Using RDoC to conceptualize impulsivity and compulsivity in relation to addiction

  • Type: #article
  • Year read:#read2017
  • Subject: Compulsivity RDoC
  • Bibtex: @brooks2017
  • Bibliography: Brooks, S. J., Lochner, C., Shoptaw, S., & Stein, D. J. (2017). Using the research domain criteria (RDoC) to conceptualize impulsivity and compulsivity in relation to addiction. Brain Research in Addiction (1st ed., Vol. 235, pp. 177–218). Elsevier B.V.

The RDoC calls for the further development of transdiagnostic approaches to psychopathy and includes five domains to improve research. Additionally, the RDoC suggests that these domains can be measured in terms of specific units of analysis.

Five RDoC domains

  • Negative valence systems

  • Positive valence systems

  • Cognitive systems

  • Social processes

  • Arousal/regulatory systems

    Units of analysis

    • Genes
    • Molecules
    • Cells
    • Neural circuits
    • Physiology
    • Behavior
    • Self-reports
    • Paradigms

    The purpose is to examine impulsivity and compulsivity in light of RDoC.

    Compulsivity and RDoC domains

    Negative valence systems

    • Repeat exposure to fear/trauma/loss
    • animal models models and optogenetic approaches implicating the amygdala-hippocampal and fronto-striatal networks in repetitive behaviors that follow initial impulse fear/trauma
    • Maladaptive motor responses
    • Maladaptive coping strategies for anxiety
    • Risk assessment and hypoervigilance to reduce negative affect
    • Self-medication behaviours
    • Frustrative nonreward
    • Repetitive attempts to experience reward

    Positive valence systems

    • Reward seeking, consummatory behaviors, and habit learning
    • Memory and stimulus characteristics
    • Incentive valence
    • Effort valuation
    • Expectancy/reward prediction error
    • Action selection/preference-based decision making (e.g., delay discounting)
    • Cost– benefit analysis, risk assessment
    • Sustained/longer-term responsiveness to reward attainment
    • Ventral striatum (nucleus accumbens)
    • Liking and wanting
    • Learning of value of reward and responses to reward driven by striatal neural responses and top-down prefrontal cortex executive functioning including the anterior cingulate (conflict monitoring and error detection)
    • Elicited behaviors that transiently lead to satisfaction followed by renewed tension (opponent process)

    Cognitive systems

    • Working memory and deficits in inhibitory control
    • Reversal learning/ extinction deficits
    • Visual stream activation associated with cognitive biases in line with learning and arousal states
    • Anterior insular cortex activation may drive compulsive responses to cues deemed salient
    • Declarative memory (episodic and semantic)
    • Tourette’s syndrome motor and vocal tics

    Social processes

    • Social (e.g., facial) communication and reinforcement
    • Perceptual understanding of the self
    • Understanding mental states
    • Stress/tension relief
    • Development of bonding to peers or to substitute addictive practices (e.g., OCRD routines, eating disorder behaviors, using substances)
    • Inability to effectively self-regulate in social situations
    • Heightened exteroception

    Arousal/regulatory systems

    • Cues that become related to threat and disorder (e.g., drug paraphernalia)
    • Facilitating interaction with the environment (e.g., maladaptive)
    • Compulsivity as a behavioral continuum or state that can be measured
    • And may be associated with increased motor or cognitive responsivity
  p.177: it may become clearer as to whether impulsivity and compulsivity function antagonistically, complementarily or in some other way at the behavioral, cognitive, and neural -- Highlighted 10 nov. 2017

        p.178: level and how this relationship underpins addiction. Thus, here we consider research into impulsivity and compulsivity in light of the transdiagnostic RDoC to help better understand these concepts and their application to evidence-based clinical intervention for addiction. -- Highlighted 10 nov. 2017

        p.178: Broadly, there are commonalities between substance use disorders (SUDs), including the use of stimulants, alcohol, nicotine—and behavioral addictions including gambling, internet use, shopping, and eating, in terms of elements of automatized, dysregulated cognitions, and behaviors. -- Highlighted 10 nov. 2017

        p.178: Similarly, obsessive–compulsive and related disorders (OCRDs) such as hoarding disorder, skin-picking disorder, trichotillomania, eating disorders (EDs) while not -- Highlighted 10 nov. 2017

