The metacognitive paradox of OCD: confidence is globally reduced but shows increased sensitivity to local evidence

The metacognitive paradox of OCD: confidence is globally reduced but shows increased sensitivity to local evidence | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The metacognitive paradox of OCD: confidence is globally reduced but shows increased sensitivity to local evidence Alisa Loosen, Brian Zaboski, Avalon Moore, Calvin Bohner, Helen Pushkarskaya, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7609740/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Confidence is a critical metacognitive signal that guides performance. Biases in confidence, such as excessive doubt, are hallmark features of mental health disorders, especially obsessive- compulsive disorder (OCD). Yet, the underlying neurocognitive mechanisms and how they link to learning and decision-making remain elusive. We asked patients with OCD and matched healthy controls to perform a novel rule-shifting task incorporating trial-by-trial confidence ratings. Using a Bayes-optimal model, we identified two distinct confidence biases: while patients with OCD indicated lower overall confidence, their trial-by-trial confidence ratings more accurately tracked task-relevant information, rendering their confidence reports more Bayes-optimal than those of controls. These findings challenge the idea of a simple, unified metacognitive impairment in OCD. Instead, they suggest that OCD is linked to an enhanced responsiveness to environmental evidence and feedback during decision-making. Biological sciences/Psychology Biological sciences/Neuroscience/Learning and memory Obsessive-Compulsive Disorder Rule-Shifting Decision Making Learning Metacognition Confidence Cognitive Flexibility Full Text Additional Declarations Yes there is potential Competing Interest. All authors declare no conflicts of interest. TUH consults for limbic ltd and holds shares in the company, which is unrelated to the current project. In the past three years, CP has consulted for Biohaven Pharmaceuticals, Ceruvia Neurosciences, UCB BioPharma, Freedom Biosciences, Transcend Therapeutics, Alco Therapeutics, Lucid/Care, Nobilis Therapeutics, Mind Therapeutics, F-Prime Capital, and Madison Avenue Partners. He holds equity in Alco Therapeutics, Mind Therapeutics, and Lucid/Care. He receives or has received research support from Biohaven Pharmaceuticals, Freedom Biosciences, and Transcend Therapeutics. He receives royalties from Oxford University Press and UpToDate. He has filed patents on pharmacological treatments for OCD and related disorders, psychedelic therapeutics, and autoantibodies in OCD. None of these relationships are of relevance to the work described here. For the past three years, BZ has consulted with Biohaven Pharmaceuticals and received royalties from Oxford University Press. Supplementary Files LoosenEtAlSupplementalInformationMetacognitiveParadoxOfOCD.pdf Supplemental Information for The metacognitive paradox of OCD: confidence is globally reduced but shows increased sensitivity to local evidence Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7609740","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":514697869,"identity":"e287370b-e18b-4afe-941e-ee7ddbb3aeb1","order_by":0,"name":"Alisa Loosen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9ElEQVRIiWNgGAWjYDACdsYGIGkB4XxgYJAB0RJ4tTCDtUDUMM5gYOAhQgsDQg0zDzFa+JuZmz/8YJCQ4+c/fOyxbZsdDz8D88HbPHi0SBxmbJPsYZAwlpyRlm6c25bMI9nAlmyNTwsDUAvQMRKJG27wmEnntjHzGBwAMvBpkT/M2PzxD0jL+fPfpC3b6nnsD/B/w6vF4DBjgzTYlgM5bNKMbYd5DBh42PBqMQQ6TFrGAOwXM8mec8d5JA6zGVvOwaNF7nj7449vKmxAIfZM4kdZtRx/e/PDG2/weR/iPCjNyMYAiymiwR/SlI+CUTAKRsHIAABPbD7Bz/aBPAAAAABJRU5ErkJggg==","orcid":"","institution":"Yale University","correspondingAuthor":true,"prefix":"","firstName":"Alisa","middleName":"","lastName":"Loosen","suffix":""},{"id":514697870,"identity":"c4413813-fcc5-40a3-b11c-4b01fd300c79","order_by":1,"name":"Brian Zaboski","email":"","orcid":"","institution":"Yale University","correspondingAuthor":false,"prefix":"","firstName":"Brian","middleName":"","lastName":"Zaboski","suffix":""},{"id":514697871,"identity":"1500c868-08a3-4ac3-ba0f-44dacccd50e7","order_by":2,"name":"Avalon Moore","email":"","orcid":"","institution":"Yale University","correspondingAuthor":false,"prefix":"","firstName":"Avalon","middleName":"","lastName":"Moore","suffix":""},{"id":514697872,"identity":"141fdc99-e096-4122-9bbb-8c0e1db8a1fa","order_by":3,"name":"Calvin Bohner","email":"","orcid":"","institution":"Quinnipiac University","correspondingAuthor":false,"prefix":"","firstName":"Calvin","middleName":"","lastName":"Bohner","suffix":""},{"id":514697873,"identity":"bc8e6592-a62a-4d3c-9c56-10004fd9d7a8","order_by":4,"name":"Helen Pushkarskaya","email":"","orcid":"","institution":"Yale University","correspondingAuthor":false,"prefix":"","firstName":"Helen","middleName":"","lastName":"Pushkarskaya","suffix":""},{"id":514697874,"identity":"835387e2-9bd3-4f9e-9925-472d834c5672","order_by":5,"name":"Christopher Pittenger","email":"","orcid":"","institution":"Yale