Comprehensive Behavioral Intervention for Tics reduces perception-action binding during inhibitory control in Gilles de la Tourette syndrome

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.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 . Traditionally, GTS has been considered as a movement disorder. This is not undisputed though given that most tics can, at least partially, be controlled, are associated with premonitory sensations and might reflect motor learning and habit formation 3 . On the basis of these findings, it has recently been suggested that a hallmark of GTS is an abnormally strong interrelation of perceptual processes and motor actions, particularly between premonitory sensation including preceding urges and tics, and that GTS might be conceptualized as a disorder in which purposeful actions play an important role 3 . Indeed, several studies have reported that GTS patients make better use of multi-or bi-modal sensory stimuli for response selection 4,5 . Moreover, findings from procedural learning also suggest that GTS patients establish connections between stimuli and the corresponding response faster and more strongly 6,7 . In line with this, GTS is associated with increased habit formation tendencies 8 depending on the establishment of strong stimulus-response mappings. These findings corroborate the notion that GTS might be a disorder characterized by an abnormally strong 'binding' between perception and action, for which a cognitive framework based on the Theory of Event Coding (TEC) detailing the link between perception and action is an attractive o...

Gilles de la Tourette Syndrome—A Disorder of Action-Perception Integration

“…Findings related to the usefulness of TEC as an explanatory framework for GTS are also relevant for the understanding of the mechanisms of behavioral interventions. For instance, in a recent study, the effects of comprehensive behavioral intervention for tics on perception-action binding during inhibitory control were investigated (113). It was shown that the intervention altered inhibitory control in a condition where reconfigurations of perception-action bindings were necessary to perform inhibitory control.…”

Non-invasive Brain Stimulation for the Treatment of Gilles de la Tourette Syndrome

“…However, it is important to note that findings suggesting impairments in inhibitory control are not undisputed. There are also studies showing no difference (15,(81)(82)(83), sometimes depending on the difficulty to inhibit a response (12,84), or even enhanced performance (85)(86)(87) in inhibitory tasks in GTS. Also, the notion of a general impairment of inhibitory functions in GTS is contentious given the ability of these patients to actively suppress their tics, at least for certain periods of time (88).…”

Short-term Focused Attention Meditation Restricts the Retrieval of Stimulus-Response Bindings to Relevant Information

“…Feature binding has been found to be altered in aging (Hommel et al 2011) and neurological conditions such as Tourette syndrome (Kleimaker et al 2020a, b;Petruo et al 2019Petruo et al , 2020, Parkinson's disease (Colzato et al 2012) and stress (Frings et al 2013). Against this background, in order to ameliorate these conditions, there is a rising interest for enhancing practices aimed on optimizing feature binding.…”