CBITroleplaytranscript

Comprehensive Behavioral Intervention Treatment (CBIT) Douglas Woods, PhD and Michael Himle, PhD

Role-Playing Demonstration Video

(note - student production facility produced low resolution video and low bandwidth audio;

audio for the first 6 minutes is indistinct – this is a transcript of those first 6 minutes)

DW is Douglas Woods, PhD – on the right side of the screen

MH is Michael Himle, PhD – to the left of Dr. Woods

DW: So Mike, you have a lot of tics right now, but we’re going to focus on

your arm tic right now, all right?

DW: Let me tell you a little bit about what we're going to do, essentially

what this is, is a self-management treatment

we are going to teach you how to manage your symptoms when they show

up, all right.

DW: This isn’t a cure, we're not going to completely get rid of them forever

and ever but we are going to teach you what to do when you need to manage these tics, We’ll start with the arm tic today,

when you need to manage it, we are going to teach you the skills you

can use to do that.

DW: I'm just doing habit reversal right now, I am not getting into

the function-based treatments right now.

DW: Now, what I'm going to teach you to do today is to notice when this arm

jerk tic is happening, and then teach you to do a behavior we’ll call

your exercises, that you can do every time you feel like you have the

tic coming on and or if you start doing the tic itself

and we're going to keep doing this exercise for a minute or until the

feeling goes away, whichever takes longer, and we'll practice that a

number of times. All right?

DW: Now, eventually what we'll, what we'll do is we'll have you go out and

get out in the real world, and do this for real, okay? All right.

DW: So, you've done a couple of those things, um, can you, ah tell me what,

pretend I can't see, pretend I can't see anything, can you tell me,

ah, what that tic looks like?

MH: Um, pretty much just my arm jerking out to the side.

DW: Okay, all right, which arm?

MH: Um, my right arm.

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DW: Only your right arm, you never do it with your left arm?

MH: Never happens with the left arm.

DW: Okay, now, as I'm sitting here, I'm looking at what he's doing, okay,

part of my attention is divided, and I've got a couple things in mind

already.

DW: If I'm doing awareness training, and he responds to scripts here, what

should I be doing? What am I thinking the definition is?

What's the first thing he does?

Audience: His arm goes back and then goes out

.

DW: Okay, so, Mike, you said it's only your left arm, okay and it goes out

a little bit off to the side little bit.

MH: No the right arm

DW: Okay, the right arm, and it goes out, a little bit off to the side a

little bit. Okay, can you slow it down for me?

MH: Should I do it slower?

DW: Okay, just do it really, really slow motion

MH: I go like this (demonstrates a motion)

DW: Okay. Now, describe everything that you're doing as you're going real

slow.

MH: Well one thing that I notice is that when it comes out, I flip my wrist…

DW: Okay you flip your wrist a little bit, okay that's good. What else?

Audience: It’s a little hard to hear Mike.

MH: I notice that when my arm comes out I flip, I flip my wrist a little bit.

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DW: Okay, why don't you do it again really slow. (MH demonstrates)

DW: Okay, good, do you notice anything else?

MH: No, not really

DW: Okay, here's something I notice when you, when your arm starts to

go, when your arm is going to do the tic, your arm starts to go back a little bit.

(MH makes the arm tic motion)

DW: All right, see?

MH: Oh yeah

DW: All right, now let's do it in real speed. Okay, now did your arm go up

fast or slow?

MH: It goes up fast, a little bit.

DW: Do you feel like the, do you feel anything?

DW (to audience): You have to kind of empathize with your client, what, what is he feeling. DW: Do you feel any like popping in your arms or anything like that like, in

your at your elbow?

MH: I feel it right here on the inside of my elbow. Tight pops.

DW: Okay, what happens to your fingers, can you do it again?

MH: Um, they tend to go up, like that. (MH thrusts his fingers upward)

DW: Okay, do you feel any tension up here? (DW references elbow area)

when they pop out?

MH: Not. Only in my wrist

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DW: So again, we are really just fleshing this out, probably important,

but it doesn't have anything to do with him detecting it in terms of being

able to define it because he knows what this is, it has to do with getting

him to really think about this thing, really put some cognitive effort into this thing,

okay?

DW: Mike, before you do that tic can you think of anything in your body,

that tells you it’s coming?

MH: Um, well, I don’t know if it’s, if it’s like the tic, but I do notice,

and this doesn’t make sense, but, it’s like a cold burn in my shoulder and it

hurts back here where I can’t reach…

DW: How big is it?

MH: Um, it’s about an egg...

DW: Okay, all right, it’s like a cold burn?

MH: Yeah. It seems like, it’s kind of like, if you shoved an ice pack behind my shoulder blade.

DW: Okay, and, and how, how soon before you tic does that actually show up?

MH: Um, I think it's part of the tic.

DW: Okay, all right, and what happens after you tic? Is that cold burn still

there or does it go away?

MH: It goes away but it always, it always comes right back.

DW: It comes right back, okay.

DW: Is that cold burn an uncomfortable feeling or is it, does it feel fun

or good?

MH: It doesn't feel good, it doesn't hurt but it doesn't feel good. I just

notice it.

DW: Okay, all right, and it makes it, you feel like you have to do it when

that shows up?

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MH: Yeah and the only other way that I know of to get rid of it is to

what I do in school. I stretch like this until I’m not still crazy about it.

DW: And that gets rid of it too?

MH: Yeah

DW: Okay, good.

DW: Okay, so at this point we've done, early warning descriptions, we've done

response descriptions we've got a pretty good feel what this thing

looks like, all right.

So now we are going into response detection.

DW: Okay Mike you know what the whole point of this is, is to notice when

you're doing these tics.

and then do something that prevents the tic from happening and ultimately what we’ll do is we teach you those exercises that keep your tic from happening---we’re going to let that feeling sit there, okay, and eventually it'll go way.

MH: I don't think it's going to go away.

DW: You don't think so?

MH: No

DW: Why is that?

MH: For me even in school I mean, I mean obviously I don’t like it when people see it --that’s why I do the stretching and stuff. I don’t think it’s going to stick or that it’ll go away.

DW: What are we talking about? Are we talking about that feeling or are we talking about the tic?

MH: The feeling.

DW: Okay, we'll get back to that.

We'll talk about that little bit.

(end of transcript as floor microphone is set up)

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