Lecture 10: OCD 2 Flashcards
transdiagnostic perspective=
the idea that common underlying biological and psychological processes play a role in the
development and maintenance of various disorders. While the specific symptoms of the disorders in this course differ greatly, they all share the central aspect of compulsivity.
3 main transdiagnostic processes
a) top-down processes (executive functions)
b) bottum-up processes (habits)
c) neurobiological bases
habit account in OCD says…
In contrast to the classical cognitive view, the habit account proposes that temporary relief caused by performing compulsions may lead to reinforcement of habitual rituals associated with antecedent triggers. According to the Law of Effect, reinforcement leads to habit formation.
-> Strong habit formation could lead to the experience of a compulsive urge.
which observations support the habit account
- Patients report that they have sometimes suddenly started a compulsion without being aware of it.
- Some also report that symptoms temporarily diminish in a new environment.
executive dysfunctioning in OCD
- cognitive flexibility -> more errors on the WCST
- decision-making -> less the ability to adjust their behaviour on the basis of gains and losses in the IGT
- impulse control -> score less on stop-signal task
-> impaired top-down control may contribute to the disrupted balance of goal-directed control vs habitual control in OCD.
stop-signal task SST
a task in which a cue (indicating to press a button) is occasionally followed by a stop signal, in response to which participants have to inhibit the activated response (not press the button). The stop signal is presented at various intervals: the later the stop signal is presented, the more difficult the trial.
symptom provocation studies
a research paradigm in which patients are subjected to triggers of obsessions and compulsive behavior while they are monitored with brain imaging methods. These studies consistently show hyperactivity in the orbitofrontal cortex (OFC), vmPFC and caudate.
wat hebben die symptom provocation studies voor implicatie
The goal-directed system is more active in patients with OCD, which is different from addiction (where there is reduced activity).
(An overactive system does not necessarily mean more goal-directed control. According to Sanne, it can be said that the system is functioning differently, but you have to look at other evidence to know what this means.)
habit strength in OCD experiment
Using the SRHI and an index for OCD severity (OCI-R), habit strength was correlated with the severity of several OCD-related behaviors. Results showed that there was a positive correlation with severity of checking, hoarding, and ordering.
-> Habits might play a role in the compulsiveness of OCD-related behaviors.
slips of action test in OCD
In the slips-of-action test (see page 13), OCD patients committed more slips of action: they pressed more for the devalued outcomes than healthy controls. This shows a general enhanced habit propensity since the task is irrelevant to the obsessions and compulsions.
Further, the severity of OCD symptoms predicted vulnerability to slips of actions.
shock avoidance task in OCD
Follow-up research using the shock avoidance task (see page 34) and fMRI found hyperactivation of the OFC during the learning phase (which disappeared during the course of training) and hyperactivation of the caudate after forming habits. Further, the self-reported urge to avoid the safe (devalued) stimulus was positively correlated with caudate activation.
-> It seems that hyperactivation of the caudate (and perhaps the OFC) is related to an imbalance between goal-directed and habitual control, namely an overreliance on habits.
conclusie van habit vs goal directed
In summary, outcome-revaluation studies support an increased habit propensity in OCD. However, it remains to be investigated whether this is the result of excessive habit formation or impaired goal-directed control (or both).
habit reversal therapy =
HRT: a therapy form based on the habit account of OCD. 2 components:
- awareness training: enhance awareness of triggers of compulsions (daily monitoring)
- competing response training: training of a physically incompatible response to help patients to control their compulsions by implementation of an alternative response.
