REFERENCE · RECOVERY TECHNIQUE

Understanding Therapy Options for Functional Tics

Original entry 3: Individually formulated behavioral or psychological treatment.

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For the Person With FND

What therapy is trying to help with

A therapist familiar with functional tics can help you understand the situations, sensations and responses that make daily life difficult, then choose skills to practise. Treatment should have a clear purpose you agree with. “Behavioural” describes work with patterns of responses; it does not mean the symptoms are deliberate. [1]

Cognitive behavioural therapy (CBT) looks at relationships between thoughts, feelings, bodily experiences and actions. For example, therapy might address the fear of being judged during a conversation as well as the tic symptoms. That is different from assuming every tic comes from anxiety.

The names you may hear

Comprehensive Behavioural Intervention for Tics (CBIT) was developed for primary tic disorders, including Tourette syndrome. Its established evidence cannot simply be transferred to functional tics. An assessment is needed to decide whether and how parts of it fit your presentation. [1]

Integrated Cognitive Behavioural Intervention for Functional Tics (I-CBiT) combines education, work with urges, attention skills and psychological support. A 2023 report described improvement in eight young people receiving the programme. It was a small series without a comparison group, so it cannot show which parts caused improvement or how well it applies to other people. [2]

In that programme, urge acceptance means learning to experience an uncomfortable urge with less struggle. Exposure and response prevention involves clinician-guided practice experiencing an urge while delaying the usual response. Grounding means directing attention toward something in the present surroundings. These were parts of a combined approach; none was proven effective on its own. [2]

Before agreeing to practice

Ask the therapist to explain what you will do, why it might help, how they will adapt it and when to pause. Tell them about pain, absent warnings, other symptoms and sensory difficulties. An urge-based exercise may need changing if you do not experience an urge.

This page is an introduction for a treatment discussion, not a set of suppression exercises. Practice should be agreed, tolerable and reviewed. You can report that an exercise is confusing, painful or unhelpful. Access to care, school or work should never depend on holding tics in.

If specialist therapy is unavailable, ask what local support can address distress, communication and daily access while you wait.

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For Family, Friends, and Other Supporters

Help the person remember their questions or attend with permission. Ask what support they want between appointments. Do not take over as a therapist, set suppression targets or practise exposure without an agreed professional plan.

Notice whether the programme leaves enough energy for ordinary life. A successful session on paper may still need adjustment if its cost is too high.

For the Person With FND
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For Clinicians and the Care Team

Differentiate primary tic treatment evidence from functional-tic evidence. I-CBiT is a multicomponent uncontrolled series; it does not validate a universal ERP dose or mechanism. Obtain consent, assess risks and adapt to motor/vocal phenomenology, neurodevelopmental needs and comorbidity. [2]

The prospective follow-up literature also describes improvement over time and associations with coexisting-condition treatment. Non-randomized associations do not establish medication or psychotherapy efficacy for the functional tic mechanism. Use shared goals and monitor harms, burden and participation, not suppression duration alone. [3]

For the Person With FND
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Research and Sources

The I-CBiT series offers preliminary treatment evidence. Its participants and clinical setting limit generalization, especially to older adults. The prospective cohort adds outcome information but is not a randomized comparison. Targeted searches on September 24, 2026 did not identify a functional-tic randomized treatment trial; that is not an exhaustive proof of absence.

Citation	Figure	Full citation and scope
[1]	—	Malaty IA, Anderson S, Bennett SM, et al. Diagnosis and management of functional tic-like phenomena. Journal of Clinical Medicine. 2022;11(21):6470. Source. FND-CIT-0110.
[2]	—	Maxwell A, Zouki JJ, Eapen V. Integrated cognitive behavioral intervention for functional tics (I-CBiT): case reports and treatment formulation. Frontiers in Pediatrics. 2023;11:1265123. Source. FND-CIT-0113.
[3]	—	Nilles C, Szejko N, Martino D, Pringsheim T. Prospective follow-up study of youth and adults with onset of functional tic-like behaviours during the COVID-19 pandemic. European Journal of Neurology. 2024;31(1):e16051. Source. Prospective observational cohort; treatment associations are not causal treatment comparisons. FND-CIT-0218.

Evidence checked September 24, 2026. Human review pending. No new community quotations have been verified.

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —