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  • Professional CBIT Training

    Steve
    I've been looking for a way to get certified in CBIT the Tourettes foundation doesn't have a training planned currently, do you know if there is anyone else providing training toward certification? I was hoping to find something in the next month or two.

  • #2
    Re: CBIT Webinars: View Here (Free)

    Originally posted by Journey View Post
    I've been looking for a way to get certified in CBIT the Tourettes foundation doesn't have a training planned currently, do you know if there is anyone else providing training toward certification? I was hoping to find something in the next month or two.
    We are working closely with TAA with regard to CBIT training, with the intention of setting up training in Canada to supplement the training provided by the TAA BTI. There is no training in the works by TAA, but if you go to the TAA website HERE you can contact Denise Walker by email to get your name on the list for the next TAA BTI session.

    If the Canadian session is scheduled before one of theirs, you would be welcome to attend, likely in either Ottawa or Toronto.

    The curriculum and content would be virtually identical, as we are working in collaboration with TAA.

    As I get more information, I can let you know.
    Steve
    TouretteLinks Forum

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    • #3
      Re: CBIT Webinars: View Here (Free)

      Hi Steve
      I actually heard from Denise, but the next training is right when I'm hoping to start a new job ugh. I'm hoping they will offer something else at least a few months from now but I'm not sure how often they have trainings. Do you have any info about a training in Canada yet, if so I'd be very interested.
      Journey
      Last edited by Steve; January 2, 2017, 10:03 AM. Reason: edit at author's request

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      • #4
        Re: CBIT Webinars: View Here (Free)

        I actually heard from Denise, but the next training is right when I'm hoping to start a new job
        Not sure where / when that one is, but how's early May 2107?
        Steve
        TouretteLinks Forum

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        • #5
          Re: CBIT Webinars: View Here (Free)

          Really? So you are having a certification training up there in May? The TA one is Feb 3-4, which doesn't allow me much notice. I would love to get any info on my personal email or be added to your email list for events like this. Please let me know how I can gather the needed details.
          Thank You Steve
          Journey

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          • #6
            Re: CBIT Webinars: View Here (Free)

            So you are having a certification training up there in May?
            Please see my Private Message to you for more information. As soon as final arrangements are confirmed, more info will be posted publicly.
            Steve
            TouretteLinks Forum

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            • #7
              Re: CBIT Webinars: View Here (Free)

              Thank you Steve....please add me to your mailing list for training. The TA training is Feb 3-4.
              I'm Hoping to meet you in Canada!

              Comment


              • #8
                Re: CBIT Webinars: View Here (Free)

                Will keep you posted. It looks like the training in Louisiana was just recently arranged.
                Steve
                TouretteLinks Forum

                Comment


                • #9
                  Re: CBIT Webinars: View Here (Free)

                  Hi Steve
                  Yes I believe so, it is just a bit soon with it already being January. Thanks so much for helping me and I look forward to learning about any trainings in Canada.
                  Journey

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                  • #10
                    Re: Professional CBIT Training

                    Steve
                    Can you think of a competing response for a sniffing outward or snorting out tic? The adult client gets embarrassed as people constantly offer her a tissue, and the snorting out gets loud.
                    Journey

                    ---------- Post Merged at 04:10 PM ---------- Previous Post was at 04:09 PM ----------

                    I hope I put this in the correct forum, my apologies if not

                    Comment


                    • #11
                      Re: Professional CBIT Training

                      Originally posted by Journey
                      Can you think of a competing response for a sniffing outward or snorting out tic?
                      Developing an effective competing response (CR) that will act a a tic blocker requires an analysis or "reverse engineering" of the target tic. The reason is that the tic may not involve simply a sniff, but may incorporate some other component activity involving facial , neck or nose muscles that evolve into the final sniff.

                      Once the entire tic process is understood, then an appropriate CR can be assembled.

