Cognitive deficits are a matter of emotional context: Inflexible strategy use mediates context-specific learning impairments in OCD

Individual differences in probabilistic learning and updating predictive representations in individuals with obsessive-compulsive tendencies

BACKGROUND

Obsessive-compulsive (OC) tendencies involve intrusive thoughts and rigid, repetitive behaviours that also manifest at the subclinical level in the general population. The neurocognitive factors driving the development and persistence of the excessive presence of these tendencies remain highly elusive, though emerging theories emphasize the role of implicit information processing. Despite various empirical studies on distinct neurocognitive processes, the incidental retrieval of environmental structures in dynamic and noisy environments, such as probabilistic learning, has received relatively little attention.

METHODS

In this study, we aimed to unravel potential individual differences in implicit probabilistic learning and the updating of predictive representations related to OC tendencies in a non-clinical population. We conducted two independent online experiments (NStudy1 = 164, NStudy2 = 256) with university students. Probabilistic learning was assessed using an implicit visuomotor probabilistic learning task, involving sequences with second-order non-adjacent dependencies.

RESULTS

Our findings revealed that implicit probabilistic learning remained remarkably robust among OC tendencies within a non-clinical population. Furthermore, the results highlighted effective updating capabilities of predictive representations, which were not influenced by OC tendencies.

CONCLUSIONS

These results offer new insights into individual differences in probabilistic learning and updating in relation to OC tendencies, contributing to theoretical, methodological, and practical approaches for understanding the maladaptive behavioural manifestations of OC disorder and subclinical tendencies.

Decision-making using the Iowa gambling test in unaffected first-degree relatives of obsessive-compulsive disorder: Comparison with healthy controls and patients with obsessive-compulsive disorder

Decision-making has been suggested as an endophenotype candidate for obsessive-compulsive disorder (OCD). However, few studies have examined whether decision-making under ambiguity is an endophenotype of OCD. This study aimed to investigate decision-making under ambiguity, as assessed by the Iowa Gambling Task (IGT), in patients with OCD and unaffected first-degree relatives (UFDR). Forty-seven non-medicated, non-co-morbid patients with OCD, 30 UFDR, and 47 healthy controls (HC) were compared in terms of decision-making using the IGT. The correlation between obsessive-compulsive symptoms and IGT performance was also investigated. Patients with OCD and UFDR performed worse than HC on the IGT. No correlation was found between obsessive-compulsive symptoms and IGT performance. A deficit in decision-making under ambiguity may be a trait and an endophenotype candidate for OCD.

Temporal dynamics of autonomic nervous system responses under cognitive-emotional workload in obsessive-compulsive disorder

Dysregulation of the autonomic nervous system (ANS) is commonly observed in various mental disorders, particularly when individuals engage in prolonged cognitive-emotional tasks that require ANS adjustment to workload. Although the understanding of the temporal dynamics of sympathetic and parasympathetic tones in obsessive-compulsive disorder (OCD) is limited, analyzing ANS reactions to cognitive-emotional workload could provide valuable insights into one of the underlying causes of OCD. This study investigated the temporal dynamics of heart rate (HR) and pupil area (PA) while participants with OCD and healthy volunteers solved antisaccade tasks, with affective pictures serving as central fixation stimuli. The data of 31 individuals with OCD and 30 healthy volunteers were included in the study, comprising three separate blocks, each lasting approximately 8 min. The results revealed an increase in sympathetic tone in the OCD group, with the most noticeable rise occurring during the middle part of each block, particularly during the presentation of negative stimuli. Healthy volunteers demonstrated adaptive temporal dynamics of HR and PA from the first block to the last block of tasks, whereas individuals with OCD exhibited fewer changes over time, suggesting a reduced adaptation of the ANS sympathetic tone to cognitive-emotional workload in OCD.

