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Thread: CBIT (Comprehensive Behavioural Intervention For Tics) Experiences - Anyone?

  1. #1

    Default CBIT (Comprehensive Behavioural Intervention For Tics) Experiences - Anyone?

    I just have some questions for anyone who has any experience either personally or related to a family member and CBIT (Comprehensive Behavioural Intervention For Tics). What type of tics were you dealing with and did the CBIT help you (or your family member). Did it ever exacerbate the tics to attend that therapy and if so, did that eventually subside?

    My almost 10-yr-old son has TS - with differing bouts of severity and intensity. His motor tics lately mostly involve his hands but aren't too severe or bothering him too much now. His vocal tics have increased in severity since he first had one. And, he seems to be ok for a while and then something triggers it - and then he is dealing with severe complex vocal tics. I read to him a post written by someone with TS and who mentioned some things that helped him deal with it - and my son felt better knowing others have it. But, he does not want to know about others' tics or anything as he said he is afraid he will get their tics. Anyway, I'm just wondering if I can find some Cognitive therapy program for him and if I should...as they may see him during a time he is nearly tic-free and not know how bad things can get for him. And, I don't want the therapy to put so much focus on his tics that they worsen. Part of me thinks that deep down the therapy hopefully should help him when needed now and in the future..I'm just wondering what others have experienced...thank you in advance for any info!

  2. #2
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    Default Re: CBIT (Comprehensive Behavioural Intervention For Tics) Experiences - Anyone?

    What type of tics were you dealing with and did the CBIT help you (or your family member). Did it ever exacerbate the tics to attend that therapy
    CBIT can address any tic that is associated with a Tourette Syndrome diagnosis. Tics are not exacerbated by the competing response used in CBIT therapy because the competing response is an external influence that acts as a tic blocker.

    However, if the child / person receiving CBIT therapy is not receiving appropriate social support from family, the stress the child might experience by trying to manage symptoms in the absence of social support might have a negative impact on his overall symptoms.

    This has nothing to do with CBIT, just the environmental influence of a non compliant family.

  3. #3

    Default Re: CBIT (Comprehensive Behavioural Intervention For Tics) Experiences - Anyone?

    Thanks Steve. Just wondering if anyone has gone through this therapy and if it has helped them. Support is hugely important - I agree.

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    Default Re: CBIT (Comprehensive Behavioural Intervention For Tics) Experiences - Anyone?

    HBM,
    I have not gone through CBIT, but in my experience the method is sound. Over the years I fell into behaviors that are functionally identical to CBIT. The idea is that you learn to recognize the tic and what it feels like, then you replace the tic with something else that uses the same body parts. In fact I recently saw a list of replacement behaviors and it is interesting how many I use (a list I unfortunately can't share because it is someone's incomplete project).

    My almost 10-yr-old son has TS - with differing bouts of severity and intensity. His motor tics lately mostly involve his hands but aren't too severe or bothering him too much now. His vocal tics have increased in severity since he first had one. And, he seems to be ok for a while and then something triggers it - and then he is dealing with severe complex vocal tics. I read to him a post written by someone with TS and who mentioned some things that helped him deal with it - and my son felt better knowing others have it.
    There is good reason to think that those can be replaced. I saw vocal tics on that list.

    But, he does not want to know about others' tics or anything as he said he is afraid he will get their tics.
    That should be taken seriously. TS does include mimicry phenomena (echolalia, echopraxia), and our feelings about our tics do influence our tics. Genuine belief might trigger the reality. It might be better to let him become comfortable reading about the specific tics of other people.
    Anyway, I'm just wondering if I can find some Cognitive therapy program for him and if I should...as they may see him during a time he is nearly tic-free and not know how bad things can get for him. And, I don't want the therapy to put so much focus on his tics that they worsen. Part of me thinks that deep down the therapy hopefully should help him when needed now and in the future..I'm just wondering what others have experienced...thank you in advance for any info!
    You can always record a video of him if you are worried that he will not be ticcing for some reason. I don't think that CBIT is something to be worried about as far as making any tics worse.

  5. #5

    Default Re: CBIT (Comprehensive Behavioural Intervention For Tics) Experiences - Anyone?

    Hi Flutterguy - thank you SO much again for a thoughtful reply. I actually replied to your other post and accidentally deleted it. So I hope I can reply again and respond to your comments. Thank you so much for any and all advice or thoughts on here. My son talked to me more the other day about his tics and that they were actually really bothering him - and I didn't realize it as I don't see them happening all the time. We did read about some methods before like replacing the tic with something different and my son tries it sometimes. I'm assuming it takes time and practice..maybe improvements are little by little...