                      If, for example, the entire tic process that culminates in the sniff begins with, say, a shoulder roll, thet then becomes a head shrug, then a mouth pull ending in a sniff, the CR should begin with the shoulder roll, because that movement is the one triggered by the premonitory urge. In CBIT, the premonitory, it is the premonitory urge the subject uses as the cue for the CR, in order to block the entire process of the target tic.

                      That being said, and as you have likely isolated the sniff as the target tic, and if the sniff is the premonitory urge she is responding to, you may want to propose she try "reverse diaphragmatic breathing".

                      Typically diaphragmatic breathing is done by inhaling through the nose and exhaling through the mouth, so by reversing and inhaling through the mouth and exhaling through the nose would effectively block the sniff.

                      Caution should be used with diaphragmatic breathing in a person with Tourette, as diaphragmatic breathing can trigger a diaphragmatic tic, especially if one inhales to full capacity. This can usually be avoided by recommending inhaling to about 80% capacity, and focusing on the cool air coming in / warm air coming out, to distract attention from the diaphragm.

                      You may also want to incorporate additional CR components like those used for nose crunching (see attached).

                      I've attached a PDF from my slide presentation taken from Dr. Woods' textbook Managing Tourette Syndrome that illustrate some sample CR's for some typical tic activity.

                      This is the textbook that is provided to participants of CBIT training as part of the course materials.

                      As you know, the CR should be used whenever the premonitory urge for that tic is felt, and the CR should be repeated for at least one minute or until the urge subsides, as tics come in bouts.

                      Practicing the CR for two to three weeks (or more) ultimately should strengthen the neural pathways so that your client can unconsciously apply the CR to manage her tic in circumstances she feels it necessary.

                      She should be reminded this won't eradicate her tic, but rather gives he a tool to manage her tic when she feels it's needed.

                      Additionally, you might explore what external factors (antecedents and consequences) might be exacerbating this particular tic activity, so she can take the necessary steps to mitigate those factors.

                      Hope this helps!

                      Looking forward to your feedback.
                      Attached Files
                      Steve
                      TouretteLinks Forum

                      Comment


                      • #12
                        Re: Professional CBIT Training

                        Fascinating stuff, Steve!

                        Journey, I have another idea to share. My 13yo son with Tourette has a respiratory tic that we have recently been working on disguising. My son has found both disguising and re-engineering helpful for him.

                        The primary socially unacceptable respiratory tic he has is to put his finger in his nose. I recently showed him how to hold up a kleenex as a privacy curtain. I told him, "If you hold the kleenex up and act like you're blowing your nose, you can do what you need to do, behind the screen (the kleenex)." We practiced a few variations on this, with lots of fun and laughter. (I don't know if you have that sort of relationship with your client, but if so, there is a funny Car Talk podcast episode, where they joke around about Ray's snorting. Let me know if you want me to upload it -- I have it saved on my computer.)

                        If I imagine my son developing a snorting tic, and then working with him to manage it in a more socially acceptable way... I suppose one hurdle might be that it could be difficult to grab a kleenex quickly enough to get it to his nose before the snort comes out. However, in terms of social acceptability, I think that even pulling a kleenex out from one's pocket, or from a box of tissues on a nearby desk or table, might be a helpful signal that the snorter is trying to be considerate of others. (I have another funny audio-visual to share related to this, if you want it! This one is a video clip from a web series.)

                        I wonder if doing this might have a side benefit to your client, of helping develop awareness of a premonitory urge?

                        May I ask, how is your client doing with giving brief, matter-of-fact explanations of her tics to people? In the long run, I think this can be an extremely helpful thing to learn to do; but it can take some doing to get to that point.

                        Steve, is that something that is covered in CBIT training? I see several aspects to the process:

                        - convincing the person that such explanations can be helpful

                        - coach models giving explanations

                        - person with Tourette practices giving explanations

                        - person with Tourette reports to coach, or coach makes direct observation, and then the two talk about how it felt and how it was received
                        Last edited by aparente001; January 9, 2017, 04:28 PM.

