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

A L van der Straten, W van Leeuwen, D Denys, H J F van Marle, G A van Wingen

Research output: Contribution to journalArticleAcademic

Abstract

Introduction: The classical cognitive-behavioral theory of obsessive-compulsive disorder (OCD) holds that compulsions (repetitive behaviors) are performed to reduce distress that is evoked by obsessions (intrusive thoughts), whereas a recent neuroscience-inspired theory suggests that compulsivity results from a disbalance between goal-directed and habit-related neural networks. Stress exacerbates OCD symptoms in patients but also shifts goal-directed behavior towards habitual behavior in healthy volunteers. To bridge these theories, we investigated whether acute stress would influence the balance between goal-directed and habit networks in patients with OCD. Methods: 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, blood pressure and heart rate measurements and anxiety ratings, while brain activity was measured with resting-state functional magnetic resonance imaging. A seed-to-voxel analysis was performed for the caudate nucleus and posterior putamen as hubs of the goal-directed and habit network, respectively. Results: Stress induction increased blood pressure and psychological stress measures across groups and resulted in blunted cortisol responses in patients. Furthermore, acute stress increased connectivity between the caudate nucleus and precuneus in patients compared to healthy controls, which was positively correlated with compulsivity but not obsession severity. The posterior putamen showed no significant group differences in stress-induced connectivity. Conclusion: Acute stress increases the interaction between the goal-directed and default mode network in OCD, which is associated with compulsivity severity. These findings suggest that stress-related compulsivity involves increased recruitment of the goal-directed network.

Original languageEnglish
Pages (from-to)598268
JournalBiorxiv
DOIs
Publication statusPublished - 2019

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