        p.180: typically regarded as addictions are sometimes comorbid with them (Pallanti et al., 2011), with compulsive cognitions and behaviors a central feature (Gruner and Pittenger, 2017). Within the diagnoses of these disorders impulsive–compulsive symptoms generally tend to occur and are to some extent associated with excessive dependence on routines and repetitive behavior (Starcevic, 2016), high sensitivity to environmental stimuli, also known as cue reactivity (Dalley et al., 2011) and cognitive biases toward specific stimuli -- Highlighted 10 nov. 2017

        p.184: Previously, impulsivity and compulsivity were regarded as dissociable states underpinned by distinct neural mechanisms within the fronto-striatal network for sensation/risk seeking and aversion avoidance, respectively -- Highlighted 10 nov. 2017

        p.184: However, neurobiological research since the advent of neuroimaging, has led to updated conceptualizations of impulsivity and compulsivity that broadly share common substrates within the fronto-striatal circuitry for high levels of automaticity, impaired cognitive inhibition, lack of self-control, and maladaptive self-regulation. Discrete differences in regional activation within this broad network may shed further light on the neural mechanisms of interaction between impulsivity and compulsivity that present as fluctuating symptoms for many mental disorders. -- Highlighted 10 nov. 2017

        p.186: With this in mind, impulsivity is regarded as a multifactorial construct, which may involve inattention (cognitive impulsivity) and hyperactivity (behavioral/motor impulsivity). Similarly, recent distinctions have been made between choice impulsivity, that is, the choice for immediate over delayed rewards; and rapid response impulsivity, that is, the tendency to act without forethought, and out of context with immediate demands -- Highlighted 10 nov. 2017

        p.186: Recently, more specific constructs of impulsivity have been hypothesized, namely (i) motor impulsivity; (ii) disadvantageous decision making; (iii) choice impulsivity; and (iv) reflection impulsivity -- Highlighted 10 nov. 2017

        p.186: It has been defined as the repetitive, irresistible urge to perform a be-havior, the experience of loss of voluntary control over this intense urge, the -- Highlighted 10 nov. 2017

        p.187: diminished ability to delay or inhibit thoughts or behaviors, and the tendency to per-form repetitive acts in a habitual or stereotyped manner -- Highlighted 10 nov. 2017

        p.187: Compulsivity can be seen as a cross-disorder trait leading to behavior that is inappropriate to the situation and that persists despite a lack of goal orientation, resulting in adverse consequences -- Highlighted 10 nov. 2017

        p.187: Compulsive, perpetual, and ritualized behaviors and cognitions are likely employed in an attempt to neutralize NVSs that are activated in conjunction with these thoughts (e.g., fear, anxiety, and perceived threat) and for the individual to gain a rewarding sense of control (e.g., symptoms of hoarding, checking, cleaning in obsessive– compulsive disorder [OCD], compulsive appetite restraint and exercise regimens in those with EDs, compulsive substance use, and gambling). -- Highlighted 10 nov. 2017

        p.187: Constructs of compulsivity include (i) contingency-related cognitive inflexibility; (ii) task/attentional set shifting; (iii) attentional bias/disengagement; and (iv) habit learning (for a detailed review, see Fineberg et al., 2014). Contingencyrelated cognitive inflexibility is also known as heightened perseverance, particularly in anticipation of a previously experienced reward; task/attentional set shifting requires the ability to switch rules/attention as stimuli change; attentional bias/disengagement is associated with heightened attention directed toward disorder-related stimuli (saliency); and habit learning is the automatic repetition of behaviors and cognitions that are associated with a reward (which can be maladaptive). -- Highlighted 10 nov. 2017

        p.188: In other words, compulsivity may be linked to the reduction of arousal and termination of behaviors, cognitions, and affect, whereas impulsivity corresponds to initiating them, with the differences observed in terms of varying activation of corticostriatal loops -- Highlighted 10 nov. 2017

        p.188: There is mounting neuroimaging and neurocognitive evidence to suggest that impulsivity significantly contributes to relapse in psychiatric disorder, whereas the role of compulsivity is less clear, with its persistent function likely aimed at reducing negative affect that might otherwise obscure the detection of more serious mental or physical illness -- Highlighted 10 nov. 2017

