Behavioral Treatment for Tics: First-Line Intervention

Kissel Goldman, PhD

Tics are movements, twitches, words, or noises that seem to happen for no reason. A person may not even know that they are “ticcing”. Treatments for tics usually involve medication and/or behavioral therapy. About a year ago, the American Academy of Neurology published a research paper and press release in which they described and recommended treatments for tics. They recommended that Comprehensive Behavioral Intervention for Tics (or CBIT) should be used as the first-line treatment for tics. CBIT is as or more effective than some medications at treating tics and is not associated with medication-related side effects like loss or gain of appetite or being tired. Also, CBIT works for children and adults.

CBIT involves several components. First, the therapist will talk with a person about their tics and what it feels like before and after they tic, and the person will be taught ways to monitor their tics. Second, the therapist helps the person create techniques called “competing responses” that they can do when they feel like they need to tic. Learning to use competing responses is one of the most important parts of CBIT. Third, the therapist will teach those who interact most often with the person how respond to these techniques and tics. Fourth, the therapist will work with the person and their family to understand situations that make tics worse and help them to come up with a plan on how to approach these situations. Depending on the person’s needs, CBIT may also include other behavioral therapies like relaxation training. Therapists also educate clients and family members about tic disorders and other potential treatment options.

Each person’s tics are unique and so are the treatments. Tics get better for many people by the time they become adults. However, CBIT may be helpful if tics are continuing to worsen or if they affect a person’s daily life, lead to social or emotional difficulties, or cause pain. These “side effects” of tics may lead to other behavior problems later in a person’s life.

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