    For example when he was having a hand tic (normally involves squezzing or bending) pretty bad he tried holding his hands together (fingers intertwined like a prayer position) and he was trying so hard to hold it that he was on the floor like moving his legs around getting really overwhelmed and saying it was building up so much worse, etc but he still held his hands like that as long as he could. Maybe he needs to take it slow or slower and not force himself to hold it ..I don't know..But it is bothering him enough that he wants to try to do something about it. Also, he definitely is aware of the urge before it happens or at least as it is happening. I noticed that when people are over he rarely has many tics - not too noticeable to most people unless he has a big flare up and that is not suppressible for him in any way if it's really bad. As soon as our company left yesterday (they were over all day until 5 pm) he started having them more. I didn't know if he was aware he was suppressing them but he said he could feel he was...I'm learning a lot on here.

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    Default Re: CBIT (Comprehensive Behavioural Intervention For Tics) Experiences - Anyone?

    Quote Originally Posted by HBM
    he does not want to know about others' tics or anything as he said he is afraid he will get their tics.
    I don't believe this concern is supported by the literature. According to my understanding of the dynamics of tic expression, as has been described by various authorities I have heard talking about this, tics are generated in one's own basal ganglia. That is, an individual's tic repertoire are unique to that person, although there may be some commonality of tics from person to person.

    When people with Tourette congregate, it's not unusual to "try on" someone else's tic, and it seems this is done out of curiosity.

    Tics do not appear to be the result of a learned behaviour, and there is no evidence of so-called symptom substitution.

    Similar research was done (Deckersbach et al., Wilhelm et al., 2003) to examine whether behaviour therapy replaced old tics with new tics and the research did not support this belief.1

    Quote Originally Posted by HBM
    I noticed that when people are over he rarely has many tics - not too noticeable to most people unless he has a big flare up and that is not suppressible for him in any way if it's really bad. As soon as our company left yesterday (they were over all day until 5 pm) he started having them more.
    The concern you express has to do with whether tic suppression results in a rebound of symptoms.

    Three controlled studies have failed to demonstrate a "rebound effect" in tics in children and adolescents with TS, although successful suppression was obtained. (Himle & Woods, 2005; Woods & Himle, 2005; Woods et al., 2008).

    Thus existing research does not support the idea of a rebound effect following tic suppression.

    Perhaps these increases at home following school (or other periods of suppression) have more to do with contextual changes than "suppression" occuring throughout the day. Further research will be needed to explore this possibility.1
    1) Source for the information contained in this post: Managing Tourette Syndrome, Douglas Woods et al., Pages 16, 17

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    Default Re: CBIT (Comprehensive Behavioural Intervention For Tics) Experiences - Anyone?

    I've never tried to substitute a tic, but have had success in using a replacement word as a substitute for something I hated saying. Someone suggested trying this and I didn't think it would work. But I was persistent, because I really wanted to change it.

    After two years, the replacement word came out about 20% of the time; and after 10 years, it was used about 90% of the time. That may sound discouraging that it took so long, but I'm very happy with the result and glad I persisted. The replacement word was only substituted for one thing, however.

    With respect to copying others' tics, I'm not quite convinced it doesn't happen at least occasionally. Could be coincidence, but I've observed what would appear to be copying a tic in myself and also a friend. In both cases, it was a few months between first witnessing the tic and later beginning to perform it. If it weren't for the fact that the tics were complex and probably rare, I'd have no problem believing it was coincidence.

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    Default Re: CBIT (Comprehensive Behavioural Intervention For Tics) Experiences - Anyone?

    HBM,
    I actually replied to your other post and accidentally deleted it. So I hope I can reply again and respond to your comments. Thank you so much for any and all advice or thoughts on here.
    No problem. I'm glad you found it useful.

    My son talked to me more the other day about his tics and that they were actually really bothering him - and I didn't realize it as I don't see them happening all the time. We did read about some methods before like replacing the tic with something different and my son tries it sometimes. I'm assuming it takes time and practice..maybe improvements are little by little...
    How are you at changing your habits? It is a gradual thing that has to be structured to have the best effect. Looking back on it I might have taken years to come up with the things I did and it was not a conscious process. I was aware that I was a "twitchy person" but never made the connection to something like TS. Eventually I just "did things that made life easier" without it being deliberate of focused on tics.

