Intact capacity for implicit learning in obsessive-compulsive disorder

Compulsive rituals in Obsessive-Compulsive Disorder - A qualitative exploration of thoughts, feelings and behavioral patterns

BACKGROUND AND OBJECTIVES

Rituals are common among healthy individuals and across cultures and often serve adaptive purposes. In individuals with obsessive-compulsive disorder (OCD), rituals become compulsive, time-consuming and distressing, and may lead to functional impairment. Previous research has examined the functions and characteristics of compulsive rituals, but there is paucity of in-depth, first-person reports about this topic.

METHOD

We used a qualitative approach to explore thoughts, feelings, and behavioral patterns that characterize OCD rituals. Ten individuals with OCD participated in a semi-structured interview that focused on their most prominent compulsive ritual. The interviews were subjected to a thematic analysis.

RESULTS

Eight themes emerged from the analysis and were organized in two main categories: Micro Level perspective, comprising triggers, attention, emotional changes, and stopping criteria; and Macro Level perspective, comprising feelings and perceptions, change over time, motives, and inhibitors. The findings shed light on the role of fixed rules and feelings of "completeness" in OCD rituals, the nature of emotional and attentional characteristics during rituals performance, and the evolution of compulsive rituals over time.

LIMITATIONS

This study used a qualitative approach based on a small number of participants, which limits the generalizability of the findings.

CONCLUSION

Our results, if replicated, may have clinical implications. The reported patterns of anxiety reduction during ritual performance may contribute to the fine-tuning of CBT for OCD. The findings concerning the nature of attention during ritual performance and the development of rituals over time may be important for understanding the mechanisms that maintain compulsive rituals.

Habitual or hyper-controlled behavior: OCD symptoms and explicit sequence learning

BACKGROUND AND OBJECTIVES

This study examined whether ritualistic behaviors characteristic of obsessive-compulsive disorder (OCD) are a product of dysfunctional goal-directed behavior leading to habitual behavior (Gillan & Robbins, 2014). We used an explicit motor sequence learning task to investigate the repetition of chunked action sequences across the OC spectrum. As sequential motor behavior is practiced, action movements appear to get bundled together, and the initial movement of the sequence activates the entire sequence, leaving it relatively insensitive to change. Therefore, compulsive behavior in OCD may be a result of failing to inhibit the full activation of an extensively learned action sequence.

METHODS

Fifty-seven participants across the range of OCD symptoms practiced one sequence and then tested on a novel sequence in which one of the middle movements was omitted. Optimal performance for the new sequence required goal-directed inhibition of the original sequence and goal-directed execution of the new sequence instead. To manipulate activation of goal-directed behavior, we added a dual-task condition with a competing auditory tonal N-Back task. Data were analyzed using mixed-effects models.

RESULTS

Although we did observe expected learning patterns during learning of the original sequence, slower reaction times for the new sequences, and higher errors in the dual-task condition, performance was not significantly related to either obsessive-compulsive symptoms or distress symptoms.

LIMITATIONS

The current study used an analog sample; replication in a treatment seeking sample is warranted.

CONCLUSIONS

These findings challenge the goal-directed dysfunction model of OCD.