CBIT

CBIT is the Gold Standard treatment for tic disorders and Tourette Syndrome.  The goal of this program is to significantly decrease tics and for all clients to leave with a knowledge of how to use these tools for long lasting benefits.  This is a behavioral approach where change takes place through science, education, support, and effort.

Together, we follow an occupational therapy-based model to look at all of the aspects that make you who you are. From there, we integrate behavioral training, habit reversal training, stress management, and environmental awareness and modification to comprehensively reduce your tic severity and frequency.  Through weekly video therapy sessions, you learn not only how to better manage your tics but also how to incorporate the CBIT principles for the rest of your life.  Success is not only measured by tic reduction but also by your ability to incorporate these principles in all future scenarios. 

Children age 8+ and adults.  There really is no “ideal” client, because everyone with a Tic Disorder or Tourettes has the potential for success.  There are a few qualities that lead to increased outcomes:

The client needs to want to reduce their tics and needs to put in the work.  Clients will be challenged with daily work and consistency is important.  This work is based on an internal drive to desire tic reduction.  It involves repetition, commitment, and an element of regular effort.  It is not recommended for someone that is unable to commit to 8 weeks of weekly treatment. Clients need to have the cognitive and physical capacity to perform the work.  Clients need the age/mental IQ to participate in dialogue about their tics, and the body awareness to recognize basic sensations.  Adaptations will be made in any way possible to adapt treatment to everyone, but the source of change in CBIT is internal and the drive needs to be self-imposed.

There is a population of people with TS and tic disorders that feel that they should not need to adapt themselves or their tics, and they deserve to show up in life exactly as they are and with uncompromised acceptance.  Mooney Wellness has the highest respect for this perspective.  I have spent my career advocating for ADA regulations for accessibility and modifications.  Large aspects of my work as an OT have been collaborating with clients to find pride in showing up as they are despite any physical or mental impairment.  When I view CBIT through this lens, I think of what I wanted when I was struggling through early adolescence.  I wanted to be comfortable in my own skin - tics and all - but I also cared deeply about what I thought others thought about me. I didn't want to stand out for my tics or be the kid that twitches and makes noises.  This is a highly personalized decision, and all opinions are welcome.

Why Work With Ben?

When I was 7, I started noticing my body was twitching in repeated movement patterns.  It was embarrassing and so I didn’t talk about it and just wanted it to go away.  My friends on my baseball team asked me why I repeatedly “kissed the bat,” and the kids on the soccer team asked why I kept touching the field with my hands and blinking my eyes.  I had no idea why, but I knew it was exhausting.  At first, I could resist the actions.  But similar to a pressure cooker, there was always a threshold where I was too mentally exhausted to stop myself or my body took over and moved itself.  I worked so hard to try to hide these movements, and I became so exhausted from disguising my strange behaviors from others. 

I spent excessive time laying in bed - not sleeping - wondering who was going to make fun of me the next day, creating different scenarios of how I should react when it happened. I also thought of different ways to mask my tics and wondered if I would ever get a girlfriend - and if I did, how embarrassing it would be for her to be with me and my tics.  I was also kept awake by a steady stream of eye twitches, head shakes, verbal grunts, hand squeezes, neck flexions, and various other motions that came in different combinations as the seasons passed. I thought about talking to my parents about these ruminating thoughts, my concerns for my uncontrolled movements, and my general feelings of being different than other kids; but I didn't want them to think I was crazy or admit to myself that I might be.  My sleep suffered, but the thoughts didn't go away and the time I spent in dark mental spaces expanded longer into the night. 

When I finally initiated the conversation with my parents, it felt like an out of body experience.  I was so terrified I was opening Pandora’s box.  And, at no fault to my parents, I was correct. Sharing led to diagnosis of Tourette’s syndrome and Obsessive Compulsive Disorder.  I then entered the world of psychiatrists, pharmacology, and a never ending stream of trial and error with medication doses that turned me into an erratic, forgetful, bed-wetting zombie.  It wasn't long before the diagnosis of depression got added to the list, and the doses of lithium, prozac, haldol and all of the other tic-suppressing drugs were increased.  I met a lot of “experts” who seemed to think they knew me better than I knew myself.  Things got harder as I approached adolescence, and when puberty started I went into a tailspin. In the eighth grade I had to be hospitalized to find a therapeutic medication balance for my unstable behaviors. 

As I continued to grow up, I was extremely fortunate to have been surrounded by a lot of good humans, including all of the professionals that were trying their best to treat me.  In High School, I made the intentional decision to stop taking my medications.  I felt like my tics, repetitive thoughts, and potential depression was better than the dullness and imbalanced internal chemistry from all of the medications.  Secretly, I wanted to be able to drink at the parties in my ever-present effort to try to fit in as much as possible.  As I stopped my medications, I felt better overall, though I had an abundance of energy and a longing to fit in.  Although my sleep was terrible, my insecurities were significant, and my Tourette’s was complicated, I had an excellent high school experience.     

Please note as I share my story that I believe pharmacology is so important, and this is such an individual and nuanced process.  There is no such thing as a perfect answer, and we all need to find what is right for ourselves.

As a young adult, I used travel, various substances, and relationships to “relax my mind”, and this strategy worked so well that I brought it along for the ride into adulthood. Society validated that “strength” is my ability to persist through difficult situations, so I created a persona that I was strong enough to survive on limited sleep and simply keep very busy. “Work hard, play hard” was my motto, and it wasn't hard to find people that held similar beliefs. When I was being honest with myself, I knew my fast pace was a method of avoiding insecurities about my Tourette as an adult, and this avoidance trickled into my relationships. I never spoke to my friends about my Tourette, and I internalized so many vulnerabilities. I would spend countless hours preparing versions of ways I would tell a potential girlfriend that I have Tourette Syndrome, imagining she may not have already realized it.  I used so much energy trying to hide my tics around people, especially girlfriends.  I would go into internal battles of debating how I wouldnt want to burden someone I liked, so I should end the relationship, and engage in primarily superficial relationships.  Every time I actually told a girlfriend about my Tourette, I was always shocked when she didn’t seem to care. I lived in a self-imposed version of reality about myself that was so drastically different from actual reality. 

I spent so much time feeling sorry for myself and creating false realities about what I thought others felt, I failed to recognize that my Tourette has been one of my super powers all along. I am resilient and good at rebounding from almost any scenario.  After so many years of repeatedly hearing other kids and adults make comments about me and my behavior, I have learned to filter out ignorant statements and not absorb them.  Additionally, like almost anyone I know with Tourette syndrome, I am such an amazing judge of character.  Living with tics gives you a wise perspective on personality traits of the people around you, and it is very easy to know who is genuine, kind, and trustworthy.  Additionally, I have been a successful OT because I can relate to others well.  I have so much compassion for others as we all work through this journey.

I am drawn to CBIT as a provider because I have seen it significantly help people with TS and tic dosorders.  CBIT offers ways to understand your nervous system, your environment, your stressors, and it gives you a strategy to do something about your tics.  Without knowing it, I have always incorporated aspects of CBIT into my tic management, and the structure of CBIT is so helpful to serve as a guide not only for tic management, but for self awareness.  I am so honored to be able to provide CBIT as an OT, and if you are inspired by my story and you want to learn more, please consider reaching out for a complimentary call to discuss more. 

30 minute Introductory consultation at no charge - lets see if this space is a good fit!

75-90 minutes (Evaluations): $150

50 minute sessions: $100

30 minute sessions: $60

If you need a sliding scale, please ask.