PDF(Pubmed)
Abstract：
Compulsive behaviour may often be triggered by Pavlovian cues. Assessing how Pavlovian cues drive instrumental behaviour in obsessive-compulsive disorder (OCD) is therefore crucial to understand how compulsions develop and are maintained. An aversive Pavlovian-to-Instrumental transfer (PIT) paradigm, particularly one involving avoidance/cancellation of negative outcomes, can enable such investigation and has not previously been studied in clinical-OCD. Forty-one participants diagnosed with OCD (21 adults; 20 youths) and 44 controls (21 adults; 23 youths) completed an aversive PIT task. Participants had to prevent the delivery of unpleasant noises by moving a joystick in the correct direction. They could infer these correct responses by learning appropriate response-outcome (instrumental) and stimulus-outcome (Pavlovian) associations. We then assessed whether Pavlovian cues elicited specific instrumental avoidance responses (specific PIT) and induced general instrumental avoidance (general PIT). We investigated whether task learning and confidence indices influenced PIT strength differentially between groups. There was no overall group difference in PIT performance, although youths with OCD showed weaker specific PIT than youth controls. However, urge to avoid unpleasant noises and preference for safe over unsafe stimuli influenced specific and general PIT respectively in OCD, while PIT in controls was more influenced by confidence in instrumental and Pavlovian learning. Thus, in OCD, implicit motivational factors, but not learnt knowledge, may contribute to the successful integration of aversive Pavlovian and instrumental cues. This implies that compulsive avoidance may be driven by these automatic processes. Youths with OCD show deficits in specific PIT, suggesting cue integration impairments are only apparent in adolescence. These findings may be clinically relevant as they emphasise the importance of targeting such implicit motivational processes when treating OCD.
摘要：
强迫性行为通常可能是由巴甫洛夫线索触发的。因此，评估巴甫洛夫线索如何在强迫症（OCD）中驱动工具行为对于了解强迫症的发展和维持至关重要。令人厌恶的巴甫洛夫到工具转移(PIT)范式，特别是涉及避免/取消负面结果的情况，可以进行此类研究，并且以前尚未在临床OCD中进行过研究。41名被诊断患有强迫症的参与者（21名成人；20名青年）和44名对照（21名成人；23名青年）完成了令人厌恶的PIT任务。参与者必须通过向正确方向移动操纵杆来防止发出令人不快的噪音。他们可以通过学习适当的反应-结果（工具）和刺激-结果（巴甫洛夫）关联来推断这些正确的反应。然后，我们评估了巴甫洛夫线索是否引起了特定的工具回避反应（特定PIT）并引起了一般的工具回避反应（一般PIT）。我们调查了任务学习和信心指数是否在组间差异影响PIT强度。PIT性能没有总体组差异，尽管患有强迫症的青少年表现出比青少年对照组更弱的特异性PIT。然而,避免令人不快的噪音和对安全而不是不安全刺激的偏好分别影响了强迫症中特定和一般的PIT，而对照组的PIT更受对工具性和巴甫洛夫学习的信心的影响。因此，在强迫症中，内隐的动机因素，但没有学到知识，可能有助于将厌恶的巴甫洛夫和器乐线索成功整合。这意味着这些自动过程可以驱动强制回避。患有强迫症的年轻人在特定的PIT中表现出缺陷，提示提示整合障碍仅在青春期明显。这些发现可能与临床相关，因为它们强调了在治疗强迫症时针对此类内隐动机过程的重要性。
