L10: OCD II Underlying Processes

Question 1

Define compulsivity

Answer 1

behavior that is continued despite explicit knowledge of profound negative consequences

Question 2

which is NOT a cognitive bias in OCD?
1. Emotion-action fusion
2. Perfectionism
3. Overestimating dangers

Answer 2

emotion action fusion

Question 3

How does the cognitive theory explain OCD?

Answer 3

• compulsion are goal directed to prevent/reduce anxiety (this reasoning comes from cognitive biases)
• 3 multipliers: high perceived responsibility, high perceived probability of harm, high perceived seriousness of harm = intense/prolonged checking
• compulsion is consequence of obsession
• so cognitive therapy should focus on addressing obsessions & cognitive biases first

Question 4

What does the habit theory of OCD say?

Answer 4

the temporary relief caused by performing compuslions may lead to reinforcement of habitual rituals associated w antecendent triggers
so compulsions are driven by super strong habits

Question 5

According to the DSM, compulsions reduce anxiety or distress,
or prevent some dreaded event or situation. In terms of
conditioning, this is a case of…
A.Positive reinforcement
B.Negative reinforcement
C.Punishment

Answer 5

B

Question 6

Define cognitive disonnance

Answer 6

unpleasant tension that arises from conflict between (one’s) incompatible beliefs, or from (one’s) behavior that conflicts w beliefs.
- ppl feel strong urge to reduce this by modifying / rationalizing their beliefs or behaviour

Question 7

How could cognitive disonnance cause obsessions to result from compulsions, rahter than the other way around (C-O-D account)?

Answer 7

in this view: obsessions are form of post-hoc rationalization that can reduce the cognitive disonnance that occurs as a result of excessive compulsions

Question 8

What are the critiques on the view of compulsions as goal directed behaviours aka pro compulsions as habits account?

Answer 8

• the behaviour is usually egodystonic, meaning that the patient feels that the symptoms dont really belong to them
• client recognizes that the compulsions are irrational and/or excessive but does them anyway
• the relief experienced upon performing the compulsive act is very short lived
• some patients report having started the compulsion without realizing (habit vibes)
• & sometimes reported that symptoms temporarily diminish in a new environment (habit vibes)

Question 9

What are the 3 main executive functions?

Answer 9

• Cognitive flexibility: including set shifting: ability to shift attention between tasks: e.g., Wisconsin-Card Sorting Test
• Decision making: basing choices on advantages/costs /risks associated w behavior: e.g., Iowa Gambling task and Delay Discounting Task
• Inhibitory (impulse) control: ability to inhibit actions and thoughts: e.g., Go/NoGo task, stop-signal task, Stroop task

Question 10

What are disruptions in cognitive (or executive) control function in OCD?

Answer 10

• cognitive flexibility: more errors in Wisconsin card sorting test, so impaired ability to modify responses on basis of feedback
• decision making: iowa gambling task showed that OCD patients have imparied ability to adjust their behaviour on basis of monetary gains & losses (they choose worse decks) & are more inclided to take an immediate small reward rather than obtain a delayed larger reward in delay discounting
• impulse control: stop signal task showed OCD performed poorere but these are inconsisstent w go/no go & stroop task results
  -> impaired top-down control may contribute to disrupted balance of goal directed control vs habtis in OCD
  -> executive dysfunciton also found in unaffected relatives of OCD patients so could be endophenotype candidate for OCD (heritable marker)

Question 11

Which executive function is impaired in both substance use
disorders and OCD?
A. Delay discounting
B. Cognitive flexibility
C. Both

Answer 11

C

Question 12

Does the DSM characterize compulsions as habits or as goal-directed actions?

Answer 12

as goal directed acitons performed in response to obsession

Question 13

How can symptom provocation studies provide insight into the neural basis of OCD?

Answer 13

“wash” pictures in fMRI study caused more anxiety in OCD patients (w fear of pollution) than in healthy controls
this allows us to examine which parts of the brain become active when symptoms are provoked

Question 14

What did symptom provocation studies show about neural basis of OCD?

Answer 14

Hyperactivity in orbitofrontal cortex (OFC) / ventromedial prefrontal cortex & caudate compared to controls
Other brain regions that have been implicated are the anterior cingulate cortex (ACC), dorsolateral PFC and parietal cortex…
-> Based on abnormalities in these corticostriatal circuits in compulsive patients, it was proposed that OCD is a disorder of balance between goal-directed control and habits in line with the idea of enhanced “habit tendency”

Question 15

Which brain region are implicated in goal directed action/control? which in habits?

Answer 15

habit: putamen & premotor cortex
goal directed: caudate & ventromedial PFC

Question 16

What does habit research show on OCD?

Answer 16

Self reported habit strenght of compulsions correlated positively w severity of checking, hoarding, and ordering symptoms
& showed more “slips of action” which shown enhanced habit tendency (the more severe the OCD symptoms, the more vulnerable to slips of action)

Question 17

Which is nót a criterion for goal-directed action?
A.The behaviour is mediated by anticipation of the outcome.
B.The behaviour is mediation by evaluation of the outcome.
C.The behaviour is carefully planned.

Answer 17

C

Question 18

How do studies using the shock avoidance paradigm show that the balance between habits & targteted control is disrupted in OCD?

Answer 18

• patients were trained to press left & right foot pedals to avoid electric shocks to the left & right hand (respectively)
• red or blue square signaled whether right or left shock would be delivered
• after training period, 1 of 2 electrodes was removed & subjects were told they couldnt get shock to that hand anymore & that their only task thereafter was to continue avoiding shocks. aka one of the shocks was “revalued”
• results: OCD patients as able as controls to stop pressing to the stimulus that signalled the devalued shock but when electrode was reattached to both hands & they were given extra training before electrode was removed from other hand: OCD pressed more often to avoid the devalued shock than controls
  -> ocd show more avoidance after long training & show hyperactivation of orbitofrontal cortex & caudate related to imbalance between goal directed control & habitual control (habit formation > goal directed control)

Question 19

How do studies using the “outcome revaluation” paradigm show that the balance between habits & targteted control is disrupted in OCD?

Answer 19

show that OCD patients continue responding to devalued outcomes, indicating a dominance of habitual control

Question 20

What could explain the high comorbidity between OCD & anxiety disorders?

Answer 20

anxiety been shown to promote habit formation which is strong in OCD as well

Question 21

How do the cognitive account & habit account differ in their treatment views?

Answer 21

cognitve: focus on cognitive biases in treatment
habit account: habit reversal therapy

Question 22

How does habit reversal therapy work?

Answer 22

2 components:
- awareness training (eg daily monitoring of compulsions & antecedents/triggers)
- competing response training (physically incompatible response)
results show that its a promising alternative OCD treatment!

Question 23

Why do people with OCD persist with compulsive acts even though they are fully aware of the negative consequences? Do you think that compulsions are habits?

Answer 23

• ## to reduce the distress caused by obsessions (so the compulsions are goal directed)

Question 24

How do OCD patients exhibit a bias toward forming avoidance habits?

Answer 24

due to excessive stimulus response habit formation
as shown in shock avoidance task: OCD patients are more prone to develop habits (and often OCD compulsions aka habits are avoidant)