Table 1.

Overview of the ICBIT Modules

Module 1	Psycho-education about tics and awareness training for tic occurrence ("Tic detectives'' team). Youth and their parents are taught to recognize their tics and increase awareness of precipitating and maintaining factors associated with tics. They are asked to monitor and record their tics daily (e.g., time of day, location and activity, the number of tics). Youth and their parents simply enter the data by clicking the interactive fields in the table. To keep children actively engaged in the program, parents are taught how to reword their child's efforts and record the points the child won.
Module 2	Stress management skills (deep breathing and stress inoculation training and imagery).
Module 3	Identifying factors that exacerbate tics (e.g., social settings, watching television) and developing functional strategies and day-to-day changes for reducing contact with contextual factors and improving coping skills in dealing with such factors. Coping skills and strategies are linked to a corresponding matrix that directs participants how and when to use them. For example, if tics are more prominent when watching television, less screen time is suggested as a strategy for reducing tics. Likewise, a child who starts tics more before an exam at school would be taught to manage his or her stress before and during the exam.
Module 4	Education about a competing response and identifying premonitory urge for the first (out of 6) tic that the child identifies as his or hers most bothersome tics. Participants are introduced to perform a movement that is incompatible with the tic using antagonistic muscles (a "Tic blocker") that the child may apply when the urge for the tic is felt. A detailed list of 21 suggested competing responses for various motor and vocal tics and specifically created video clips, presenting a clinician specialized in CBIT for children, are used to illustrate choosing and practicing a range of competing responses. For example, a corresponding competing response for a shoulder shrug tic: "push shoulders downward to tighten shoulders and arms muscles against the shrugging movement". The child is taught to recognize the premonitory urge and begin pushing shoulders downward as a competing response.
Module 5–7	Continue training for the second, third, fourth and the fifth tics (if a child has three tics or less, the guiding principles are to continue practicing the skills on the same tics).
Module 8	Continue training for the sixth tic and generalization training. Participants practice in various daily situations including more challenging situations that may exacerbate tics (e.g., preparing for an exam, playing computer games).
Module 9	Maintaining intervention gains and relapse prevention. Creating a “final project” (e.g., a simple folder detailing the methods and gains achieved and coping skills that may help to promote further improvement and relapse prevention); instructions and demonstrations for further practicing and weekly activities intendent to assist with maintenance and improvement (e.g., recording tics and setting new goals such as practicing the skills on additional tics, in various situations and during periods of tic exacerbation).