Pavlovian-to-Instrumental Transfer across Mental Disorders: A Review

Abstract

A mechanism known as Pavlovian-to-instrumental transfer (PIT) describes a phenomenon by which the values of environmental cues acquired through Pavlovian conditioning can motivate instrumental behavior. PIT may be one basic mechanism of action control that can characterize mental disorders on a dimensional level beyond current classification systems. Therefore, we review human PIT studies investigating subclinical and clinical mental syndromes. The literature prevails an inhomogeneous picture concerning PIT. While enhanced PIT effects seem to be present in non-substance-related disorders, overweight people, and most studies with AUD patients, no altered PIT effects were reported in tobacco use disorder and obesity. Regarding AUD and relapsing alcohol-dependent patients, there is mixed evidence of enhanced or no PIT effects. Additionally, there is evidence for aberrant corticostriatal activation and genetic risk, e.g., in association with high-risk alcohol consumption and relapse after alcohol detoxification. In patients with anorexia nervosa, stronger PIT effects elicited by low caloric stimuli were associated with increased disease severity. In patients with depression, enhanced aversive PIT effects and a loss of action-specificity associated with poorer treatment outcomes were reported. Schizophrenic patients showed disrupted specific but intact general PIT effects. Patients with chronic back pain showed reduced PIT effects. We provide possible reasons to understand heterogeneity in PIT effects within and across mental disorders. Further, we strengthen the importance of reliable experimental tasks and provide test-retest data of a PIT task showing moderate to good reliability. Finally, we point toward stress as a possible underlying factor that may explain stronger PIT effects in mental disorders, as there is some evidence that stress per se interacts with the impact of environmental cues on behavior by selectively increasing cue-triggered wanting. To conclude, we discuss the results of the literature review in the light of Research Domain Criteria, suggesting future studies that comprehensively assess PIT across psychopathological dimensions.

Effects of a Brief Mindfulness-Based Intervention on Pavlovian-To-Instrumental Transfer in Alcohol Use Disorder

“…Moreover, other studies also failed at detecting an increased PIT effect in populations with various substance use disorders (45)(46)(47)(48)(49). The mixed data situation has been proposed to result from discrepancies between the paradigms as well as systematic differences between AUD samples (42).…”

“…Here, a paradigm that consisted of the same stimuli but utilized a button-box response device, was administered on two consecutive days. Analysis of intra-class correlation coefficients (ICC) for subject-specific PIT effects revealed a moderate temporal and moderate to good internal consistency (42). So, in summary, the proficient psychometric properties of our PIT task in combination with randomized intervention administration render our results well-founded and reliable.…”

“…Concerning the AUD sample, our numbers reflect the epidemiological situation as men are diagnosed with AUD about four times as often as women (55). However, it has been repeatedly shown, that PIT effects are not affected by confounders such as age or gender (42). Another limitation is the comparatively small sample size that could have prevented us from detecting group differences in PIT effects as previous studies that noted positive results have used larger sample sizes (11-14, 43, 44).…”

Cognitive Functions in Compulsive Buying-Shopping Disorder: a Systematic Review

“…The shift from Pavlovian-to-instrumental conditioning has been studied in many mental health conditions including substance use disorders and behavioral addictions (for an overview: Garbusow et al, 2022 [40]), but only once so in CBSD. Vogel et al [30••] administered a PIT paradigm with appetitive pictures related to online gaming and online shopping applications in a convenience sample.…”

Targeting Learning Mechanisms in Addictive Disorders

“…Adding to this line of research, Fey et al [10] examine the biological correlates of the interaction of the imagination of individual drinking situations and alcohol-related stimuli to address the influence of drinking context on cue reactivity. The effect of Pavlovian conditioned cues on instrumental behavior can be assessed using Pavlovian-to-Instrumental Transfer (PIT) paradigms, which are discussed with respect to drug-related findings by Garbusow et al [11]. Further exploring the interaction between Pavlovian conditioning and operant learning mechanisms, Belanger et al [12] describe the development and first empirical test results regarding a novel task to assess outcome-specific and general PIT effects.…”