Comprehensive Behavioral Intervention for Tics

Cognitive Behavioral Therapy can be very effective in managing the symptoms of Tourette Syndrome. CBIT (Cognitive Behavioral Intervention for Tics) is an evidence-based type of behavioral therapy for Tourette Syndrome that includes habit reversal training in addition to other strategies, such as psychoeducation about tics, relaxation techniques, and function-based behavioral interventions.

CBIT focuses on two main concepts: tic-awareness and competing response training. Tic awareness teaches the individual how to monitor when a tic is about to occur. Competing response training teaches the individual how to substitute a voluntary behavior for the existing tic. This voluntary behavior is designed to be physically incompatible with the tic, which disrupts the cycle and decreases the tic behavior.

CBIT for children includes parent training as well. Parents are taught to manage their own reactions to their children’s tics, and how to encourage and praise their children for practicing the behavioral intervention techniques they are learning. Parents also receive education with regard to helping their child manage their tics, as well as navigate school, including accommodations common only provided to students with Tourette’s, and how to obtain a 504/IEP. Parents may utilize forms that follow along with the weekly treatment sessions, reinforcing the concepts learned, as well as keeping track of practice logs and assignments. Adults learning CBIT are provided worksheets that they can refer to outside of the sessions to reinforce concepts discussed, and track their practice and assignments.

CBIT is a highly structured therapy where treatment typically involves 8 sessions over 10 weeks, but can be adjusted depending on the needs of the patient and their family. Through the therapy, the child (and their parents) or the adult with Tourette Syndrome will come to better understand the types of tics they are having and understand the situations in which the tics are at their worst. Changes to the surroundings may be made, if possible, in addition to learning a competing response to the tic behavior.

CBIT is not the same as voluntary tic suppression. A person with Tourette Syndrome can voluntarily suppress their tics for a short time but it is not a very effective strategy for long-term use, as it can be stressful and cause the individual to become tired, frustrated and irritable. CBIT teaches people with Tourette Syndrome a set of specific skills they can use to manage their tic behaviors. CBIT skills require practice in order to be successful at managing tic urges and behaviors.

Treatment Information and Fees:

Prior to beginning CBIT Sessions, parents of children or adolescents must schedule a “New Patient Appointment” which is attended by the adults only. Sessions 1 and 2 of the CBIT series are 60 minutes long. The initial diagnostic session must be scheduled under “New Patient” and is billed at $450 for the session. Session 2 is also 60 minutes and must be scheduled specifically under “60 minute session” CBIT on the online scheduler. and is billed at $450. Sessions 3 through 8 are 45 minutes long, scheduled under “existing patient 45 min session” and are billed at $275 each session.

Please note before scheduling: Dr. Rappaport is not a participating provider with any insurance panel. Payment is due at time of service. Upon request, patients may be provided with a superbill at the end of each month, which can be directly submitted to insurance, with payments being reimbursed directly to them, if their insurance covers out of network providers.

Additional information about CBIT, including treatment outcome studies and statistics, can be found in the CBIT brochure on the TSA (Tourette Syndrome Association) website.