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This is always a hard topic for me to discuss as I know results vary greatly between individuals.


For my son, CBT (as I know it) was so very beneficial; for his OCD and Tourettic OCD,

but had a sometimes opposite effect with "just tics"

Any attempts to get him to focus too intensely on the tics side always resulted in tic explosions.


So he did fine on most aspects of it but the "awareness" section not so much.

His therapist focused instead on just helping him try to find substitutes for tics that were either personally or socially unacceptable, rather than total emphasis on the "competitive" phase


I do wish they would not call that phase "habit reversal" as I cannot ever call TS tics "habits".....they are involuntary movements or sounds, and where the person does have a small measure of control, but where it is also known that suppressing tics for too long can cause not only a tic meltdown later, but sometimes a channeling into increased OCD, anxiety etc etc


So we were thankful to have an excellent therapist who was willing to modify things to adapt to my son's specific needs....and it worked. The previous attempt we had was disastrous, as the therapist was more interested in molding my son into what her image of him was, rather than helping him be a better himself!!!


I think therefore that the answer to your question is that everyone with TS is most likely a candidate for CBIT BUT

not every therapist is necessarily a good candidate for providing it. Choose with care!!


Dealing with the triggers and practicing relaxation techniques were the easy part as we had already been doing that.



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Primarily psychologists, tho there are a few psychiatrists who do it.


ALWAYS ask ahead if they have CBT experience, and specifically related to tics.


Sometimes your health insurance provider can give you a list of therapists who specifically are trained in CBT

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  • 2 weeks later...


My daughter just completed CBIT (she still goes for follow up appointments) with amazing success. We have tried everything since she was 5 and she started CBIT at 12 (she's 13 now) and the results have been life changing. CBIT - doesn't use the word habit reversal - at least with the doctors we dealt with - in fact they won't use the word habit - for that is so far from what Tourettes or tics are. CBIT is a program specifically for Tics (that is why it is called Comprehensive Behavioral Intervention for Tics) it is focused just on tics. Not reversal of tics but rather the awareness of them and taking control of them. We are in Canada and their are some hospitals here with out patient services that are within the Tourette''s clinics that have areas where the psychologists are trained specifically in CBIT. The book Nix your Tics is where we found out the hospitals that provided this service.


Our daughter was a candidate for the program because the tics bothered her (so she was motivated to put the work into the program), she was aware of her tics (she could tell when they would happen before they happened - so she could control them in the Premonitory urge

stage, and she was old enough to be committed to doing the program. My other daughter who has tics is only 8 and is not a candidate right now - for her tics do not bother her - so she is not motivated to work on controlling them. She probably has inattentive adhd - which means that she is not always aware of when they are happening either.


Good luck!


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But Dr Dunc, who wrote Nix Your Tics does call it Habit Reversal! http://www.lifesatwitch.com/nixyourtics_book.html

learn effective alternative treatments for tics like habit reversal training and the Comprehensive Behavioral Intervention for Tics (CBIT)


I really like his site and his perspective on TS...it was one of the first TS sites I found when my son was initially dx over a decade ago, but I still don't like the term "habit" for tics...

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I don't like the term habit either and it was never used for us when following CBIT at the clinic we went to.


Dr Dunc speaks of habit reversal training and CBIT. We didn't do the 'habit reversal training' rather the "and the Comprehensive Behavioral Intervention for Tics (CBIT) program.

I am sorry if I mislead in some way. I was just saying what CBIT was for us and its benefits for our daughter.

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So sorry if I sound pedantic here but I really want to be sure no one is confused.....


If you look at the link I posted in my first reply here, it explains that CBIT is made of of three components and that Habit Reversal Training is the first of these three......

CBIT consists of three basic components each of which may vary depending on the age of the person and nature of the tics. The most integral component is habit reversal training. .......





This was the main reason that we opted for CBT alone.


I realize some therapists may not incorporate the Habit Reversal training in what they call CBIT, as your experience shows mythree :) ....but just want to be sure anyone else reading here is aware and that they remain informed in exactly what the therapist plans to do.


and PS Dr Dunc seems to feel HRT is helpful, so I am not saying it does not work. Just was not for us, at least not in that terminology. Our therapist did help my son find substitutes for tics he my son) selected, due to their problematic nature, either socially, or for him personally...but it was never considered "habit reversal" per se.

Edited by Chemar
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