Action sequence learning, habits, and automaticity in obsessive-compulsive disorder.

This study investigates the goal/habit imbalance theory of compulsion in obsessive-compulsive disorder (OCD), which postulates enhanced habit formation, increased automaticity, and impaired goal/habit arbitration. It directly tests these hypotheses using newly developed behavioral tasks. First, OCD patients and healthy participants were trained daily for a month using a smartphone app to perform chunked action sequences. Despite similar procedural learning and attainment of habitual performance (measured by an objective automaticity criterion) by both groups, OCD patients self-reported higher subjective habitual tendencies via a recently developed questionnaire. Subsequently, in a re-evaluation task assessing choices between established automatic and novel goal-directed actions, both groups were sensitive to re-evaluation based on monetary feedback. However, OCD patients, especially those with higher compulsive symptoms and habitual tendencies, showed a clear preference for trained/habitual sequences when choices were based on physical effort, possibly due to their higher attributed intrinsic value. These patients also used the habit-training app more extensively and reported symptom relief post-study. The tendency to attribute higher intrinsic value to familiar actions may be a potential mechanism leading to compulsions and an important addition to the goal/habit imbalance hypothesis in OCD. We also highlight the potential of smartphone app training as a habit reversal therapeutic tool.

Using skeletal position to estimate human error rates in telemanipulator operators.

In current telerobotics and telemanipulator applications, operators must perform a wide variety of tasks, often with a high risk associated with failure. A system designed to generate data-based behavioural estimations using observed operator features could be used to reduce risks in industrial teleoperation. This paper describes a non-invasive bio-mechanical feature capture method for teleoperators used to trial novel human-error rate estimators which, in future work, are intended to improve operational safety by providing behavioural and postural feedback to the operator. Operator monitoring studies were conducted in situ using the MASCOT teleoperation system at UKAEA RACE; the operators were given controlled tasks to complete during observation. Building upon existing works for vehicle-driver intention estimation and robotic surgery operator analysis, we used 3D point-cloud data capture using a commercially available depth camera to estimate an operator's skeletal pose. A total of 14 operators were observed and recorded for a total of approximately 8 h, each completing a baseline task and a task designed to induce detectable but safe collisions. Skeletal pose was estimated, collision statistics were recorded, and questionnaire-based psychological assessments were made, providing a database of qualitative and quantitative data. We then trialled data-driven analysis by using statistical and machine learning regression techniques (SVR) to estimate collision rates. We further perform and present an input variable sensitivity analysis for our selected features.

Improvements in Attention Following Cognitive Training With the Novel "Decoder" Game on an iPad.

Work and study increasingly rely on the use of technologies requiring individuals to switch attention rapidly between emails, texts and tasks. This has led to healthy people having problems of attention and concentration and difficulties getting into the "flow," which impedes goal attainment and task completion. Possibly related to this, there is an increasing diagnosis of attention deficit hyperactivity disorder (ADHD) and prescriptions of drugs such as methylphenidate. In addition to ADHD, attention is impaired in other neuropsychiatric disorders, such as schizophrenia and in traumatic brain injury (TBI). Based on neuropsychological and neuroimaging evidence, we developed "Decoder," a novel game for targeted cognitive training of visual sustained attention on an iPad. We aimed to investigate the effects of cognitive training in 75 healthy young adults randomly assigned to a Cognitive Training (8 h of playing Decoder over 4 weeks; n = 25), Active Control (8 h of playing Bingo over 4 weeks; n = 25) or Passive Control (continuation of activities of daily living; n = 25) group. Results indicated that cognitive training with Decoder was superior to both control groups in terms of increased target sensitivity (A') on the Cambridge Neuropsychological Test Automated Battery Rapid Visual Information processing (CANTAB RVP) test, indicating significantly improved sustained visual attention. Individuals playing Decoder also showed significantly better performance on the Trail Making Test (TMT) compared with those playing Bingo. Significant differences in visual analogue scales were also found between the two gaming groups, such that Decoder received higher ratings of enjoyment, task-related motivation and alertness across all hours of game play. These data suggest that cognitive training with Decoder is an effective non-pharmacological method for enhancing attention in healthy young adults, which could be extended to clinical populations in which attentional problems persist.

A Mobile Phone App for the Generation and Characterization of Motor Habits.

Habits are a powerful route to efficiency; the ability to constantly shift between goal-directed and habitual strategies, as well as integrate them into behavioral output, is key to optimal performance in everyday life. When such ability is impaired, it may lead to loss of control and to compulsive behavior. Habits have successfully been induced and investigated in rats using methods such as overtraining stimulus-response associations and outcome devaluation, respectively. However, such methods have ineffectively measured habits in humans because (1) human habits usually involve more complex sequences of actions than in rats and (2) of pragmatic impediments posed by the extensive time (weeks or even months), it may take for routine habits to develop. We present here a novel behavioral paradigm-a mobile-phone app methodology-for inducing and measuring habits in humans during their everyday schedule and environment. It assumes that practice is key to achieve automaticity and proficiency and that the use of a hierarchical sequence of actions is the best strategy for capturing the cognitive mechanisms involved in habit formation (including "chunking") and consolidation. The task is a gamified self-instructed and self-paced app on a mobile phone that enables subjects to learn and practice two sequences of finger movements, composed of chords and single presses. It involves a step-wise learning procedure in which subjects begin responding to a visual and auditory cued sequence by generating responses on the screen using four fingers. Such cues progressively disappear throughout 1 month of training, enabling the subject ultimately to master the motor skill involved. We present preliminary data for the acquisition of motor sequence learning in 29 healthy individuals, each trained over a month period. We demonstrate an asymptotic improvement in performance, as well as its automatic nature. We also report how people integrate the task into their daily routine, the development of motor precision throughout training, and the effect of intermittent reinforcement and reward extinction in habit preservation. The findings help to validate this "real world" app for measuring human habits.

