2017 IOCDF Grant

Decision-making impairments in OCD: An integrated behavioral economics model

Ryan Jacoby, MA

Massachusetts General Hospital/Harvard Medical School (Boston, MA)

Award Amount: $35,039

Patients with OCD often view risky situations as aversive, with high rates of avoidance of feared situations and stimuli (e.g., public restrooms, kitchen stoves). However, the research on risk aversion in OCD is conflicting. To explore this further, Dr. Jacoby and her team combined insights from economic Decision Science theories and psychological models of intolerance of uncertainty (IU), a key cognitive bias in OCD characterized by negative beliefs about ambiguity and uncertainty. Specifically, they examined whether inconsistencies in the literature may be explained by examining decision making when the decision is either high or low in ambiguity. They hypothesized that ambiguity during decision-making may prime IU beliefs for people with OCD and lead to worse decision-making.

By having 30 patients with OCD and 30 individuals in a control group complete an economic decision making task, the team found that patients with OCD felt high uncertainty and distress regardless of how ambiguous the task was, compared to healthy controls whose level of certainty matched the level of ambiguity (i.e., they felt significant less certain on the high ambiguity vs. the low ambiguity task version). Participants’ self-reported IU was also associated with higher levels of distress during the task. The results of Dr. Jacoby’s study can be used to inform clinical treatment. They show that therapists should help patients shift their attention from seeking more information about an ambiguous situation to instead embracing this uncertainty, as well as understanding the role that distress plays when patients with OCD have to make decisions.