        p.188: In this vein, accumulating evidence appears to suggest that the initiation of mental disorder begins with excessive arousal that is linked to impulsivity, with compulsivity regarded as a maladaptive coping strategy for such arousal, which in turn is linked to poor treatment efficacy (Blanco et al., 2009; Grant et al., 2010). However, whether impulsivity and compulsivity act concomitantly, sequentially, antagonistically, complementarily, or a combination of these at the neural level is not yet clear (Voon and Dalley, 2016)—and so considering impulsivity and compulsivity in light of the RDoC might help to better understand the two processes and how they interact. -- Highlighted 10 nov. 2017

        p.189: Structural variation in large-scale brain systems related to motor inhibitory control, including the cortico-thalamic-striatal-cortico (CTSC) circuitry may mediate a component of the genetic risk for compulsivity and arguably represents a neurocognitive endophenotype of response inhibition difficulties. -- Highlighted 17 nov. 2017

        p.191: From this perspective, it could be that brain functioning aligned with impulsivity may be related to the over stimulated release of neurotransmitters such as serotonin, dopamine, and noradrenaline in the reward/motivation networks (e.g., pertaining to impulsive drug-taking, binge-eating, shopping, aggressive acts, etc.), which overlap with the release of hypothalamic–pituitary–adrenal axis hormones that are concomitant with negative affect and subsequent compulsivity within a range of fight/flight responses. -- Highlighted 17 nov. 2017

        p.192: For compulsivity, the ventral tegmental area—a dopaminergic cell nucleus within the mesolimbic reward pathway—is often implicated in the process of drug-induced compulsive seeking behavior underlying addiction, which is often typified on a neural level as a shift from trait impulsivity to compulsivity (Everitt, 2014), particularly given that there are well-known dopaminergic projections to the ventral striatum underlying the subjective experiences of wanting and liking. -- Highlighted 17 nov. 2017

        p.193: a recent review reports that glutamate-related pathways are major deficient systems in patients with OCD, with the GRIN2A, GRIN2B, and GRIA2 genes the most central glutamatergic nodes in the OCDR network -- Highlighted 17 nov. 2017

        p.193: As such, other glutamate receptor antagonists (e.g., ketamine) have the potential to be effective treatments for those with OCD and mood disorders -- Highlighted 17 nov. 2017

        p.193: Constructs of impulsivity have been identified and described earlier, namely (i) motor impulsivity; (ii) disadvantageous decision making; (iii) choice impulsivity; and (iv) reflection impulsivity -- Highlighted 17 nov. 2017

        p.194: if we again take the more specific constructs of compulsivity as recently defined and described earlier, one can briefly examine brain imaging studies that specifically map onto these constructs, namely (i) contingency-related cognitive inflexibility (prediction error); (ii) task/attentional set shifting; (iii) attentional bias/disengagement; and (iv) habit learning -- Highlighted 17 nov. 2017

        p.194: The most prominent neural circuitry identified in relation to compulsivity observed in OCD and related disorders is the CTSC loop, and dysfunction within this circuit appears to (a) be most susceptible to the cognitions and behaviors associated with compulsivity and (b) most altered by psychological intervention -- Highlighted 17 nov. 2017

        p.194: Finally, as Everitt and colleagues have extensively reviewed, habit formation and compulsivity are often related to a switch from predominantly ventral striatal (nucleus accumbens) neural activation in line with controlled drug use, for example, to dorsal striatal conditioned responses that are habitual and correspond to deficits in the prefrontal cortex executive control system -- Highlighted 17 nov. 2017

        p.195: it might be that measures associated with adaptation and attentional bias—rather than measures of arousal—underpin perseverative behaviors and cognitions. -- Highlighted 17 nov. 2017

        p.196: Bradley and colleagues have recently shown that patients with OCD demonstrate greater frequency and duration of fixations on OCD stimuli (compared to aversive or neutral), reflecting the maintenance of attentional bias, and severity of compulsive symptoms -- Highlighted 17 nov. 2017

        p.196: In summary, selection of RDoC physiological measures we examine here suggest that attention deficits and saliency processes, rather than arousal mechanisms, underpin the development, and maintenance of compulsivity. -- Highlighted 17 nov. 2017

        p.198: In terms of laboratory tests of compulsivity, contingency-related cognitive flexibility refers to the ability to learn and unlearn behaviors based on predicting environmental outcomes and reverse learning. -- Highlighted 17 nov. 2017