CBIT isn’t a cure, but it gave me control — 9.8.2025
A job is a lot easier to get done when you have the right tools for the job. Have you ever tried to cut a vegetable with a spoon or make a cheesecake on a cookie sheet?
That’s what life was like for me before Comprehensive Behavioral Intervention for Tics. CBIT is what gave me the right tools to live my life with Tourette’s more successfully. I do still have to put in the work, but CBIT changed my life and gave me control over my tics for the first time in my life.
I’ve mentioned Comprehensive Behavioral Intervention for Tics (CBIT) a lot on this blog, and this post is to go over what that is and how it’s helped me— So to start off, what is CBIT?
CBIT is a tool that helps you identify the urge to tic before you tic. This is called the premonitory urge. Once you’ve identified it with your therapist, then, depending on what your tic is, you create a competing response that is more socially acceptable. For example, my first tic of my complex tics is hard blinking that includes my eye brows, wearing out the muscles in my face. The competing response I came up with is a slow, gentle blink that is not as noticeable to other people, nor as tiring for the muscles in my face. After you create the competing response, you learn to ride the wave of still wanting to tic while going through tasks in your daily life by doing your competing response.
What are my competing responses to my tics? I have a complex series of tics that I go through during what I call my “tic storms.” I have developed a competing response for each tic. Instead of hard, painful, obvious blinking, I blink slowly and gently. This is a very common competing response for people whose tic disorders involve blinking. When I feel my sniff coming on (which is my vocal tic), then I breathe through my mouth. It’s really difficult to sniff with your mouth open, so it interrupts the unconscious urge to tic. Once I could get the blinking and sniffing under control, all the tics that would happen in the sequence after that almost disappeared. Sometimes weather or stress might bring some of those tics back now and then, but it is a tiny fraction of the amount that I used to tic.
Tics happen without me noticing, as they do for most people with Tourette’s, so CBIT is all about developing the skills to recognize and interrupt the urge. One of the biggest components of CBIT is becoming mindful about what has become involuntary.
My daughter, Mia, was my partner to help me identify my tics. She would flag whenever she saw me ticcing by raising a finger, and that helped me recognize the urge to tic, which I slowly but surely learned to ride out. We would practice randomly, or during dinner, or other daily activities. Practicing during dinner was really hard because anything that requires me to move my face a lot, like chewing, is more likely to trigger my tics.
Just yesterday, my therapist was telling someone that I worked like a dog and practiced almost 24/7. Because of that, I saw good results really fast. There were probably 10 to 15 minutes a day that I didn’t practice. It was super tiring, and easier said than done to get as far as I have with CBIT as fast as I did. The work effort I put in, along with the mindset of confidence and trust in people around me that were supporting me, allowed me to be successful in this. I want my blog to offer a space for people to learn about this tool and develop the relationships to succeed in their own lives, despite the fact that it is a lot of work! CBIT is a powerful tool, I had a great therapist, and I gave it my all.
What did my day to day while practicing look like?
Hell.
I had the worst headaches when I first started. I could not relax. It was work to keep my face relaxed enough to rest and not tic. This was the most important competing response– actively relaxing my face. But it was stressful to try to relax! It was really counterintuitive to how I had held my face for over 50 years.
Most people start their day with a kick of caffeine, but this was something I had to change as my tics worsened. For me personally, taking control of my tics has meant completely cutting out caffeine, and even decaf coffee. Diet isn’t an adequate treatment on its own, but for some people, what they eat or drink can really ramp up their urge to tic. It’s good to learn that about yourself if you tic, to take time to understand your own relationship with your body and what foods and drinks work or don’t work for you. But please, take any advice you find on the internet about diet and Tourette’s with a grain of salt (unless you can’t eat salt— then skip the salt! ;) ) and talk through any major diet changes with your medical professionals.
If you or someone you know has Tourette’s, I recommend taking the time to learn about CBIT through official organizations like Tourette Association of America and if you are interested, find a qualified professional to offer you this therapy. It can be hard to find someone, especially if you live in a more rural area. I live in Denver, which as cities in the U.S. go, tends to have a lot of resources, but even so, I need to drive almost an hour to another city to meet with my therapist. But that hour drive is worth it, and I’m fortunate to have the opportunity to do a type of therapy that has greatly improved my quality of life. We do meet virtually often which saves me the drive, but it’s just the reality that it can be hard to find someone to do CBIT with.
I’ll continue to share my experience with CBIT on this blog. My ability to navigate my tics still varies day by day, and even now, writing this, I am struggling. Thank you for reading and for Facing Tourette’s with me.
