Tics can be confusing, frustrating, and sometimes overwhelming for the people who experience them and for their families. Whether they involve blinking, throat clearing, shoulder shrugging, facial movements, or vocal sounds, tics often occur suddenly and can feel difficult, or even impossible, to control. Many individuals describe feeling an intense urge to perform the tic, followed by temporary relief once the movement or sound has occurred.

Unfortunately, misconceptions about tic disorders remain common. Well-meaning adults often tell children to “just stop,” while adults with tics frequently worry that others believe they are making noises or movements on purpose. These misunderstandings can lead to embarrassment, anxiety, social isolation, and reduced self-confidence.

The reality is that tic disorders, including Tourette Syndrome, are neurodevelopmental conditions, not habits or behaviours that someone simply chooses to do. While stress and strong emotions make tics more noticeable, poor parenting, lack of discipline, or insufficient willpower do not cause them.

The good news is that effective, evidence-based treatments are available. One of the most well-researched behavioural treatments for tic disorders is Comprehensive Behavioural Intervention for Tics (CBIT). CBIT helps individuals better understand their tics, recognize the earliest signs that a tic is about to occur, and develop practical strategies to reduce the frequency and impact of tics over time. Rather than focusing on eliminating every tic, CBIT aims to improve daily functioning, increase confidence, and help individuals feel more in control of their symptoms.

At Colibri NeuroWellness, we provide Comprehensive Behavioural Intervention for Tics (CBIT) for children, adolescents, and adults in Kitchener-Waterloo through in-person therapy, as well as online CBIT therapy across Ontario.

What Are Tic Disorders?

A tic is a sudden, rapid, recurrent movement or vocalization that occurs involuntarily or semi-voluntarily. While some people can briefly suppress a tic, doing so often requires considerable effort and may lead to increasing discomfort until the tic is eventually expressed.

Tics vary greatly from person to person. They may be subtle and barely noticeable, or more frequent and disruptive depending on the individual and the situation.

Tic disorders are neurodevelopmental conditions that typically begin during childhood, most often between 5 and 10 years of age. Symptoms commonly fluctuate over time, with periods where tics become less noticeable followed by times when they increase in frequency or intensity. This pattern is often referred to as “waxing and waning.”

Although many children experience improvement as they grow older, some individuals continue to experience tics during adolescence and adulthood.

Types of Tics

Tics are involuntary, rapid, and repetitive movements or sounds. They are generally divided into two main categories: motor tics and vocal (phonic) tics, both of which can range from simple to complex.

1. Motor Tics

Motor tics involve physical movements of the body.

  • Simple Motor Tics: These are brief, sudden movements that involve a limited number of muscle groups. Common examples include excessive eye blinking, facial grimacing, nose twitching, head jerking, and shoulder shrugging.
  • Complex Motor Tics: These involve more coordinated, sequential movements that can appear purposeful. Examples include repeating specific gestures, jumping, hopping, touching objects in a distinct pattern, or neck and limb stretching.

2. Vocal (Phonic) Tics

Vocal tics involve sounds produced by moving air through the nose, mouth, or throat.

  • Simple Vocal Tics: These are basic, involuntary sounds such as throat clearing, sniffing, coughing, grunting, clicking, humming, or squeaking.
  • Complex Vocal Tics: These involve more structured linguistic patterns, such as repeating words, phrases, or suddenly changing pitch and volume.

You might have seen movies or TV shows where characters with Tourette Syndrome involuntarily shout out swear words or inappropriate phrases. This is called coprolalia. In reality, this symptom is actually quite rare. The vast majority of people with Tourette Syndrome never experience this, despite how often it is shown on screen.

Understanding the Different Tic Disorders

Not all tic disorders are the same. Mental health and medical professionals use specific diagnostic criteria to distinguish between different types of tic disorders.

  • Provisional Tic Disorder: Diagnosed when motor and/or vocal tics have been present for less than one year. Many children experience a gradual, natural reduction in these symptoms without needing intensive treatment.
  • Persistent (Chronic) Motor or Vocal Tic Disorder: Diagnosed when either motor tics or vocal tics (but not necessarily both) have been present for more than one year.
  • Tourette Syndrome (TS): Diagnosed when an individual has multiple motor tics and at least one vocal tic that have lasted for more than one year, starting before age 18.

Note on Severity: While Tourette Syndrome is often considered the most severe tic disorder, symptoms vary widely. Many people have mild tics that barely affect daily life, while others experience more frequent or complex tics that impact school, work, or social activities.

What Causes Tic Disorders?

