Abstract
Gilles de la Tourette Syndrome (GTS) is a developmental disorder. Empirical studies and an emerging cognitive framework on GTS suggest that GTS is a disorder of abnormally strong ‘perception-action binding’. Theoretical considerations imply that the effectiveness of long-established behavioral interventions might be related to a normalization of increased binding in GTS. This has not been tested yet. We examined the effect of a standardized Comprehensive Behavior Intervention for Tics (CBIT) in N = 21 adolescent GTS patients and N = 21 healthy controls on perception-action binding in an inhibitory control paradigm. Prior to CBIT, GTS patients showed compromised performance compared to controls, specifically when inhibitory control was triggered by uni-modal visual compared to bi-modal stimuli. After CBIT intervention, GTS patient’s performance was at the same level as healthy controls. This is supported by a Bayesian data analysis. CBIT specifically affected inhibitory control in a condition where reconfigurations of perception-action bindings are necessary to perform inhibitory control. A power of 95% was evident for these effects. CBIT reduces increased ‘binding’ between perception and action in GTS and thereby increases the ability to perform response inhibition. The results are the first to provide insights as to why CBIT is effective by relating elements of this intervention to overarching cognitive theoretical frameworks on perception-action bindings.
Highlights
Gilles de la Tourette Syndrome (GTS) is a developmental disorder with multi-faceted neuropsychiatric symptoms, as onset and highest prevalence in childhood or adolescence and is characterized by multiple motor and vocal tics[1,2]
In a previous study by our group[13], we provided evidence that a stronger contextual representation of stimulus-response bindings in GTS patients impedes performance to inhibit prepotent responses, when the same inhibitory control processes had to be exerted upon different sensory input
If this is the case, and the relevant mechanism underlying the habit reversal training (HRT) component in Comprehensive Behavioral Intervention for Tics (CBIT) can be framed as a restructuring of event files, it is possible that the CBIT does affect perception-action bindings impeding the ability to inhibit prepotent responses, when the same inhibitory control processes has to be exerted following different sensory input[13]
Summary
Gilles de la Tourette Syndrome (GTS) is a developmental disorder with multi-faceted neuropsychiatric symptoms, as onset and highest prevalence in childhood or adolescence and is characterized by multiple motor and vocal tics[1,2]. In a previous study by our group[13], we provided evidence that a stronger contextual representation of stimulus-response bindings in GTS patients impedes performance to inhibit prepotent responses, when the same inhibitory control processes had to be exerted upon different sensory input. From a cognitive-theoretical, including the TEC perspective on GTS, the HRT component in CBIT may be effective because it restructures tic-specific event files If this is the case, and the relevant mechanism underlying the HRT component in CBIT can be framed as a restructuring of event files, it is possible that the CBIT does affect perception-action bindings impeding the ability to inhibit prepotent responses, when the same inhibitory control processes has to be exerted following different sensory input[13]. In that particular condition the stimulus input was altered, as compared to the other two Nogo conditions and caused problem in response inhibition whenever there is a strong binding between the more common combination of stimuli and responses (response inhibitions) in the other conditions of the task
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