Tics and Body-Focused Repetitive Behaviors

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Online OTs specializes in CBIT Therapy as well as the ComB protocol. 

Our Boston-based telehealth treatment includes the following components for tics and body-focused repetitive behaviors (BFRB):

Awareness training: 

• Identifying thoughts and sensations that precede the behavior.
• Noticing exactly when  the repetitive behavior is occurring.
• Understanding how your muscles move while doing the behavior.
• Identifying premonitory sensations or urges.
• Recognizing triggers at home and in the community.

 Competing response training: 

• Inhibiting the unwanted behavior with incompatable muscle contractions and activities.
• Putting the urge on hold to decrease it's intensity and the frequency of unwanted actions.

Conditions addressed with CBIT Habit Reversal Training include: 

• Functional Neurological Disorder (FND)
• Tic Disorders (including Tourette Syndrome)
• Body-Focused Repetitive Behaviors (BFRB) including skin picking and scratching, nail biting, and hair pulling.

Tics are unvoluntary and repetitive sudden muscle movements (motor tics) or uttered sounds (vocal tics) which can be highly disruptive in daily life.  Tics are often very distracting, frustrating, painful, stressful, and embarrassing. Tics tend to worsen during times of anxiety, excitement, and boredom. They wax and wane  over weeks, months, and years. Some tics last a lifetime while others fade away and new ones appear. Common motor tics include repetitive blinking and unusual eye movements, shoulder shrugging, and head jerks. Common vocal tics include throat clearing, and saying words or sentences. Tics often involve complex movements and sounds such as torso twisting with facial and neck movement and a high pitched noise. CBIT Therapy is the most effective strategy to manage tics in Boston and throughout the world.

Tic Disorders include:

• Tourette Syndrome (Tourette Disorder, Tourette's, TS)
• Provisional Tic Disorder 
• Persistent Tic Disorder

Functional Neurological Disorder (FND) is a physical and / or sensory impairment that is due to an abnormality in how the brain processes information rather than structural damage in the brain. FND occurs suddenly but is often preceded by a lengthy period of heightened anxiety and loneliness. People with FND benefit from a proper diagnosis and guidance identifying and addressing stressors. Inhibiting unwanted and involuntary movements is also critical. 

Online OTs treat patients with the following FND conditions:

• Functional tic-like behavior
• TikTok Tics (functional tic-like behavior in which there is a false belief that one has Tourette Syndrome based on erroneous social media)
• Functional tremors - tremor-like movements

Body-Focused Repetitive Behaviors (BFRB) are habitual grooming actions that cause significant physical damage to hair, skin, or nails. Online OTs utilizes two habit reversal programs (the ComB protocol and CBIT Therapy) to address unwanted repetitive behaviors. The ComB model was designed specifically for concerns such as excessive hair pulling, skin picking, and nail biting to address some of the sensory, cognitive, and emotional triggers. CBIT, which was initially used to address tics and Tourette Syndrome, enables patients and therapists a means to better understand the anatomy and physiology behind behaviors.With Online OTs, patients learn to use common household items as barriers to habitual actions and are introduced to wearable technology when appropriate. Training in CBIT Competing Responses also decreases unwanted movements and behaviors, as well as the urges that precede them.

Body-Focused Repetitive Behaviors include:

• Excoriation (skin picking)
• Trichotillomania (hair pulling)
• Onychophagia (nail biting or chewing)
• Onychotillomania (nail picking and pulling)
• Lip Bite Keratosis (lip biting)
• Cheek Keratosis (biting of inner cheeks)

It should be noted that some of these behaviors seem to be somewhat weather related. When the skin is exposed to colder temperatures and lower levels of moisture, it can become dry and irritation can occur. Be sure to moisturize during the long winter months in New York,Boston, and the rest of New England, Contact a dermatologist if at risk for infections or other damage to the skin.