Occupational Formulation and CBIT: A Seamless Partnership for Tic Management

Occupational therapy brings a unique lens to tic management, one that looks beyond symptoms to the person’s daily life, roles, and routines. When paired with Comprehensive Behavioral Intervention for Tics (CBIT), the occupational formulation process helps create a treatment plan that’s both evidence-based and personally meaningful. Here’s how these two approaches blend seamlessly to support lasting change.

What is Occupational Formulation?

Occupational formulation is the process occupational therapists use to synthesize information from evaluations, interviews, and observations. It considers how a person’s strengths, challenges, environment, and personal goals intersect to influence participation in daily life.

This process answers key questions: What is most important to the client? What are the client’s values, habits and routines, and volition? What environmental factors are helping or hindering? How do symptoms-like tics-affect school, work, hobbies, and relationships?

A Quick Refresher on CBIT

CBIT is an evidence-based behavioral therapy for tics. It combines habit reversal training, functional interventions, and relaxation/self-awareness strategies. The goal is to reduce tic severity and improve daily functioning.

How Occupational Formulation Enhances CBIT

When an occupational therapist integrates CBIT into their practice, the occupational formulation process shapes every aspect of treatment to match the client’s life context.

Here’s how they work together:

• **Goal Alignment** CBIT targets tic reduction, but occupational formulation ensures the goals connect directly to meaningful activities, like being able to participate fully in band practice, focus during class, or feel confident in social situations.

• **Contextual Adaptations** Occupational therapists analyze environments and suggest modifications to make CBIT strategies more practical in real-world settings, such as using a discreet competing response in a noisy classroom.

• **Holistic Insight** By considering sensory needs, emotional regulation, and daily routines, occupational formulation ensures CBIT isn’t just about stopping a tic, it’s about enabling the client to engage more successfully in life.

A Real-World Example

Case: A student’s tics increase during math class. CBIT might identify and train a competing response for that specific tic. Through occupational formulation, the therapist also discovers that the student’s chair height, lighting, and timed tests create extra stress. Additionally, the student’s thoughts and feelings about the social environment elicit a fight-or-flight response that creates muscle tension, thereby increasing the likelihood of the tic. The intervention becomes richer by adapting the environment and incorporating relaxation/mindfulness and competing response strategies.

When occupational formulation and CBIT together, the result is a plan that’s deeply individualized, context-aware, and aligned with the client’s life goals. This blend ensures that tic management strategies are practical, sustainable, and connected to meaningful participation, not just symptom reduction.

Final Thoughts

CBIT provides the structure and evidence for reducing tics, while occupational formulation ensures those strategies fit the person’s real life. Together, they create a powerful partnership that helps clients not only manage tics but also thrive in the roles and activities that matter most.