One of the most common questions families ask is, “Why did this happen?”. Tic disorders are complex conditions caused by a combination of genetic, neurological, and environmental factors. They are medical conditions, not the result of poor parenting, lack of discipline, or emotional weakness

  • Brain Chemistry: Research suggests tics are linked to differences in how brain regions communicate, particularly those controlling movement and habits. Brain chemicals like dopamine also play a key role.
  • Genetics: Tics often run in families. Having a family history of tics, ADHD, or OCD increases the likelihood of developing a tic disorder.

What Triggers Tics?

While stress and emotions do not cause tics, they can temporarily make them more frequent or noticeable. Common triggers include:

  • Fatigue or poor sleep
  • Illness
  • Anxiety, excitement, or stress
  • Changes in routine or major life events
  • Increased demands at school or work

Identifying these personal triggers is a key part of management, helping individuals and families anticipate and prepare with effective coping strategies.

Tics Often Occur Alongside Other Conditions

Many people with tic disorders also have other neurodevelopmental or mental health conditions. Often, these co-occurring conditions impact daily life more than the tics themselves. Common co-occurring conditions include:

For example, a student might struggle more with schoolwork due to ADHD-related focus issues than the tics themselves, while an adult might find that anxiety or workplace stress makes their tics more frequent.

Because of this, a comprehensive assessment is essential. It ensures that support and therapy address the person’s overall well-being, strengths, and goals, rather than focusing solely on reducing tics.

Understanding Premonitory Urges: The Feeling Before a Tic

One of the most misunderstood parts of having a tic disorder is the uncomfortable physical sensation that happens before a tic occurs. This is called a premonitory urge, and performing the tic temporarily relieves this feeling.

People often describe this urge as:

  • An itch that must be scratched
  • Pressure or tightness building up in a muscle, body part, or the throat
  • A tingling sensation.
  • A feeling that something is “not quite right” until the tic is done

Why it matters: Recognizing these urges is a key step in Comprehensive Behavioral Intervention for Tics (CBIT). While young children may struggle to notice or describe these sensations, older children and teens usually become better at identifying them, which helps them use strategies to manage their tics.

Why Can’t Someone “Just Stop”?

This is one of the questions individuals with tic disorders hear most often.

While many individuals can temporarily suppress a tic, doing so requires intense mental effort. Suppressing a tic is like trying to hold back a sneeze or resist blinking, and the urge to do it builds and becomes increasingly uncomfortable. Eventually, the tic must be released, sometimes even more strongly than before.

Because of this, asking someone to “just stop” is not helpful. Instead, evidence-based treatments like CBIT teach individuals how to recognize these urges early and manage them using helpful, structured strategies.

Tics Naturally Change Over Time

An important feature of tic disorders is that symptoms are rarely constant. Instead, they naturally fluctuate over time. This pattern is known as waxing and waning, and it is a normal part of the condition. During these cycles, you may notice that:

  • Certain tics disappear completely
  • New tics develop
  • Tics become more or less frequent
  • One tic replaces another

Everyday factors like stress, excitement, fatigue, illness, or changes in routine often temporarily influence these changes. Understanding that tics naturally go up and down can help individuals and families feel less discouraged when symptoms temporarily increase.

Common Myths About Tics and Tourette Syndrome

Misconceptions about tic disorders can cause unnecessary stigma and prevent people from seeking help. Here are the facts behind five common myths:

Myth: People with tics are doing it on purpose and can stop them if they try hard enough.

Fact: Tics are involuntary or semi-voluntary neurological symptoms. While some people can briefly suppress them, doing so requires intense effort and is physically and emotionally exhausting.

Myth: Stress causes Tourette Syndrome.

Fact: Stress does not cause tic disorders. However, stress, fatigue, illness, excitement, and emotional changes can temporarily make tics more frequent or noticeable.

Myth: Everyone with Tourette Syndrome swears.

Fact: This is a common media stereotype. Involuntary swearing (coprolalia) affects only a small minority of people with Tourette Syndrome. Most tics involve everyday movements and sounds.

Myth: Children will simply outgrow tics.

Fact: While many children see their tics improve or disappear during adolescence, some will continue to have tics in adulthood. Fortunately, adults can learn effective strategies to manage them.

Myth: There is no effective treatment for tics.

Fact: Behavioural therapy is highly effective. Comprehensive Behavioural Intervention for Tics (CBIT) is a research-backed, first-line treatment recommended by medical professionals to help individuals manage and reduce the impact of tics.

What is Comprehensive Behavioral Intervention for Tics (CBIT)?

If you are looking for effective, non-medication options to manage tics or Tourette Syndrome, you may have heard of Comprehensive Behavioral Intervention for Tics (CBIT). CBIT is a highly researched, evidence-based behavioural therapy designed for children, teens, and adults. Rather than asking you to just suppress your tics, CBIT empowers you to manage them by helping you:

  • Understand your unique tic patterns.
  • Recognize the earliest physical sensations (premonitory urges) before a tic happens.
  • Learn and practice alternative, competing physical responses to interrupt the tic.
  • Identify and modify daily situations or triggers that make tics worse.
  • Develop practical coping strategies for school, work, and social settings.

