Evaluation of an Online Comprehensive Behavioral Intervention for Tics (CBIT) Therapist Training Program

Tic disorders are a class of childhood-onset neuropsychiatric disorders that occur in 1-3% of the population. Studies have shown that a non-drug treatment known as Comprehensive Behavioral Intervention for Tics (CBIT) is more effective than supportive therapy for reducing tics in children and adults. Although CBIT is now recommended as a first-line intervention for tic disorders, many patients do not have access to CBIT, in part due to a lack of trained therapists. Currently, the only option available for training therapists in CBIT is an intensive, two day, in-person behavior therapy training institute (BTTI). This study will compare the traditional in-person training approach to a recently developed online, self-paced CBIT therapist training program called CBIT-Trainer with regard to (1) therapists' ability to accurately administer CBIT and (2) change in the severity of patients' tic symptoms after being treated by a CBIT-trained therapist.

This study will recruit therapist-patient dyads who meet the criteria below: Therapist Inclusion Criteria: 1. Have the equivalent of a Master's degree (or higher) in a mental/behavioral health, medical, or related discipline. 2. Professionally licensed or certified to practice in their area of speciality. 3. Attest that providing comprehensive behavioral intervention for tics (CBIT) to treat children and/or adults with tic disorders falls within their scope of practice according to state licensing laws and regulations in the therapist's jurisdiction. 4. Have never attended the Tourette Association of America's Behavior Therapy Training Institute or an equivalent focused on CBIT. 5. Have access to a secure personal computer with high-speed internet access. 6. Speaks fluent English. 7. Has identified, or is willing to try to identify, at least 1 child or adult patient with a tic disorder who meets the patient inclusion criteria and who might be willing to participate in the study as a member of the therapist-patient dyad, and for whom the therapist is licensed or certified to treat with CBIT according to state licensing laws and regulations in the therapist's jurisdiction. 8. Is willing to be randomly assigned to training condition. 9. Is willing, able, and has the necessary resources to travel to, and attend, one of several in-person training sites if assigned to the in-person training condition. Therapist Exclusion Criteria: (1) Therapist is a first, second, or third degree biological relative, stepparent, or legal guardian of the study-matched patient. Patient Inclusion Criteria: 1. 7 years of age or older (with consenting adult for minors). 2. Self- or parent-reported diagnosis of a tic disorder (e.g., provisional tic disorder, persistent motor/vocal tic disorder, or Tourette's disorder) issued by a qualified professional. 3. Currently engages in at least one motor and/or vocal tic multiple times per day. 4. Patient (and consenting adult for minors) speaks fluent English. 5. Access to a private computer with high-speed internet access. Patient Exclusion Criteria: 1. Patients will be excluded if the study team is unable to identify and enroll a patient-matched therapist who meets the therapist inclusion criteria. 2. Patient is a first, second, or third degree biological relative of the study-matched therapist or if the study-matched therapist is the patient's legal guardian. 3. Any serious psychiatric or neurological condition that requires more immediate intervention or would interfere with study participation, based on the assessment of the treating therapist or the study investigators.