Action sequence learning, habits, and automaticity in obsessive-compulsive disorder.

This study investigates the goal/habit imbalance theory of compulsion in obsessive-compulsive disorder (OCD), which postulates enhanced habit formation, increased automaticity, and impaired goal/habit arbitration. It directly tests these hypotheses using newly developed behavioral tasks. First, OCD patients and healthy participants were trained daily for a month using a smartphone app to perform chunked action sequences. Despite similar procedural learning and attainment of habitual performance (measured by an objective automaticity criterion) by both groups, OCD patients self-reported higher subjective habitual tendencies via a recently developed questionnaire. Subsequently, in a re-evaluation task assessing choices between established automatic and novel goal-directed actions, both groups were sensitive to re-evaluation based on monetary feedback. However, OCD patients, especially those with higher compulsive symptoms and habitual tendencies, showed a clear preference for trained/habitual sequences when choices were based on physical effort, possibly due to their higher attributed intrinsic value. These patients also used the habit-training app more extensively and reported symptom relief post-study. The tendency to attribute higher intrinsic value to familiar actions may be a potential mechanism leading to compulsions and an important addition to the goal/habit imbalance hypothesis in OCD. We also highlight the potential of smartphone app training as a habit reversal therapeutic tool.

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© 2023, Banca et al.

Déclaration de conflit d'intérêts

PB, MH, MG, MB, AM, TP, AS No competing interests declared, NF NAF in the past three years has received research funding paid to her institution from the NIHR, COST Action and Orchard. She has received payment for lectures from the Global Mental Health Academy and for expert advisory work on psychopharmacology from the Medicines and Healthcare Products Regulatory Agency and an honorarium from Elsevier for editorial work. She has additionally received financial support to attend meetings from the British Association for Psychopharmacology, European College for Neuropsychopharmacology, Royal College of Psychiatrists, International College for Neuropsychopharmacology, World Psychiatric Association, International Forum for Mood and Anxiety Disorders, American College for Neuropsychopharmacology. In the past she has received funding from various pharmaceutical companies for research into the role of SSRIs and other forms of medication as treatments for OCD and for giving lectures and attending scientific meetings, TR TWR discloses consultancy with Cambridge Cognition and receives research grants from Shionogi & Co. He also has editorial honoraria from Springer Verlag and Elsevier