Risk judgment in Obsessive–Compulsive Disorder: Testing a dual-systems account Gideon Goldin a,n , Mascha van ‘t Wout a , Steven A. Sloman a , David W. Evans b , Benjamin D. Greenberg c,d , Steven A. Rasmussen c,d a Department of Cognitive, Linguistic & Psychological Sciences, Brown University, Box 1821,190 Thayer St., Providence, RI 02912, USA b Program in Neuroscience, Bucknell University, 315 O'Leary, Lewisburg, PA 17837, USA c Department of Psychiatry and Human Behavior, Brown University, Box G-BH, Providence, RI 02912, USA d Alpert Medical School, Brown University, Box G-A1, Providence, RI 02912, USA article info Article history: Received 5 September 2012 Received in revised form 15 April 2013 Accepted 8 August 2013 Available online 20 August 2013 Keywords: Obsessive–Compulsive Disorder Dual-systems theory Risk perception Probability judgment abstract Dual-systems theorists posit distinct modes of reasoning. The intuition system reasons automatically and its processes are unavailable to conscious introspection. The deliberation system reasons effortfully while its processes recruit working memory. The current paper extends the application of such theories to the study of Obsessive–Compulsive Disorder (OCD). Patients with OCD often retain insight into their irrationality, implying dissociable systems of thought: intuition produces obsessions and fears that deliberation observes and attempts (vainly) to inhibit. To test the notion that dual-systems theory can adequately describe OCD, we obtained speeded and unspeeded risk judgments from OCD patients and non-anxious controls in order to quantify the differential effects of intuitive and deliberative reasoning. As predicted, patients deemed negative events to be more likely than controls. Patients also took more time in producing judgments than controls. Furthermore, when forced to respond quickly patients' judgments were more affected than controls'. Although patients did attenuate judgments when given additional time, their estimates never reached the levels of controls’. We infer from these data that patients have genuine difficulty inhibiting their intuitive cognitive system. Our dual-systems perspective is compatible with current theories of the disorder. Similar behavioral tests may prove helpful in better understanding related anxiety disorders. & 2013 Elsevier Inc. All rights reserved. 1. Introduction Most patients suffering from Obsessive–Compulsive Disorder (OCD) maintain some level of insight into the fact that their thoughts or behaviors are unreasonable or irrational 1 (Foa & Kozak, 1995); and insight itself has traditionally served as a criterion in clinical diagnosis. Patients exhibiting this trait tend to hold simultaneous, contradictory beliefs. One belief is intuitive; it can be grounded in affective reactions like fear. This sort of belief is often implicated in OCD. The other type of belief is based on a relatively dispassionate appraisal of the world, whereby patients are able to form more thoughtful assessments. Indeed, the simultaneous presence of these beliefs is a hallmark of dual- systems theory (Epstein, 1994; Evans, 2008; Evans & Over, 1996; Sloman, 1996; Stanovich & West, 2000), wherein intuition—which is fast, automatic, and inaccessible to conscious introspection—and deliberation—which is slow, effortful, and reliant on working memory—are distinct systems of the mind. During reasoning, intuition relies on similarity and contiguity to make inferences; when evaluating risk, this can lead to systematic biases as people neglect more analytic bases for judgment (Darlow & Sloman, 2010). Deliberation, on the other hand, uses rules (such as rules of logic) and is therefore more likely to result in responses that are justifiable and attuned to reality. We explored the hypothesis that a dysfunction in the otherwise healthy cooperation of these systems explains extreme risk-sensi- tivity in OCD. In particular, we expected OCD patients to face greater difficulty in suppressing intuitive responses than controls. To test this, we varied the ability of patients and controls to inhibit intuition by manipulating the presence of time–pressure. When faced with time–pressure, we anticipated that patients—like controls—would respond based on intuitive processing, but that patients alone would provide severely inflated judgments of risk. When given additional time, we predicted these same patients to invoke their deliberative Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/jocrd Journal of Obsessive-Compulsive and Related Disorders 2211-3649/$ - see front matter & 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jocrd.2013.08.002 n Corresponding author. Tel.: þ1 401 863 9951; fax: þ1 401 863 2255. E-mail addresses: Gideon_Goldin@Brown.edu (G. Goldin), mascha_vant_wout@brown.edu (M.v.‘. Wout), steven_sloman@brown.edu (S.A. Sloman), dwevans@bucknell.edu (D.W. Evans), bgreenberg@butler.org (B.D. Greenberg), srasmussen@butler.org (S.A. Rasmussen). 1 Although OCD has traditionally been associated with good insight, some studies have suggested that the degree of insight is actually graded (Eisen et al., 2001). Journal of Obsessive-Compulsive and Related Disorders 2 (2013) 406–411