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

Abstract

Enhanced habit formation, greater automaticity and impaired goal/habit arbitration in obsessive-compulsive disorder (OCD) are key hypotheses from the goal/habit imbalance theory of compulsion which have not been directly investigated. This study tests these hypotheses using a combination of newly developed behavioral tasks. First, we trained both OCD patients and healthy controls, using a smartphone app, to perform chunked action sequences. This motor training was conducted daily for one month. Both groups displayed equivalent procedural learning and attainment of habitual performance (measured with an objective criterion of automaticity), despite greater subjective habitual tendencies in patients with OCD, self-reported via a recently developed questionnaire. Participants were subsequently tested to evaluate the arbitration between established automatic and novel goal-directed action sequences. There was no evidence for deficits in goal/habit arbitration in OCD based on monetary feedback, but some patients showed a pronounced preference for the previously trained habitual sequence in certain contexts, hypothetically due to its intrinsic value. These patients had elevated compulsivity and habitual tendencies, engaged significantly more with the motor habit-training app, and reported symptom relief at the end of the 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 the app-training as a habit reversal therapeutic tool.