is an evidence-based, non-medication approach for reducing tic severity and improving quality of life. CBIT focuses on three main components:
1. **Awareness Training** -Learning to identify the premonitory urge or sensations that come before a tic.
2. **Competing Response Training** -Practicing an alternative, voluntary movement that makes the tic more difficult or impossible to do.
3. **Functional Interventions** -Identifying and addressing environmental triggers that worsen tics.

Why CBIT Works for Adults

While some adults assume that tics are ‘set in stone,’ research shows that CBIT can help reduce both the frequency and impact of tics at any age. Adults often benefit from CBIT because they can better recognize patterns, commit to practice, and integrate strategies into real-world situations.

What to Expect in CBIT Sessions

A CBIT-trained occupational therapist or psychologist will work with you to:
- Understand your unique tic patterns
- Build personalized competing responses
- Develop a realistic practice schedule
- Reduce tic triggers and environmental stressors

CBIT is typically provided over 8-10 weekly sessions, though some adults may benefit from shorter or longer treatment plans.

Beyond Tic Reduction

CBIT doesn’t just help reduce tics -it also supports emotional well-being, confidence, and self-advocacy. Many adults report better focus, less embarrassment, and greater control over their bodies after completing the program.

Getting Started

If you’re an adult living with tics and want to explore CBIT, consider reaching out to a CBIT-trained professional who can help!

Specific Environments or Stressors Influence Tics-How CBIT Can Help

Tics often ebb and flow depending on where we are, who we’re with, and what’s happening around us. For many adults living with Tourette Syndrome or chronic tic disorders, certain environments or situations can intensify tics, while others seem to quiet them down.

Recognizing these patterns is key to managing symptoms effectively. This is where CBIT (Comprehensive Behavioral Intervention for Tics) shines-by helping you identify triggers and equipping you with personalized strategies to navigate them.

Common Environmental and Situational Triggers

While triggers vary from person to person, some common ones include:

• High-stress environments, such as public speaking, meetings, or crowded events.
• Transitions, like moving to a new home, starting a new job, or traveling.
• Sensory-rich settings-bright lights, loud noises, or strong smells.
• Times of fatigue or illness, when self-regulation is harder.
• Situations with high social pressure or a need to 'perform'.

How CBIT Addresses Environment-Linked Tics

CBIT starts with a functional assessment of your tics-looking not only at when they happen but also at the environments that spark or amplify them. From there, your therapist helps you:

1. Develop competing responses to use in triggering environments.
2. Modify routines or settings to reduce tic-provoking elements.
3. Build stress-reduction techniques.
4. Practice exposure in safe, controlled ways so environments lose their triggering power.

Taking Back Control

The goal isn’t to avoid life’s challenges or stimulating environments-it’s to feel equipped to face them. By using CBIT tools, adults with tics often find they can participate more fully in social, professional, and recreational settings without feeling ruled by their symptoms.

If you’ve noticed that certain environments or stressors impact your tics, you don’t have to simply ‘push through.’ CBIT can help you create a plan tailored to your lifestyle so you can show up as your best self-anywhere, anytime.

CBIT Myths and Misunderstandings-And What the Science Really Says

Comprehensive Behavioral Intervention for Tics (CBIT) has been life-changing for many children, teens, and adults living with tic disorders. But despite its strong evidence base, there’s still confusion about what CBIT is, what it can (and can’t) do, and who it’s for. Let’s clear up some of the most common myths.

Myth #1: CBIT is just “holding your tics in.”

The truth: CBIT isn’t about simply suppressing tics. It teaches individuals to notice the urge before a tic happens and respond with a competing response-a movement that makes the tic harder to perform. Over time, this can retrain the brain’s response patterns and reduce tic frequency or intensity.

Myth #2: CBIT is only for mild tics.

The truth: CBIT has been shown to help people with both mild and severe tics. While results vary, many individuals with more noticeable tics report meaningful improvements in daily function and comfort.

Myth #3: CBIT works instantly.

The truth: Like learning any new skill, CBIT takes time and practice. Progress often happens gradually, over weeks or months, as competing responses become automatic and easier to use in different situations.

Myth #4: Kids can’t do CBIT because it’s too hard.

The truth: With the right therapist and age-appropriate strategies, children as young as 6–7 years old can learn and benefit from CBIT. Sessions are adapted to a child’s developmental level, attention span, and interests.

Myth #5: CBIT “cures” tics.

The truth: CBIT isn’t a cure, but it can significantly reduce tic severity and improve quality of life. Many people continue using CBIT skills long after therapy ends to maintain progress and manage new tics.

CBIT is not a quick fix, but it is a well-researched, highly effective behavioral approach for tic management. The key is realistic expectations, consistent practice, and working with a trained provider.

If you’re curious whether CBIT could help you or your child, reach out for an assessment. The right knowledge-and the right strategies-can make all the difference.