Reward learning in obsessive-compulsive disorder: an attentional perspective

Basel, Dana; Asher, Rotem; Lazarov, Amit · 2025 · Crossref

DOI: 10.1007/s11031-025-10167-5

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Summary

This study investigates reward learning in obsessive-compulsive disorder (OCD) through an attentional lens, addressing limitations of prior research that relied on non-clinical samples and failed to disentangle OCD from anxiety. While previous work suggested parallels between OCD and addiction regarding aberrant reward processing, earlier studies using the value-modulated attentional capture (VMAC) task were confounded by anxiety levels and lacked clinical generalizability. The authors aimed to determine if clinically diagnosed OCD patients exhibit heightened attentional capture by high-reward cues compared to individuals with anxiety disorders and healthy controls. The researchers employed an eye-tracking-based VMAC task with three groups: 32 participants with a clinical diagnosis of OCD, 30 with anxiety disorders (AN), and 31 healthy controls (HC). Participants performed a visual search task where they had to fixate on a target shape to earn points. Crucially, one distractor shape signaled the magnitude of the potential reward (high vs. low). Attentional capture was measured by the number of fixations on the reward-signaling distractor and the number of first saccades toward it. Clinical assessments included the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and Hamilton Anxiety Rating Scale (HAM-A) to ensure diagnostic validity and control for symptom severity. Results indicated that all groups showed a main effect of reward, with greater attentional capture by high-reward cues than low-reward cues. However, the magnitude of this VMAC effect was significantly heightened in the OCD group compared to both the AN and HC groups. This heightened capture was evident in both fixation and saccade data, suggesting that individuals with OCD are disproportionately distracted by high-reward signals, even when such distraction impairs their ability to obtain the reward. Surprisingly, the anxiety disorder group showed no significant VMAC effect, indicating blunted attentional reward learning rather than the heightened capture seen in OCD. Statistical analyses confirmed that these differences were specific to OCD and not driven by general anxiety or depression levels. The findings challenge the traditional view of OCD as purely risk-averse, supporting emerging theories that conceptualize OCD as having addiction-like reward processing mechanisms. The heightened attentional capture by high-reward cues in OCD suggests a specific deficit in regulating attention toward rewarding stimuli, which may contribute to the persistence of compulsive behaviors. The lack of a VMAC effect in the anxiety group highlights the distinct nature of reward processing in OCD compared to other anxiety-related conditions. These results underscore the importance of using clinical samples and eye-tracking methodologies to isolate disorder-specific cognitive mechanisms, providing new insights into the neurocognitive underpinnings of OCD.

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• visual occlusion