Increased error rate and delayed response to negative emotional stimuli in antisaccade task in obsessive-compulsive disorder

Ample evidence links impaired inhibitory control, attentional distortions, emotional dysregulation, and obsessive-compulsive disorder (OCD). However, it remains unclear what underlies the deficit that triggers the OCD cycle. The present study used an antisaccade paradigm with emotional valences to compare eye movement patterns reflecting inhibitory control and attention switching in OCD and healthy control groups. Thirty-two patients with OCD and thirty healthy controls performed the antisaccade task with neutral, positive, and negative visual images served as fixation stimuli. Presentation of the fixation stimulus overlapped with target stimuli appearance for 200 ms. The OCD group showed more errors to negative stimuli than the control group and they also performed antisaccades more slowly to negative and neutral stimuli than positive ones. Other patterns, including mean gaze velocity of correct antisaccades did not differ between groups. The mean gaze velocity of correct antisaccades was higher for negative and positive stimuli than for neutral stimuli in both groups. The peak velocity parameter did not show any differences either between groups or between valences. The findings support a hypothesis that an attentional bias toward negative stimuli interferes with inhibitory control in OCD.

Adaptive behavior and psychiatric symptoms in university students with ASD: One-year longitudinal study

In recent years, more young adults with ASD are attending post-secondary education, and several support programs have been proposed for this population. However, research regarding the long-term effects of university enrollment on outcomes among students with ASD is scarce. This study examined adaptive behavior and psychiatric symptoms during the first semester of two consecutive academic years (T1, T2) among 39 students with ASD, 29 students without ASD and high levels of social anxiety symptoms (High SA), and 32 students without ASD and low levels of SA symptoms (Low SA). Students with ASD participated in a university support program and resided with a peer mentor student without ASD, which encouraged social interaction. At T1, students with ASD reported lower levels of adaptive behavior and higher levels of social anxiety and obsessive-compulsive symptoms compared to the other groups. However, at follow-up (T2), significantly higher conceptual adaptive skill levels (specifically communication skills) and significantly lower depression symptom levels from T1 were reported only among students with ASD. The levels of social anxiety and obsessive-compulsive symptoms at T1 were negatively associated with adaptive functioning a year later (T2). Implications regarding adults with ASD attending university are discussed.

Intact capacity for implicit learning in obsessive-compulsive disorder

BACKGROUND AND OBJECTIVES

Individuals with OCD tend to rely on explicit processing when performing implicit learning tasks. However, it is unclear whether this tendency reflects impaired capacity for implicit processing or a preference toward explicit processing. We sought to use a psychometrically valid task to examine the hypothesis that individuals with OCD have intact capacity for implicit learning.

METHODS

Twenty-four participants with OCD and 24 non-psychiatric controls completed a modified artificial grammar learning task where acquisition and retrieval of the underlying grammatical rules are considered strictly implicit. In an exploratory condition designed to examine the effect of nudging participants toward controlled processing, 12 participants in each group were told that the stimuli presented at acquisition were composed according to grammatical rules and were encouraged to identify these rules.

RESULTS

As predicted, participants with OCD acquired and expressed knowledge of the grammatical rule, demonstrating intact capacity for implicit learning, with no differences found between the OCD and controls on the extent of implicit learning. The exploratory intentional learning instructions had no effect, as participants in this condition were unable to adhere to the instructions, supporting the robust implicit nature of the artificial grammar learning task.

LIMITATIONS

The relatively small sample size did not allow comparisons between OCD symptom subtypes.

CONCLUSIONS

Our results provide evidence for intact implicit learning in OCD, and challenge previous studies suggesting a general deficiency in implicit learning in OCD.

Comparing Effectiveness Between a Mobile App Program and Traditional Cognitive Behavior Therapy in Obsessive-Compulsive Disorder: Evaluation Study

BACKGROUND

This study proposes a digital program for the treatment of mental illness that could increase motivation and improve learning outcomes for patients. Several studies have already applied this method by using an exposure and response prevention-inspired serious game to treat patients with obsessive-compulsive disorder (OCD).

OBJECTIVE

We hypothesized that a mobile cognitive behavior therapy (CBT) program would be as effective in treating OCD as traditional offline CBT. In addition, the treatment efficacy in response to mobile CBT for OCD might be associated with increased brain activity within the cortico-striato-thalamo-cortical (CSTC) tract.

METHODS

The digital CBT treatment program for OCD, OCfree, consists of 6 education sessions, 10 quests, and 7 casual games. Information was gathered from 27 patients with OCD (15 offline CBT and 12 OCfree CBT). During the 6-week intervention period, changes in clinical symptoms and brain function activity were analyzed.