The goal of CBIT is not necessarily to cure or eliminate every tic. Instead, it focuses on giving you a greater sense of control, reducing the impact of tics on your daily life, and building your confidence.

The Core Components of CBIT

Comprehensive Behavioral Intervention for Tics (CBIT) is a structured, skills-based therapy typically delivered over 8 to 10 sessions. It consists of three core components:

1. Habit Reversal Training (HRT)

HRT is the primary therapeutic tool used in CBIT to help individuals interrupt and manage their tics. It involves two main steps:

  • Awareness Training: The clinician helps the patient identify the very first signs of a tic, specifically focusing on recognizing the premonitory urge (the physical sensation or tension that precedes the movement or sound).
  • Competing Response Training: Once the individual detects the urge, the therapist teaches them to perform a specific, physically incompatible movement or sound (a “competing response”) to prevent the tic. The patient holds this response for about one minute, or until the urge passes. For example, if the patient has a shoulder-shrugging tic, they might gently push their shoulders down and hold them against their thighs.

2. Functional Intervention

Tics are neurological, but they are highly influenced by the environment. Functional intervention involves identifying and modifying everyday factors that make tics worse.

  • Trigger Identification: Analyzing what happens immediately before and after tics occur (e.g., specific settings, stress, fatigue, or reactions from others).
  • Environmental Modification: Changing the environment or the reactions of others to reduce tic frequency. For example, educating classmates to ignore tics (removing the anxiety of being watched) or scheduling rest breaks during high-stress activities.

3. Relaxation Techniques and Stress Management

Because stress, anxiety, and fatigue temporarily increase tic frequency and intensity, CBIT teaches practical relaxation strategies. These may include:

  • Diaphragmatic (belly) breathing
  • Progressive muscle relaxation
  • Mindfulness and stress-reduction exercises to help lower overall physiological arousal.

Learning that tics do not define who they are can be an incredibly empowering experience for both children and adults. As therapy progresses, building the confidence to use these skills independently across different environments helps individuals feel better prepared to manage tics throughout everyday life.

CBIT Therapy at Colibri NeuroWellness

Because every individual’s experience with tics is unique, therapy should never follow a one-size-fits-all approach. Some people experience mild, occasional tics, while others manage multiple motor and vocal tics that impact school, work, or relationships.

At Colibri NeuroWellness in Waterloo Region, Teodora Kostadinovska, Registered Psychotherapist (Qualifying), works collaboratively with children, teens, and adults to to understand their unique tic patterns and develop practical, real-world strategies. She also provides online CBIT services across Ontario.

What to Expect in Therapy

Treatment begins with developing a clear understanding of the individual’s experiences, including:

  • The specific motor and vocal tics present and their frequency.
  • The presence of premonitory urges (pre-tic sensations).
  • Environmental triggers that make tics better or worse.
  • The impact of tics on daily life and emotional well-being.
  • Co-occurring conditions like anxiety, ADHD, OCD, or emotional regulation difficulties.

This detailed picture ensures therapy targets the areas affecting your quality of life the most. Throughout treatment, clients learn practical CBIT strategies, build confidence, and adapt these skills as their goals and circumstances change.

Family-Centered Support

For children and adolescents, parents and caregivers are actively involved in the treatment process. Family support helps reinforce new skills at home, deepens the understanding of tic disorders, and creates a supportive environment that reduces the pressure to suppress tics.

Ultimately, the goal of therapy is not perfection. It is about helping you or your child feel knowledgeable, confident, and fully equipped to manage symptoms while thriving in school, work, and daily life.

When to Seek Support for Tics or Tourette Syndrome?

Not everyone with a tic disorder requires therapy. Many tics are mild, temporary, and cause minimal disruption. However, seeking professional support can be highly beneficial when tics begin to impact physical comfort, emotional well-being, or daily functioning.

Consider consulting a professional if you or your child experience any of the following:

  • Physical Discomfort: Tics are causing pain, muscle strain, or physical injury.
  • Daily Interference: Tics disrupt schoolwork, occupational tasks, sports, or hobbies.
  • Social or Emotional Impact: Tics lead to embarrassment, anxiety, frustration, or social withdrawal, or your child is facing teasing or bullying.
  • Exhaustion from Suppression: Significant energy is spent trying to suppress tics throughout the day, leading to fatigue or increased tension.
  • Co-occurring Challenges: Symptoms of anxiety, ADHD, OCD, or emotional regulation difficulties are present alongside tics.
  • A Desire for Proactive Strategies: You want to learn practical, evidence-based tools (like CBIT) to gain a greater sense of control.