    For example when he was having a hand tic (normally involves squezzing or bending) pretty bad he tried holding his hands together (fingers intertwined like a prayer position) and he was trying so hard to hold it that he was on the floor like moving his legs around getting really overwhelmed and saying it was building up so much worse, etc but he still held his hands like that as long as he could. Maybe he needs to take it slow or slower and not force himself to hold it ..I don't know..But it is bothering him enough that he wants to try to do something about it.
    In my experience trying to do a new tic or tic replacement because the old one is a problem does have parts that are not unplesent as much at the are unsatisfying. The urge to do a specific thing involves a "getting it just right" feeling like finding out the seam of your sock is twisted under your foot so you take your shoe off and fix it because it is uncomfortable. You can just leave your sock the way that it is, but it's "not right" and annoying.

    It might take some practice for the new thing to start sticking and "feeling right". "Fake it till you make it" has some truth behind it in that your body treats faking it like practice. In the meantime it's not unpleasant that we did something other than what pour bodies wanted, but it's just not emotionally satisfying. Sort of like how a salad is not as satisfying as a steak and potatoes (for me anyway).
    Also, he definitely is aware of the urge before it happens or at least as it is happening. I noticed that when people are over he rarely has many tics - not too noticeable to most people unless he has a big flare up and that is not suppressible for him in any way if it's really bad. As soon as our company left yesterday (they were over all day until 5 pm) he started having them more. I didn't know if he was aware he was suppressing them but he said he could feel he was...I'm learning a lot on here.
    That's interesting because I can often tic less in some social situations because I'm more focused on the situation and that replaces perception that might otherwise be filled with that excess TS energy. Unless the social situation becomes stressful for some reason (though I suspect that TS might have some "good in a crisis" qualities if we have useful knowledge or abilities). Also if the social situation becomes routine I will tic more because my attention is not as sharp.


    Steve,
    I don't believe this concern is supported by the literature. According to my understanding of the dynamics of tic expression...
    That's good to know, thanks for the information. That will make my speculation more accurate in the future.

  9. #9

    Default Re: CBIT (Comprehensive Behavioural Intervention For Tics) Experiences - Anyone?

    Quote Originally Posted by flutterguy View Post
    hbm,

    no problem. I'm glad you found it useful.

    How are you at changing your habits? It is a gradual thing that has to be structured to have the best effect. Looking back on it i might have taken years to come up with the things i did and it was not a conscious process. I was aware that i was a "twitchy person" but never made the connection to something like ts. Eventually i just "did things that made life easier" without it being deliberate of focused on tics.

    good to know. Definitely makes sense. It is very difficult to change habits - a slow and painful process for me!

    in my experience trying to do a new tic or tic replacement because the old one is a problem does have parts that are not unpleasent as much at the are unsatisfying. The urge to do a specific thing involves a "getting it just right" feeling like finding out the seam of your sock is twisted under your foot so you take your shoe off and fix it because it is uncomfortable. You can just leave your sock the way that it is, but it's "not right" and annoying.

    It might take some practice for the new thing to start sticking and "feeling right". "fake it till you make it" has some truth behind it in that your body treats faking it like practice. In the meantime it's not unpleasant that we did something other than what pour bodies wanted, but it's just not emotionally satisfying. Sort of like how a salad is not as satisfying as a steak and potatoes (for me anyway).

    interesting example you use there - with the sock/seam and fixing it so it feels ok and feeling satisfied with something, ie: Tic replacement. I understand that feeling and how disturbing it is if that thing isn't "just right" or acceptable - due to a few ocd like tendencies i have. The sock example is funny because my son was (and still is) super sensitive to clothing items - like socks (drive him crazy and he has to put them inside-out) and underwear, tags - i still can't find something he can deal with that doesn't bother him. I don't know if people with ts are sensory sensitive or its just something he has had for a while.

    that's interesting because i can often tic less in some social situations because i'm more focused on the situation and that replaces perception that might otherwise be filled with that excess ts energy. Unless the social situation becomes stressful for some reason (though i suspect that ts might have some "good in a crisis" qualities if we have useful knowledge or abilities). Also if the social situation becomes routine i will tic more because my attention is not as sharp.
    thanks. This could definitely be why he is having less tics when people are over...makes sense. Thank you for sharing again.

    steve,

    that's good to know, thanks for the information. That will make my speculation more accurate in the future.


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