RESULTS

There was no significant difference in the change in OCD symptoms and depressive symptoms between the two groups. However, the OCfree group showed greater improvement in anxiety symptoms compared to the offline CBT group. Both offline CBT and OCfree CBT increased the functional connectivity within the CSTC tract in all patients with OCD. However, CBT using OCfree showed greater changes in brain connectivity within the thalamus and insula, compared to offline CBT.

CONCLUSIONS

OCfree, an OCD treatment app program, was effective in the treatment of drug-naïve patients with OCD. The treatment effects of OCfree are associated with increased brain connectivity within the CSTC tract. Multisensory stimulation by education, quests, and games in OCfree increases the activity within the thalamus and insula in patients with OCD.

A Systematic Review of Behavioral, Physiological, and Neurobiological Cognitive Regulation Alterations in Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is characterized by cognitive regulation deficits. However, the current literature has focused on executive functioning and emotional response impairments in this disorder. Herein, we conducted a systematic review of studies assessing the behavioral, physiological, and neurobiological alterations in cognitive regulation in obsessive-compulsive patients using the PubMed database. Most of the studies included explored behavioral (distress, arousal, and frequency of intrusive thoughts) and neurobiological measures (brain activity and functional connectivity) using affective cognitive regulation paradigms. Our results pointed to the advantageous use of reappraisal and acceptance strategies in contrast to suppression to reduce distress and frequency of intrusive thoughts. Moreover, we observed alterations in frontoparietal network activity during cognitive regulation. Our conclusions are limited by the inclusion of underpowered studies with treated patients. Nonetheless, our findings support the OCD impairments in cognitive regulation of emotion and might help to improve current guidelines for cognitive therapy.

Abnormal Anhedonia as a Potential Endophenotype in Obsessive-Compulsive Disorder

BACKGROUND

Obsessive-compulsive disorder (OCD) is often accompanied by cognitive, particularly executive function, impairments. Recently, anhedonia has emerged as an apparently important symptom of OCD reflecting altered emotion regulation. These two aspects are often comorbid in OCD. However, little is known about whether anhedonia may be a trait marker for OCD.

METHODS

To verify the role of executive function and evaluate the role of anhedonia in OCD and its relationship with OCD symptoms, we recruited 60 OCD patients, 30 unaffected first-degree relatives (FDRs), and 60 healthy controls (HCs). Participants completed psychometric testing to assess depression, anxiety, and anhedonia symptoms, as well as two cognitive tests to assess executive function, namely the Wisconsin Card Sorting Test (WCST) and the Stroop Color-Word Test (SCWT).

RESULTS

Compared to HCs, OCD patients and FDRs had significantly lower anticipatory and consummatory pleasure scores. The severity of anticipatory anhedonia correlated positively with obsessive-compulsive symptoms (r = 0.253, p = 0.009), even after controlling for depression and anxiety symptoms. Compared to HCs, OCD patients and FDRs made more errors and achieved fewer categories in the WCST. For all three SWCT components, OCD patients and FDRs took more time to name colors than HCs, but the three groups had similar numbers of errors.

CONCLUSION

This family-based study showed dampened pleasure together with cognitive dysfunction in OCD patients. The similar consummatory pleasure findings between OCD and FDR groups suggest anhedonia may be considered as a candidate OCD endophenotype.

The impact of symptom severity on cognitive function in obsessive-compulsive disorder: A meta-analysis

Research on cognitive functions in obsessive-compulsive disorder (OCD) is notoriously heterogeneous with no moderators identified that account for this variability. OCD severity is the primary potential moderator of interest given the longstanding trait versus state debate. Nevertheless, severity has been previously assessed exclusively as a moderator and was not directly and systematically investigated. To address this gap in the literature, the aim of this study was to conduct a systematic meta-analytic review of correlations between cognitive function and symptom severity in OCD samples. Thirty-eight studies were included, allowing for analysis of 132 effects and meta-regression analyses for potential moderators. Small effects were found for the association between cognitive function and symptom severity on major neuropsychological domains, and some subdomains exhibited medium effects for this association. However, several significant methodological and conceptual problems were identified, including the use of the Yale-Brown Obsessive-Compulsive Scale that assesses severity in the past week and not at time of testing, a tendency to not report non-significant correlations, and problematic ecological validity of neuropsychological tests in OCD. In conclusion, we found a small-to-moderate degree of association between OCD symptom severity and cognitive function, but results should be interpreted cautiously given the limitations identified. We offer recommendations that will facilitate future research into this association and move the field beyond the largely stagnant debate about the state versus trait nature of cognitive functioning in OCD, and across disorders.