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                        • #13
                          Re: Professional CBIT Training

                          Originally posted by aparente001
                          is that something that is covered in CBIT training?... giving brief, matter-of-fact explanations of her tics to people?
                          If I understand your question, is explaining (analyzing) the tic part of CBIT therapy, then yes, it is an integral part of the therapeutic process.

                          There are six distinct elements to CBIT therapy:
                          • Psychoeducation
                          • Self Awareness
                          • Tic Analysis
                          • Relaxation Therapy
                          • Competing Response Therapy
                          • Social Support


                          In order to address the tic that is most bothersome to the individual, the therapist uses several objective measurement criteria to determine the effect the tic has on the person's life and ability to function, then the tic is analyzed in detail, as I described earlier, to identify each step by step component that comprises the tic...in effect reverse engineering the tic.

                          This information provides the therapist with the information needed to work with the individual to construct a competing response the individual is comfortable with, and that effectively makes the tic impossible to express.

                          This is not the same as disguising or hiding the tic, but rather a means of functionally blocking the tic from being expressed when the premonitory urge is felt.

                          By doing so, the feedback mechanism within the brain that feeds the part of the brain that receives positive reinforcement from satisfying the urge for the tic, is effectively blocked.

                          Performing this blocking process over a period of time, has been shown to strengthen neural circuits in the brain, between the voluntary (prefrontal cortex) and the involuntary (basal ganglia CSTC circuit) by means of brain plasticity, thereby giving the individual the ability, over time to better manage the tic in situations where s/he feels the need.

                          The process of building or strengthening neural circuits by means of brain plasticity can be compared to people who have a stroke, a neurological event where some functionality is lost or impaired. As we know, not all people who have a stroke remain impaired the rest of their lives, because through therapy....like physical therapy and occupational therapy (forms of behavioural therapy) by repeating the same activity again and again, they can recover many of their lost or impaired functionality.

                          Similar principles occur in CBIT using competing responses to tics and the reason why the therapist must understand the detailed dynamics of the tic to be addressed.
                          Steve
                          TouretteLinks Forum

                          Comment


                          • #14
                            Re: Professional CBIT Training

                            That's very interesting, Steve. And it helps me understand the re-engineering my son has occasionally managed to do.

                            I was asking about something else, which I'm guessing might fit into item 6, Social Support.

                            I was talking about the individual with Tourette learning to tell other people why s/he sometimes acts funny. This has been a helpful thing for my son to learn to do. (He still has a ways to go, but he's gotten a good start.)

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                            • #15
                              Re: Professional CBIT Training

                              individual with Tourette learning to tell other people why s/he sometimes acts funny
                              Excellent point and one that I have often referred to as learning the skills to advocate and negotiate on one's own behalf.

                              These important life skills are especially important for a child / person with Tourette because one is frequently asked about and even challenged for their symptoms.

                              During childhood, parent(s) are their child's best advocates and negotiators at school and with family and friends. What the child learns from parents during this period can benefit him/her for the rest of his/her life.

                              As a way to begin the dialogue with anyone who inquires about one's tics, the explanation I recommend is,

                              "The sounds and/or movements I make are because I have Tourette Syndrome. Tourette Syndrome is a neurological disorder I was born with, and the movements / sounds are involuntary. Are you familiar with Tourette Syndrome?

                              I recommend this explanation because it hits the important points:
                              • The name: Tourette Syndrome repeated three times so there is no misunderstanding
                              • Disorder..it is NOT a sickness nor a disease and it is not "catching"
                              • Neurological: the disorder is in the brain wiring; it is genetic and we are born with it.
                              • Involuntary: NOT Behavioural...a critical distinction to make, especially with skeptical teachers and poorly informed adults.
                              • Ends with a direct question to invite a dialogue to further awareness


                              It is recommended that this be rehearsed with a parent or other trusted friend or family member, to become familiar with the words and to learn other important facts about Tourette. Have available a FAQ type brochure that can be given to the person making the inquiry.
                              Steve
                              TouretteLinks Forum

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