ReviewCognitive inflexibility in Obsessive-Compulsive Disorder
Section snippets
Cognitive inflexibility in OCD: face validity and conceptual challenges
Obsessive-Compulsive Disorder (OCD) is characterized by maladaptive patterns of repetitive, inflexible cognition and behavior. Clinically, individuals with OCD have difficulty shifting between mental processes to generate adaptive behavioral responses, especially in the context of their symptoms. In keeping with this, many neurocognitive studies suggest abnormalities in cognitive flexibility in individuals with OCD (e.g. Remijnse et al., 2006, Chamberlain et al., 2007, Chamberlain et al., 2008,
Cognitive inflexibility in OCD: attentional set shifting
Attentional set shifting is the “ability to switch attention from one aspect of a stimulus to another in an ongoing task, in accordance with changing reinforcement contingencies” (Chamberlain et al., 2005). Efficient set shifting is a core aspect of cognitive flexibility (Dajani and Uddin, 2015). There are several different types of set shifting, which appear to be associated with distinct neural substrates. These are generally defined within the context of simple discrimination tasks in which
Cognitive inflexibility in OCD: reversal learning
Reversal learning also requires shifting from one stimulus to another based on feedback. In this case, however, shifts relate to entire composite stimuli, rather than to individual stimulus attributes. Reversal learning occurs when a stimulus that was previously neutral becomes salient, or when a stimulus that was previously rewarded becomes neutral. Reversal-specific learning is associated with activation of the lateral orbitofrontal cortex (OFC) (Ghahremani et al., 2010). Neurobiological
Cognitive inflexibility in OCD: alternation tasks
In Object Alternation (OAT) and Delayed Alternation (DAT) tasks, shifts are performed on every trial. In the OAT, optimal performance requires selecting a different stimulus on every trial – that is, avoiding repeatedly selecting the same stimulus. The DAT is similar except that optimal performance requires alternation between targets at different points in space.
Patients with OCD have been found to have deficits in the OAT and DAT, with some consistency, though effect sizes have varied across
Cognitive inflexibility in OCD: cued task switching
Task switching is another core aspect of cognitive flexibility (Dajani and Uddin, 2015). It describes situations in which subjects must change strategy based on an explicit instruction or cue, rather than inferring changed contingencies from the pattern of reward receipt. Task-switching paradigms (Braver et al., 2003, Gu et al., 2008, Remijnse et al., 2013) typically include both task-repeat and task-switch trials; the number of consistent trials presented before a signaled task switch can be
Cognitive inflexibility in OCD: inhibition of cognitive and motor prepotent responses
Another category of measures often examined when assessing cognitive flexibility, typified by the Stroop Color Word Test (CWT), more specifically tests the inhibition of prepotent responses. Whether or not inhibition is a core component of cognitive flexibility is the subject of some disagreement in the literature; but a failure to inhibit prepotent responses can clearly lead to inflexible behavior. Importantly, responses can become prepotent in a variety of ways; extended repetition during
Cognitive flexibility in OCD: updating
Updating is the constant monitoring and rapid addition/deletion of working memory contents (Miyake et al., 2000, Miyake and Friedman, 2012). The ability to successfully update working memory is thought to be a key component of cognitive flexibility (Dajani and Uddin, 2015). The ability to acquire new information and manipulate it in real time is critical to adjusting one’s behavior to meet the demands of a changing environment. Updating can be measured through tests such as the n-back. In this
Habit, action, and model-based versus model-free learning
Dual-system theories posit that actions and choices may be supported by either a goal-oriented or a habitual system (Balleine and Dickinson, 1998). Recent computational literature draws a similar distinction between model-based and model-free strategies for action selection (Daw et al., 2011). Goal-oriented, model based choice permits flexibility but requires substantial cognitive resources. Habitual or model-free behavior is more efficient in familiar situations, in which past experience
The paradox of broad executive function deficits in OCD
The specificity of the findings summarized above has been questioned. In particular, three meta-analyses of cognitive function in OCD describe deficits of moderate effect size across almost all domains of EF, including planning, verbal fluency, visuospatial function, and motor speed (Abramovitch et al., 2013, Shin et al., 2013, Snyder et al., 2015). (Verbal working memory may be relatively spared; Snyder et al., 2015). This raises the question of whether deficits in cognitive inflexibility are
Sources of impaired performance in tests of cognitive flexibility
Implicit in the above discussion is the realization that there are multiple possible sources of impaired performance in behavioral tasks that purport to measure cognitive flexibility. Careful consideration of these different sources of variation, and exclusion of them when possible, will facilitate more precise characterization of the nature of cognitive abnormalities in patients.
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First, there may be a true group difference in the cognitive ability that a behavioral task is seeking to probe.
Conclusions
OCD is characterized by maladaptive patterns of repetitive, inflexible cognition and behavior that suggest a lack of cognitive flexibility. In keeping with this, many neurocognitive studies of individuals with OCD suggest behavioral and/or neurobiological abnormalities in cognitive flexibility (Remijnse et al., 2006, Chamberlain et al., 2007, Chamberlain et al., 2008, Gu et al., 2008, Viswanath et al., 2009). Meta-analytic reviews of neuropsychological functioning in OCD, as well as clinical
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