Explicit instructions facilitate performance of OCD participants but impair performance of non-OCD participants on a serial reaction time task

Previous studies have shown that individuals diagnosed with OCD tend to rely on explicit processing while performing implicit learning tasks. We sought to investigate whether individuals with OCD are capable of implicit learning, but would demonstrate improved performance when explicit processing strategies are enhanced. Twenty-four participants with OCD and 24 non-psychiatric control (NPC) participants performed an implicit learning task in which they responded to a single target stimulus that successively appears at one of four locations according to an underlying sequence. We manipulated the learning strategy by informing half of the participants that the target stimulus location was determined by an underlying sequence, which they should identify (intentional learning). The other half of the participants was not informed of the existence of the underlying sequence, and was expected to learn the sequence implicitly (standard learning). We predicted that OCD participants will exhibit inferior performance compared to NPC participants in the standard learning condition, and that intentional learning instructions would impair the performance of NPC participants, but enhance the performance of OCD participants. The results supported these predictions and suggest that individuals with OCD prefer controlled to automatic processing. We discuss the implications of this conclusion to our understanding of OCD.

The Neural Correlates of Probabilistic Classification Learning in Obsessive-Compulsive Disorder: A Pilot Study

Individuals suffering from obsessive-compulsive disorder (OCD) have been found to show deficits in implicitly learning probabilistic associations between events. Neuroimaging studies have associated these implicit learning deficits in OCD individuals with aberrant activation of the striatal system. Recent behavioral studies have highlighted that probabilistic classification learning (PCL) deficits in OCD individuals only occur in a disorder-specific context, while PCL remains intact in a neutral context. The neural correlates of implicit learning in an OCD-specific context, however, have not yet been investigated. Using functional magnetic resonance imaging during a neutral (prediction of weather) and an OCD-specific variant (prediction of a virus epidemic) of a PCL paradigm, we assessed brain activity associated with implicit learning processes in 10 participants with OCD and 10 matched healthy controls. Regions of interest (ROIs) were the striatum and the medial temporal lobe. ROI analyses revealed a significantly higher activity in the bilateral putamen and the left hippocampus of OCD participants as compared to healthy controls during both PCL tasks. The group differences could partly be subsumed under a group × task interaction effect with OCD participants showing a significantly higher activity than healthy controls in the left putamen and the left hippocampus in the OCD-specific task variant only. These results suggest a compensation of aberrant striatal activity by an augmented engagement of the explicit memory system particularly in a disorder-relevant context in OCD participants.

A Reliability Generalization Meta-Analysis of the Padua Inventory of Obsessions and Compulsions

The Padua Inventory (PI) of obsessions and compulsions is one of the most usually applied tests to assess obsessive-compulsive symptomatology in research contexts as well as for clinical and screening purposes. A reliability generalization meta-analysis was accomplished to estimate the average reliability of the PI scores and to search for characteristics of the samples and studies that can explain the variability among reliability estimates. An exhaustive literature search enabled us to select 39 studies (53 independent samples) that reported alpha and/or test-retest coefficients with the data at hand for the PI total score and subscales. An excellent average coefficient alpha was found for the PI total score (M= .935; 95%CI = .922–.949) and for Impaired Mental Control subscale (M= .911; 95%CI = .897–.924), being good for Contamination (M= .861; 95%CI = .841–.882) and Checking (M= .880; 95%CI = .856–.903), and fair for Urges and Worries (M= .783; 95%CI = .745–.822). The average test-retest reliability for PI total score was also satisfactory (M= .835; 95%CI = .782–.877). Moderator analyses showed larger coefficients alpha for larger standard deviation of the PI total scores (p= .0005;R2= .46), for adapted versions of the test (p= .002;R2= .32), and for samples composed of clinical participants (p= .066;R2= .10). The practical implications of these results are discussed as well as the need for researchers to report reliability estimates with the data at hand.

