Disruption in the Balance Between Goal-Directed Behavior and Habit Learning in Obsessive-Compulsive Disorder

Abstract

Objective:Obsessive-compulsive disorder (OCD) is characterized by repetitive, ritualistic behaviors and thought patterns. Although patients with OCD report that these compulsive behaviors are unproductive and often senseless, they are unable to desist. This study investigated whether the urge to perform compulsive acts is mediated by a disruption in the balance between flexible, goal-directed action control and habitual behavior.Method:A total of 21 patients with OCD and 30 healthy comparison subjects participated in a set of tasks designed to assess relative goal-directed versus habitual behavioral control. In the training stage, participants were asked to respond to different pictured stimuli in order to gain rewarding outcomes. In the subsequent (instructed) outcome devaluation test and in a novel “slips-of-action” test, the authors assessed whether participants were able to flexibly adjust their behavior to changes in the desirability of the outcomes. The authors also used a questionnaire to test explicit knowledge of the relationships between stimuli, responses, and outcomes.Results:Patients with OCD showed no deficit in their ability to use feedback to respond appropriately to stimuli in the training stage. However, their knowledge of the outcomes of these responses was impaired relative to healthy comparison subjects, and patients were more prone to slips of action, indicating a deficit in goal-directed control and an overreliance on habits.Conclusions:This study provides the first experimental evidence for selective impairment in flexible and goal-directed behavioral control in patients with OCD. The impairment forces patients with OCD to rely instead on habits that can be triggered by stimuli regardless of the desirability of the consequences. Goal-directed actions are supported by orbitofronto-striatal circuitry, and the study findings are thus in line with findings from research that implicate dysfunction in this circuitry in the neuropathology of OCD.

Are nonclinical obsessive-compulsive symptoms associated with bias toward habits?

“…These findings extend previous research documenting a bias toward habits among OCD patients (Gillan et al, 2011). However, these correlational data cannot determine the causal role of bias toward habits in OC symptoms, and longitudinal research examining aberrant habit learning as a risk factor for OCD are warranted.…”

“…According to the habit hypothesis of OCD (Graybiel and Rauch, 2000;McDonald et al, 2004;Robbins et al, 2012), compulsive symptoms are caused by deficits in goal-directed learning, which lead to excessive reliance on stimulus-response habits. In support of this hypothesis, Gillan et al (2011) found that OCD patients, compared to healthy volunteers, underutilized goal-directed action control and relied excessively on habits during instrumental responding.…”

Counterconditioning During Reconsolidation Prevents Relapse of Cocaine Memories

“…In other words, the paradigm is effective regardless of the direction of change in motivational or affective valence. Maladaptive associative memories are involved in the pathology of several psychiatric disorders besides addiction, such as phobias (Mineka and Ohman, 2002), post-traumatic stress disorder (Desmedt et al, 2015), and obsessive-compulsive disorder (Gillan et al, 2011). Therefore, utilizing the retrieval-counterconditioning procedure to replace these unwanted memories with adaptive memories is a potentially novel behavioral therapeutic approach for these neuropsychiatric disorders.…”

The role of learning-related dopamine signals in addiction vulnerability

“…Along the same lines, amphetamine pre-treatment speeds up the rate at which the outcome insensitivity develops (Nelson and Killcross, 2006), and this depends particularly on D 1 rather than D 2 receptors (Nelson and Killcross, 2013). In humans, there is evidence for enhanced habitization in obsessive-compulsive disorder (Everitt and Robbins, 2005;Robbins et al, 2012;Gillan et al, 2011Gillan et al, , 2013 and forthcoming evidence in cocaine addiction (N. Daw and V. Voon, personal communication), but not yet in alcohol addiction (Sebold et al, subm).…”

“…It is important, though, to bear in mind that although habits share features with compulsions (Gillan et al, 2011(Gillan et al, , 2013, they are not one and the same (Dayan 2009;Robbins et al 2012 and many others). It has been suggested that after extended training, habits become deeply engrained by shifting further dorsally in the corticostriatal loops (Belin and Everitt, 2008;Willuhn et al, 2012).…”