A transdiagnostic framework for neurological intervention in maladaptive repetitive behaviors.

From daily rituals to pathological patterns of behavior and thought, a wide spectrum of habitual behaviors emerges through repeated reinforcement learning and becomes embedded in cortico-basal ganglia circuits. Once established, these behaviors operate automatically and resist conscious control. This review summarizes neurological intervention strategies for correcting pathological habits (e.g., addiction, obsessive-compulsive disorder) and restoring adaptive behavioral patterns. Pharmacological approaches target the plasticity of habit circuits via modulation of dopamine, serotonin, and glutamate systems. Non-invasive brain stimulation techniques-such as repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and deep TMS-can modulate cortical control networks and indirectly influence connected subcortical circuitry. Behavioral interventions include extinction learning, reinforcement of alternative actions, contextual modification, cognitive strategies, and memory reconsolidation-based techniques. Recently, hybrid approaches combining AI-based digital therapeutics (DTx) with neuromodulatory devices have gained attention. Invasive techniques such as optogenetics and deep brain stimulation (DBS) enable direct modulation of specific neural circuits, allowing suppression of habitual responses or facilitation of alternative learning. Beyond clinical applications, these approaches elucidate the neural mechanisms underlying habitual behavior. Modulation of habits is most effective when employing multi-level, combinatorial interventions rather than a single technique. Integrating these strategies, this paper proposes a staged framework-habit circuit suppression → alternative learning → consolidation → sustained management-and a neuroscience-based, personalized model for behavioral treatment with implications for future clinical and research applications.