Compulsivity reveals a novel dissociation between action and confidence
Open accessAbstract
Confidence and actions are normally tightly interwoven-if I am sure that it is going to rain, I will take an umbrella-therefore, it is difficult to understand their interplay. Stimulated by the ego-dystonic nature of obsessive-compulsive disorder (OCD), where compulsive actions are recognized as disproportionate, we hypothesized that action and confidence might be independently updated during learning. Participants completed a predictive-inference task designed to identify how action and confidence evolve in response to surprising changes in the environment. While OCD patients (like controls) correctly updated their confidence according to changes in the environment, their actions (unlike those of controls) mostly disregarded this knowledge. Therefore, OCD patients develop an accurate, internal model of the environment but fail to use it to guide behavior. Results demonstrated a novel dissociation between confidence and action, suggesting a cognitive architecture whereby confidence estimates can accurately track the statistic of the environment independently from performance.
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OCD patients show an action-confidence dissociation driven by oversized unsigned prediction-error responses.
“OCD patients show an action-confidence dissociation driven by oversized unsigned prediction-error responses (59)”
From Predictive coding and neurocomputational psychiatry: a mechanistic framework for understanding mental disorders (2026) · cites this paper as [59]
The Results (Dynamics of Learning and Confidence Update; page unavailable) report weaker action–confidence coupling in OCD patients and a stronger influence of absolute prediction error on their action updates. But the Discussion says elevated action updating occurred even without an error and was not simply driven by response feedback; the paper does not establish oversized unsigned prediction-error responses as the cause of the dissociation. (LLM, conf=0.86)
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References 50 · Cited by 145
- Authors
- Vaghi, M. M., Luyckx, F., Sule, A., Fineberg, N. A., Robbins, T. W., & De Martino, B.
- Affiliations
- University of Cambridge (GB)
- Cumbria Partnership NHS Foundation Trust (GB)
- University of Hertfordshire (GB)
- Corresponding author
- Vaghi, Matilde M.
- Venue
- Neuron
- Publisher
- Elsevier BV
- Published
- 2017-10
- Volume
- 96
- Issue
- 2
- Pages
- 348-354.e4
- ISSN
- 0896-6273 (ISSN-L)
- PMC
- PMC5643443
- OpenAlex
- W2756634820
- Cited by
- 145
- References
- 50
- Citations by year
- 2026: 14 · 2025: 22 · 2024: 23 · 2023: 16 · 2022: 13 · 2021: 19 · 2020: 19 · 2019: 12 · 2018: 5 · 2017: 1
- FWCI
- 12.42
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Neuron (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- BIROn (Birkbeck, University of London) (acceptedVersion)
- UEA Digital Repository (University of East Anglia) (submittedVersion, cc-by)
- Apollo (University of Cambridge) (submittedVersion, cc-by)
- UCL Discovery (University College London) (submittedVersion)
- University of Hertfordshire Research Archive (University of Hertfordshire) (submittedVersion)
- Apollo (cc-by)
- Funders
- Wellcome Trust and Royal Society (102612/A/13/Z)
- Pinsent Darwin Scholarship in Mental Pathology
- Angharad Dodds John Bursary in Mental Health and Neuropsychiatry
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Life Sciences › Neuroscience › Cognitive Neuroscience › Memory and Neural Mechanisms
- Keywords
- compulsivity, obsessive-compulsive disorder, confidence, action, predictive inference, Bayesian updating, surprise, decision-making
- MeSH terms
- Adult, Compulsive Behavior, Decision Making, Female, Humans, Learning, Male, Middle Aged, Obsessive-Compulsive Disorder, Photic Stimulation, Psychomotor Performance
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