Comprehensive Behavior Intervention for Tics (CBIT) is a non-drug treatment consisting of three important components:

• training the client to be more aware of tics
• training the client to use “competing” behavior when they feel the urge to tic
• making changes to day-to-day activities in ways that can be helpful in reducing tics

CBIT is a protocol that usually takes 8 sessions over a 10-week time frame. Occupational Therapists and the client focus on all the tics that are bothersome to each client and work on developing a compensatory response to help suppress the tic(s). Some people do not need all the sessions and some people need all of them. We do not hold people accountable for all 8 sessions and base the number of sessions on each person and their needs.

Each session time is different and can run from 30 minutes to over an hour. The first session usually takes the longest because we conduct a great deal of interviewing, gaining better understanding of the client’s tics, what activities or daily occupations the client is having issues with due to tics, and determine if CBIT is something the client desires to participate in.

Our program is highly dependent on the commitment of the client adhering to the practice sessions outside of clinic time. An occupational therapy practitioner will work with each client to promote active participation in activities or daily occupations that are meaningful in the client’s daily life. Our occupational therapists will work to help the client develop a competing response for tics, thereby limiting the interruption of tics on their health, well-being, and participation in their daily occupations.

The occupational therapists in the Adult CBIT Program can see individuals on the campus of The University of Alabama at Birmingham and over a telehealth platform, whatever is better for the person. If an individual desire(s) to use the telehealth platform, the clinic uses Zoom that is HIPAA compliant.

The initial evaluation is $100, and the other sessions will be $50. We can only take cash, or a check made out to UAB. We will not go over $450 for the entire protocol if we do use all sessions. A physician referral is required.

A referral must come directly from a medical provider. The referral must say “OT to evaluate and treat/CBIT Protocol”, along with the name and a way to contact the potential client (phone or email). The referral should be faxed to 205-996-0991.

If we receive a referral from a medical provider that we cannot take a referral from, we will let the potential client know.

Deek Cunningham, MS, OTR/L, FAOTA

Deek earned his Master of Science with a certificate in occupational therapy from the University of Alabama at Birmingham in 1998. He is currently enrolled in a PhD in Health Education and Health Promotion in the School of Public Health at UAB.

His occupational therapy career began in the nursing home field, yet he transitioned to the pediatric arena working in both inpatient settings, psychiatric units, and outpatient settings. Deek later accepted a position in Florida continuing his work with the pediatric population. In 2009, he moved back to South Alabama beginning a new career experience in the field of adult acute care burns, trauma, and home health, while continuing to work with the pediatric population. In 2011, Deek returned to Birmingham and joined the UAB Occupational Therapy Faculty as an Assistant Professor and later in 2014 moved into the Academic Fieldwork Coordinator role.

Deek has been offering CBIT services since he obtained his certification in 2012, by Dr. Douglas Woods, in Minneapolis, MN. He began working with Dr. Jan Rowe in the established CBIT clinic for pediatrics, and then moved into providing CBIT services for adults.

Karmen Mitchell, MS, OTR/L

Karmen earned her Bachelor of Science degree with a certificate in occupational therapy from the University of Alabama at Birmingham in 1998. In 2012, she completed her post-professional Master of Science in the Occupational Therapy program at UAB as well. Karmen spent the early part of her career practicing in acute care, home health and skilled nursing facilities. Since 2002, Karmen has been working full-time as a school-based therapist. She has also worked as a flexi-pool OT for Children’s of Alabama in inpatient rehabilitation since 2009.

In late 2009, Karmen attended a CBIT training by Dr. Douglas Woods at the University of Alabama at Birmingham. In early 2011, Karmen began in the CBIT clinic established and directed by Dr. Jan Rowe and has continued to work closely with Dr. Rowe since that time, as a research assistant and as a qualified CBIT provider. Karmen now provides CBIT services for adults.

Comprehensive Behavioral Intervention for Tics (CBIT): Questions & Answers

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