Attention Allocation in OCD: Contrasting Obsession-Provoking Stimuli With Stimuli Signaling the Completion of Compulsive Acts

Research on attention allocation in obsessive-compulsive disorder (OCD) shows that obsessive-compulsive individuals are biased toward stimuli reflecting the completion of compulsive acts (end-states stimuli) over traditional obsession-provoking threatening stimuli. Yet, past research compared individuals with high and low levels of obsessive-compulsive symptoms, restricting generalizability to clinical OCD, while also inherently confounding OCD and anxiety symptoms. The present addressed both limitations. Participants with OCD (n = 32), participants with anxiety disorders (AN; n = 30), and healthy control participants (HC; n = 33) freely viewed 2-by-2 picture matrices, each presented for 8 seconds, contrasting two types of pictures: obsession-provoking threat pictures and end-state pictures. Gaze data was recorded throughout. Participants’ subjective discomfort experienced while viewing the different pictures was also assessed. Participants with OCD dwelled longer on end-state stimuli, compared to obsession-provoking threat stimuli, while AN and HC participants demonstrated no difference in dwell time between the two picture types. While all participants experienced less discomfort when viewing end-sate pictures, compared with obsession-provoking threat pictures, this difference was largest among OCD participants. Moreover, an indirect-only mediation effect emerged when using this difference in subjective discomfort as a mediator of group differences in attention allocation to the two picture types. Finally, task reliability was found to be high. Biased attention allocation toward stimuli associated with the completion of compulsive acts over obsession-provoking threat stimuli generalizes to clinical OCD. This biased attention allocation pattern may, in turn, serve as a novel target for attention bias modification procedures in OCD.