This treatment will work most effectively and gains will be optimized if the principles, skills, and exercise it promotes are universally understood and applied in the lives of our clientele.

In this spirit then, as well as to foster good communication with our community partners, the following information is intended to aid them (e.g. residence workers, school staff, community agency personnel, family members) in supporting the treatment we are providing at this time.

We hope it is of benefit; our clinic is also always receptive to feedback.

Community partners requiring a programming consultation from our team may feel free to contact our clinic administrative assistant for this purpose at 519-858-2774 ext. 2025. These consults are typically conducted in teleconferencing format.

Lastly, pending guardian consent and patient assent, any involved community partners as listed above are encouraged to attend at least some treatment sessions. Attendance via teleconference can be arranged.

Medications should remain stable (i.e. no changes) for the duration of treatment:

  • If this creates a problem, please notify our clinic to discuss.

Following session one:

  • A considerable amount of time is spent this session in psychoeducation. To familiarize yourself more with tic disorders you may browse the Brake Shop Clinic Website (in particular the Frequently Asked Questions page), download our, “Putting The Brakes on Tics” strategy sheet, and consider reviewing books and films listed in the clinic bibliographies
  • Participants chose a first symptom to target for treatment this  session. Ask the participant what the target tic is
  • Refrain from drawing attention to or pressuring the participant regarding any other tics at this time
  • At mutually-determined time with the participant, count the number of tics for a 15-minute period of time

Following Sessions Two & Three:

  • Review the “Tic Detective” handout provided in-session; aid the participant in observing the target tic to notice any sequences, ‘warning signs’, or patterns to the tic.
  • Participants are now learning “competing responses” (opposing and more benign action to prevent the occurrence of the tic). Find out each week what the new learned competing response is. Continue to ignore any tics not yet addressed in treatment.
  • Praise/reinforce the participant when you see the competing response used and remind the participant about using the competing response when you see the target tic only. Concentrate on effort invested in the competing response rather than on the tic or success, and continue tic tracking at the pre-determined time intervals.
  • Download, “How to Be a Good Cheerleader” from the “Assessment & Treatment Services” webpage to learn many additional valuable tips for supporting the participant in the use of his/her competing response. This handout was also provided in-group.
  • The first few days of using the competing response could be the most difficult work participants have ever engaged in, and additional stressors will only compound the difficulty. Protect and respect their time for this treatment (in the same way you might protect study-time around exams). To maximize energy, focus, and success, non-typical chores, tasks, or requests should be limited or carefully chosen for the duration  of treatment.
  • To enhance motivation during times of frustration, remind the participant of all the annoying things this tic brings to his/her life, and the nice changes its management will bring. Also remind the participant of the Brake Shop Store (a system to reward efforts not progress). Use the, “Starve A Tic” handout provided to participants to think of ways to minimize the stress, impact, and influence of this and other tics.

Following session four:

  • Participants were taught to use a, “Breathing Triangle” as a valuable relaxation technique this session. At times when tics are high, model the breathing triangle for participants (eyes closed, shoulders relaxed, “belly” breathing through nose) by inhaling for a count of ‘5’, exhaling for a count of ‘5’, and resting for a count of ‘5’.
  • Help the participant to choose specific times to practice the Breathing Triangle. Watch for high-stress situations arising; cue to use the “Breathing Triangle” preceding, during, or immediately following these situations.
  • Continue to cheerlead in the use of competing responses.

Following session five:

  • Again watch for high-stress situations arising; offer to read the “Progressive Muscle Relaxation” script or play the, “Scanning Relaxation” CD (both provided in-session) preceding, during, or immediately following this high-stress situation.
  • A new target tic has been identified and a new competing response learned. Begin cheerleading efforts with this symptom, and continue for previous symptoms.

Following session six:

  • Be vigilant for symptom relapses: Ensure the participant is aware when/if tics are trying to make a comeback.
  • Help the participant to identify, monitor, and treat any problem symptoms which may arise, help him/her to create good Tic Blockers for each new symptom (using the Competing Response Catalogue provided in-group and downloadable from the website), and apply your cheerleading skills again to participant efforts to manage these new tics.
  • During times of stress reassure the participant that it is expected and normal for the tic to try and come back once in a while (this is called spontaneous recovery). It won’t succeed as long as the practice continues.
  • If any serious, difficult, or complex situations arise please feel free to contact the Brake Shop team for assistance.

Referrals to all Brake Shop treatment groups are requested & arranged through the Brake Shop Case Management Coordinator, 519-858-2774 ext. 2362.

For more information on CBIT and/or Tic Management please visit the Frequently Asked Questions section of our website