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

Banca, Paula, Herrojo Ruiz, Maria, Gonzalez-Zalba, Miguel Fernando, Biria, Marjan, Marzuki, Aleya A, Piercy, Thomas, Sule, Akeem, Fineberg, Naomi A and Robbins, Trevor W (2024) Action sequence learning, habits, and automaticity in obsessive-compulsive disorder. eLife, 12: RP87346. pp. 1-39. ISSN 2050-084X
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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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