Seeking support is not reserved only for “severe” cases. Learning about tic patterns and developing coping strategies early can build lasting confidence and prevent unnecessary distress.

Living Well with Tics

A tic disorder does not define a person’s abilities, intelligence, or potential. Many children, teens, and adults with Tourette Syndrome and other tic disorders lead rich, fulfilling lives, pursuing successful careers, education, hobbies, and personal goals.

With the right support and evidence-based treatment, individuals can learn to navigate their symptoms with confidence. For some, CBIT leads to a significant reduction in tic frequency and severity. For others, the greatest benefit is gaining a sense of control, reducing distress, and feeling empowered to participate fully in daily activities.

Progress looks different for everyone, and therapy is always tailored to meet you where you are.

Get Started with Colibri NeuroWellness

Whether you prefer in-person therapy in the Kitchener-Waterloo region or virtual CBIT services anywhere in Ontario, support is available.

If you or your child are navigating tics or Tourette Syndrome and want to explore how CBIT can help, the team at Colibri NeuroWellness is here for you. Together, we can develop practical, personalized strategies to support your long-term well-being and build everyday confidence.

Frequently Asked Questions About Tics, Tourette Syndrome, and CBIT

What is CBIT?

Comprehensive Behavioural Intervention for Tics (CBIT) is a highly researched, non-medication therapy. It teaches individuals to recognize the early physical urges that precede a tic and use structured strategies to manage and reduce them. Clinical guidelines recommend CBIT as a first-line treatment for tic disorders.

Does CBIT work for Tourette Syndrome?

Yes. Research shows that CBIT significantly reduces the severity and impact of tics for many children and adults, leading to meaningful improvements in daily functioning, confidence, and overall quality of life.

Can adults benefit from CBIT?

Yes. While often associated with children, CBIT is highly effective for teens and adults. Therapy is tailored to fit adult schedules, workplace demands, and personal goals.

Can children receive CBIT?

Yes. CBIT is very effective for school-aged children. Therapists deliver the program in a developmentally appropriate, engaging way, and parents are actively involved to help reinforce skills at home.

Is Tourette Syndrome the same as a tic disorder?

Tourette Syndrome is a specific type of tic disorder. It is diagnosed when a person has experienced multiple motor tics and at least one vocal tic for more than a year, with symptoms starting before age 18.

Can stress cause tics?

No, stress does not cause tic disorders. However, stress, anxiety, fatigue, excitement, and illness can temporarily make tics more frequent or intense.

Do all people with Tourette Syndrome swear?

No. This is a common myth. Involuntary swearing (coprolalia) affects only a small minority of people with Tourette Syndrome. Most tics involve everyday movements and sounds.

Will medication always be needed?

Not necessarily. Many individuals manage their tics successfully using behavioural therapy alone. Others choose to combine CBIT with medication. Your treatment plan depends entirely on your unique symptoms, goals, and medical preferences.

How long does CBIT take to see results?

CBIT is typically a structured, short-term therapy of 8 to 10 sessions. Some individuals notice improvements within the first few weeks, while others benefit from additional sessions to strengthen and maintain their skills.

How do I know if therapy is right for me or my child?

If tics are causing physical pain, emotional distress, or interfering with school, work, or social activities, therapy can help. An initial consultation is a great way to discuss your concerns and determine if CBIT is the right fit. Contact our administrative team at Colibri NeuroWellness to find the best clinician for your needs.

References

American Academy of Neurology. (2019). Practice guideline recommendations summary: The treatment of tics in people with Tourette syndrome and chronic tic disorders.

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Association Publishing.

Centers for Disease Control and Prevention. (2024). Tourette syndrome. https://www.cdc.gov/tourette

McGuire, J. F., Piacentini, J., Brennan, E. A., Lewin, A. B., Murphy, T. K., Small, B. J., & Storch, E. A. (2015). A meta-analysis of behavior therapy for Tourette syndrome. Journal of Psychiatric Research, 63, 118–124.

Piacentini, J., Woods, D. W., Scahill, L., Wilhelm, S., Peterson, A. L., Chang, S., … Walkup, J. T. (2010). Behavior therapy for children with Tourette disorder: A randomized controlled trial. JAMA, 303(19), 1929–1937.

Pringsheim, T., Holler-Managan, Y., Okun, M. S., Jankovic, J., Piacentini, J., Cavanna, A. E., … Robinson, M. (2019). Comprehensive systematic review summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology, 92(19), 907–915.

Tourette Association of America. (2024). Comprehensive Behavioral Intervention for Tics (CBIT). https://tourette.org

Woods, D. W., Piacentini, J., Chang, S., Deckersbach, T., Ginsburg, G., Peterson, A. L., … Wilhelm, S. (2008). Managing Tourette Syndrome: A behavioral intervention for children and adults. Oxford University Press.