University","correspondingAuthor":false,"prefix":"","firstName":"Christopher","middleName":"","lastName":"Pittenger","suffix":""},{"id":514697875,"identity":"9d39a341-8ce8-4357-ac0a-bea785712d55","order_by":6,"name":"Tobias Hauser","email":"","orcid":"https://orcid.org/0000-0002-7997-8137","institution":"University of Tuebingen","correspondingAuthor":false,"prefix":"","firstName":"Tobias","middleName":"","lastName":"Hauser","suffix":""}],"badges":[],"createdAt":"2025-09-14 00:25:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7609740/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7609740/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":92605343,"identity":"e7dde9d1-db0e-4ef8-b8d8-44a5d8b711ca","added_by":"auto","created_at":"2025-10-01 15:01:38","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":756153,"visible":true,"origin":"","legend":"Article File","description":"","filename":"LoosenEtAlMetacognitiveParadoxOfOCD.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7609740/v1_covered_d8a03326-4c2e-4661-997b-ad04120c801a.pdf"},{"id":91398435,"identity":"d5c29e5a-571e-4c60-a90d-8cca4be4039f","added_by":"auto","created_at":"2025-09-16 06:28:32","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":423012,"visible":true,"origin":"","legend":"Supplemental Information for The metacognitive paradox of OCD: confidence is globally reduced but shows increased sensitivity to local evidence","description":"","filename":"LoosenEtAlSupplementalInformationMetacognitiveParadoxOfOCD.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7609740/v1/0aa3ebb35050e2e3a0f84824.pdf"}],"financialInterests":"\u003cb\u003eYes\u003c/b\u003e there is potential Competing Interest.\nAll authors declare no conflicts of interest. TUH consults for limbic ltd and holds shares in\r\nthe company, which is unrelated to the current project. In the past three years, CP has consulted\r\nfor Biohaven Pharmaceuticals, Ceruvia Neurosciences, UCB BioPharma, Freedom Biosciences,\r\nTranscend Therapeutics, Alco Therapeutics, Lucid/Care, Nobilis Therapeutics, Mind Therapeutics,\r\nF-Prime Capital, and Madison Avenue Partners. He holds equity in Alco Therapeutics, Mind\r\nTherapeutics, and Lucid/Care. He receives or has received research support from Biohaven\r\nPharmaceuticals, Freedom Biosciences, and Transcend Therapeutics. He receives royalties from\r\nOxford University Press and UpToDate. He has filed patents on pharmacological treatments for\r\nOCD and related disorders, psychedelic therapeutics, and autoantibodies in OCD. None of these\r\nrelationships are of relevance to the work described here. For the past three years, BZ has consulted\r\nwith Biohaven Pharmaceuticals and received royalties from Oxford University Press.","formattedTitle":"The metacognitive paradox of OCD: confidence is globally reduced but shows increased\r\nsensitivity to local evidence","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Obsessive-Compulsive Disorder, Rule-Shifting, Decision Making, Learning, Metacognition, Confidence, Cognitive Flexibility","lastPublishedDoi":"10.21203/rs.3.rs-7609740/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7609740/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Confidence is a critical metacognitive signal that guides performance. Biases in confidence, such\r\nas excessive doubt, are hallmark features of mental health disorders, especially obsessive-\r\ncompulsive disorder (OCD). Yet, the underlying neurocognitive mechanisms and how they link to\r\nlearning and decision-making remain elusive. We asked patients with OCD and matched healthy\r\ncontrols to perform a novel rule-shifting task incorporating trial-by-trial confidence ratings. Using\r\na Bayes-optimal model, we identified two distinct confidence biases: while patients with OCD\r\nindicated lower overall confidence, their trial-by-trial confidence ratings more accurately tracked\r\ntask-relevant information, rendering their confidence reports more Bayes-optimal than those of\r\ncontrols. These findings challenge the idea of a simple, unified metacognitive impairment in OCD.\r\nInstead, they suggest that OCD is linked to an enhanced responsiveness to environmental evidence\r\nand feedback during decision-making.","manuscriptTitle":"The metacognitive paradox of OCD: confidence is globally reduced but shows increased\nsensitivity to local evidence","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-16 06:28:26","doi":"10.21203/rs.3.rs-7609740/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4a0fa39c-b186-4d01-bc6f-22103ba2e937","owner":[],"postedDate":"September 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":54676260,"name":"Biological sciences/Psychology"},{"id":54676261,"name":"Biological sciences/Neuroscience/Learning and memory"}],"tags":[],"updatedAt":"2025-10-01T14:59:10+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-16 06:28:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7609740","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7609740","identity":"rs-7609740","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}