Cognitive Behavioral Therapy can be very effective in managing the symptoms of Tourette Syndrome. CBIT 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 utilize a workbook that follows along with the weekly treatment sessions, reinforcing the concepts learned, as well as providing practice logs and assignments. Adults learning CBIT are also given a workbook that they can refer to outside of the sessions to reinforce concepts discussed, and provides practice logs 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 his or her 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.
The CBIT treatment series includes the Parent or Adult workbook. Sessions 1 and 2 of the CBIT series are 60 minutes long, and must be scheduled specifically under “CBIT Session 1 or 2” on the online scheduler. These initial diagnostic sessions are billed at $350 each session; sessions 3 through 8 are 45 minutes long and are billed at $225 each session. Dr. Rappaport is not a participating provider with any insurance panel. Payment is due at time of service. Patients will be provided with a detailed statement at the end of each month, which can be directly submitted to insurance, with payments being reimbursed directly to you.
Additional information about CBIT, including treatment outcome studies and statistics, can be found in the CBIT brochure on the TSA (Tourette Syndrome Association) website.