Cognitive Dysfunction in Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a mental disorder featuring obsessions (intrusive thoughts) and compulsions (repetitive behaviors performed in the context of rigid rituals). There is strong evidence for a neurobiological basis of this disorder, involving limbic cortical regions and related basal ganglion areas. However, more research is needed to lift the veil on the precise nature of that involvement and the way it drives the clinical expression of OCD. Altered cognitive functions may underlie the symptoms and thus draw a link between the clinical expression of the disorder and its neurobiological etiology. Our extensive review demonstrates that OCD patients do present a broad range of neuropsychological dysfunctions across all cognitive domains (memory, attention, flexibility, inhibition, verbal fluency, planning, decision-making), but some methodological issues temper this observation. Thus, future research should have a more integrative approach to cognitive functioning, gathering contributions of both experimental psychology and more fundamental neurosciences.

Disruption of effective connectivity from the dorsolateral prefrontal cortex to the orbitofrontal cortex by negative emotional distraction in obsessive-compulsive disorder

BACKGROUND

Obsessive-compulsive disorder (OCD) has been associated with abnormal cognitive and emotional functions and these dysfunctions may be dependent on the disruption of dynamic interactions within neuronal circuits associated with emotion regulation. Although several studies have shown the aberrant cognitive-affective processing in OCD patients, little is known about how to characterize effective connectivity of the disrupted neural interactions. In the present study, we applied effective connectivity analysis using dynamic causal modeling to explore the disturbed neural interactions in OCD patients.

METHOD

A total of 20 patients and 21 matched healthy controls performed a delayed-response working memory task under emotional or non-emotional distraction while undergoing functional magnetic resonance imaging.

RESULTS

During the delay interval under negative emotional distraction, both groups showed similar patterns of activations in the amygdala. However, under negative emotional distraction, the dorsolateral prefrontal cortex (DLPFC) and the orbitofrontal cortex (OFC) exhibited significant differences between groups. Bayesian model averaging indicated that the connection from the DLPFC to the OFC was negatively modulated by negative emotional distraction in patients, when compared with healthy controls (p < 0.05, Bonferroni-corrected).

CONCLUSIONS

Exaggerated recruitment of the DLPFC may induce the reduction of top-down prefrontal control input over the OFC, leading to abnormal cortico-cortical interaction. This disrupted cortico-cortical interaction under negative emotional distraction may be responsible for dysfunctions of cognitive and emotional processing in OCD patients and may be a component of the pathophysiology associated with OCD.

Biases in probabilistic category learning in relation to social anxiety

Instrumental learning paradigms are rarely employed to investigate the mechanisms underlying acquired fear responses in social anxiety. Here, we adapted a probabilistic category learning paradigm to assess information processing biases as a function of the degree of social anxiety traits in a sample of healthy individuals without a diagnosis of social phobia. Participants were presented with three pairs of neutral faces with differing probabilistic accuracy contingencies (A/B: 80/20, C/D: 70/30, E/F: 60/40). Upon making their choice, negative and positive feedback was conveyed using angry and happy faces, respectively. The highly socially anxious group showed a strong tendency to be more accurate at learning the probability contingency associated with the most ambiguous stimulus pair (E/F: 60/40). Moreover, when pairing the most positively reinforced stimulus or the most negatively reinforced stimulus with all the other stimuli in a test phase, the highly socially anxious group avoided the most negatively reinforced stimulus significantly more than the control group. The results are discussed with reference to avoidance learning and hypersensitivity to negative socially evaluative information associated with social anxiety.

Individuals With OCD Lack Unrealistic Optimism Bias in Threat Estimation

Overestimating the occurrence of threatening events has been highlighted as a central cognitive factor in the maintenance of obsessive-compulsive disorder (OCD). The present study examined the different facets of this cognitive bias, its underlying mechanisms, and its specificity to OCD. For this purpose, threat estimation, probabilistic classification learning (PCL) and psychopathological measures were assessed in 23 participants with OCD, 30 participants with social phobia, and 31 healthy controls. Whereas healthy participants showed an optimistic expectation bias regarding positive and negative future events, OCD participants lacked such a bias. This lack of an optimistic expectation bias was not specific to OCD. Compared to healthy controls, OCD participants overestimated their personal risk for experiencing negative events, but did not differ from controls in their risk estimation regarding other people. Finally, OCD participants' biases in the prediction of checking-related events were associated with their impairments in learning probabilistic cue-outcome associations in a disorder-relevant context. In sum, the present results add to a growing body of research demonstrating that cognitive biases in OCD are context-dependent.