Novel Smartphone Interventions Improve Cognitive Flexibility and Obsessive-Compulsive Disorder Symptoms in Individuals with Contamination Fears.

One type of obsessive-compulsive disorder (OCD) is characterized by contamination fears and compulsive cleansing. Few effective treatments are available for this debilitating condition. Compulsive symptoms, such as excessive washing, are believed to be mediated by cognitive inflexibility-arguably the most striking cognitive impairment in OCD. In this study, we investigated the effects of two novel smartphone interventions on cognitive flexibility and OCD symptoms in healthy individuals with OCD-like contamination fears. In the first intervention, participants watched a brief video recording of themselves engaging in handwashing on a smartphone, four times a day, for a total of one week (N = 31). The second intervention was similar except that participants watched themselves repeatedly touching a disgust-inducing object (N = 31). In a third (control) "intervention", participants watched themselves performing sequential hand movements (N = 31). As hypothesized, the two smartphone interventions, unlike the control, improved cognitive flexibility; as assessed on the Intradimensional-Extradimensional Set Shifting task (a sensitive marker of cognitive flexibility). The two interventions, unlike the control, also improved OCD symptoms (measured with the Obsessive-Compulsive Inventory-Revised and Yale-Brown Obsessive-Compulsive Scale). Finally, we found high levels of adherence to the interventions. These findings have significant clinical implications for OCD.

Cognitive Training Using a Novel Memory Game on an iPad in Patients with Amnestic Mild Cognitive Impairment (aMCI).

Background: Cognitive training is effective in patients with mild cognitive impairment but does not typically address the motivational deficits associated with older populations with memory difficulties. Methods: We conducted a randomized controlled trial of cognitive training using a novel memory game on an iPad in 42 patients with a diagnosis of amnestic mild cognitive impairment assigned to either the cognitive training (n=21; 8 hours of gameplay over 4 weeks) or control (n=21; clinic visits as usual) groups. Results: Significant time-by-pattern-by-group interactions were found for cognitive performance in terms of the number of errors made and trials needed on the Cambridge Neuropsychological Test Automated Battery Paired Associates Learning task (P=.044; P=.027). Significant time-by-group interactions were also found for the Cambridge Neuropsychological Test Automated Battery Paired Associates Learning first trial memory score (P=.002), Mini-Mental State Examination (P=.036), the Brief Visuospatial Memory Test (P=.032), and the Apathy Evaluation Scale (P=.026). Within-group comparisons revealed highly specific effects of cognitive training on episodic memory. The cognitive training group maintained high levels of enjoyment and motivation to continue after each hour of gameplay, with self-confidence and self-rated memory ability improving over time. Conclusions: Episodic memory robustly improved in the cognitive training group. "Gamified" cognitive training may also enhance visuospatial abilities in patients with amnestic mild cognitive impairment. Gamification maximizes engagement with cognitive training by increasing motivation and could complement pharmacological treatments for amnestic mild cognitive impairment and mild Alzheimer's disease. Larger, more controlled trials are needed to replicate and extend these findings.

The impact of neuroscience on society: cognitive enhancement in neuropsychiatric disorders and in healthy people.

In addition to causing distress and disability to the individual, neuropsychiatric disorders are also extremely expensive to society and governments. These disorders are both common and debilitating and impact on cognition, functionality and wellbeing. Cognitive enhancing drugs, such as cholinesterase inhibitors and methylphenidate, are used to treat cognitive dysfunction in Alzheimer's disease and attention deficit hyperactivity disorder, respectively. Other cognitive enhancers include specific computerized cognitive training and devices. An example of a novel form of cognitive enhancement using the technological advancement of a game on an iPad that also acts to increase motivation is presented. Cognitive enhancing drugs, such as methylphenidate and modafinil, which were developed as treatments, are increasingly being used by healthy people. Modafinil not only affects 'cold' cognition, but also improves 'hot' cognition, such as emotion recognition and task-related motivation. The lifestyle use of 'smart drugs' raises both safety concerns as well as ethical issues, including coercion and increasing disparity in society. As a society, we need to consider which forms of cognitive enhancement (e.g. pharmacological, exercise, lifelong learning) are acceptable and for which groups (e.g. military, doctors) under what conditions (e.g. war, shift work) and by what methods we would wish to improve and flourish.