Interventions targeting impaired cognitive flexibility in patients with obsessive-compulsive disorder - a review of clinical trials
Abstract
Introduction: Obsessive-compulsive disorder (OCD) is a chronic neuropsychiatric disorder with heterogeneous symptoms of obsessive thoughts and compulsive behaviour. Compulsive behaviour, which is characterised by maladaptive patterns of repetitive, inflexible cognition and behaviour, indicates a lack of cognitive flexibility in OCD patients.
Consistent with this clinical observation, many studies show abnormalities in cognitive flexibility in OCD patients at both behavioral and neurobiological levels. Cognitive flexibility, in brief, is the ability to change one's behavior based on external conditions and thus adapt it to one's needs and those of the environment.
The aim of this review is to map studies that address the effectiveness of interventions targeting cognitive flexibility in patients with OCD. Method: A systematic search of the PubMed database was performed according to pre-selected keywords for the literature review.
Clinical and randomized clinical trials focusing on an intervention targeting cognitive flexibility were used. Results: The findings of the reviewed studies are consistent in terms of impaired cognitive flexibility in OCD patients, but inconsistent with regard to the effectiveness of the interventions used.
While some studies report an improvement in cognitive flexibility in OCD patients after the applied intervention (especially in the case of methods using procedures directly targeting cognitive functions), other studies do not find the expected change in measured cognitive flexibility. Moreover, the comparability of findings is severely limited, particularly with regard to the variability of the methods used to assess cognitive flexibility, but also with regard to the often small number of participants tested.
Conclusion: Cognitive flexibility is impaired in OCD patients. Its improvement could lead to increased quality of life, but interventions directly targeting cognitive flexibility seem to be more preferable.
However, validated methods directly assessing this cognitive ability should be used to evaluate the effectiveness of these therapeutic interventions in future studies.