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The effect of distress on the balance between goal-directed and habit networks in obsessive-compulsive disorder.

ABSTRACT: The classical cognitive-behavioral theory of obsessive-compulsive disorder (OCD) holds that compulsions are performed to reduce distress that is evoked by obsessions, whereas a recent neuroscience-inspired theory suggests that compulsivity results from a disbalance between goal-directed and habit-related neural networks. To bridge these theories, we investigated whether the balance between goal-directed and habit networks in patients with OCD was affected during psychological distress. Twenty-three OCD patients and twenty-three healthy controls participated in a controlled stress induction paradigm using the socially evaluated cold-pressor test in a crossover design. Stress responses were evaluated through cortisol levels, blood pressure, and anxiety ratings. Functional connectivity of the caudate nucleus and posterior putamen was assessed using seed region analysis of resting-state functional magnetic resonance imaging data, which are hubs of the goal-directed and habit network, respectively. Stress induction increased blood pressure and psychological stress measures across groups and resulted in blunted cortisol responses in patients. Furthermore, patients showed a blunted reduction in connectivity between the caudate nucleus and precuneus during psychological distress, which was positively correlated with compulsivity but not obsession severity. The posterior putamen showed no significant group differences in distress-induced connectivity. These results suggest that compulsivity in OCD is associated with altered connectivity between the goal-directed and default mode networks during psychological distress.

SUBMITTER: van der Straten A

PROVIDER: S-EPMC7039895 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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The effect of distress on the balance between goal-directed and habit networks in obsessive-compulsive disorder.

van der Straten Anouk A van Leeuwen Wieke W Denys Damiaan D van Marle Hein H van Wingen Guido G

Translational psychiatry 20200224 1

The classical cognitive-behavioral theory of obsessive-compulsive disorder (OCD) holds that compulsions are performed to reduce distress that is evoked by obsessions, whereas a recent neuroscience-inspired theory suggests that compulsivity results from a disbalance between goal-directed and habit-related neural networks. To bridge these theories, we investigated whether the balance between goal-directed and habit networks in patients with OCD was affected during psychological distress. Twenty-th ...[more]

PMID: 32094333

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Project description:ImportanceDimensional definitions of transdiagnostic mental health problems have been suggested as an alternative to categorical diagnoses, having the advantage of capturing heterogeneity within diagnostic categories and similarity across them and bridging more naturally psychological and neural substrates.ObjectiveTo examine whether a self-reported compulsivity dimension has a stronger association with goal-directed and related higher-order cognitive deficits compared with a diagnosis of obsessive-compulsive disorder (OCD).Design, setting, and participantsIn this cross-sectional study, patients with OCD and/or generalized anxiety disorder (GAD) from across the United States completed a telephone-based diagnostic interview by a trained rater, internet-based cognitive testing, and self-reported clinical assessments from October 8, 2015, to October 1, 2017. Follow-up data were collected to test for replicability.Main outcomes and measuresPerformance was measured on a test of goal-directed planning and cognitive flexibility (Wisconsin Card Sorting Test [WCST]) and a test of abstract reasoning. Clinical variables included DSM-5 diagnosis of OCD and GAD and 3 psychiatric symptom dimensions (general distress, compulsivity, and obsessionality) derived from a factor analysis.ResultsOf 285 individuals in the analysis (mean [SD] age, 32 [12] years; age range, 18-77 years; 219 [76.8%] female), 111 had OCD; 82, GAD; and 92, OCD and GAD. A diagnosis of OCD was not associated with goal-directed performance compared with GAD at baseline (? [SE], -0.02 [0.02]; P?=?.18). In contrast, a compulsivity dimension was negatively associated with goal-directed performance (? [SE], -0.05 [0.02]; P?=?.003). Results for abstract reasoning task and WCST mirrored this pattern; the compulsivity dimension was associated with abstract reasoning (? [SE], 2.99 [0.63]; P?<?.001) and several indicators of WCST performance (eg, categories completed: ? [SE], -0.57 [0.09]; P?<?.001), whereas OCD diagnosis was not (abstract reasoning: ? [SE], 0.39 [0.66]; P?=?.56; categories completed: ? [SE], -0.09 [0.10]; P?=?.38). Other symptom dimensions relevant to OCD, obsessionality, and general distress had no reliable association with goal-directed performance, WCST, or abstract reasoning. Obsessionality had a positive association with requiring more trials to reach the first category on the WCST at baseline (? [SE], 2.92 [1.39]; P?=?.04), and general distress was associated with impaired goal-directed performance at baseline (? [SE],-0.04 [0.02]; P?=?.01). However, unlike the key results of this study, neither survived correction for multiple comparisons or was replicated at follow-up testing.Conclusions and relevanceDeficits in goal-directed planning in OCD may be more strongly associated with a compulsivity dimension than with OCD diagnosis. This result may have implications for research assessing the association between brain mechanisms and clinical manifestations and for understanding the structure of mental illness.

Dataset Information

The effect of distress on the balance between goal-directed and habit networks in obsessive-compulsive disorder.

Publications

The effect of distress on the balance between goal-directed and habit networks in obsessive-compulsive disorder.

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