van Passel Boris, Danner Unna N, Dingemans Alexandra E, Broekman Theo G, Sternheim Lot C, Becker Eni S, van Elburg Annemarie A, van Furth Eric F, Hendriks Gert-Jan, Cath Daniëlle C
Overwaal Centre of Expertise for Anxiety Disorders, Obsessive Compulsive Disorder (OCD) and Posttraumatic Stress-Disorder (PTSD), Institution for Integrated Mental Health Care, Pro Persona, Nijmegen, Netherlands.
Behavioural Science Institute, Radboud University, Nijmegen, Netherlands.
Front Psychiatry. 2025 Jan 13;15:1456890. doi: 10.3389/fpsyt.2024.1456890. eCollection 2024.
Obsessive compulsive disorder (OCD) and anorexia nervosa (AN) are conditions associated with poor cognitive flexibility, a factor considered to interfere with treatment, but research into the relationship between cognitive flexibility and treatment outcome is limited. This study explores whether baseline measures of cognitive flexibility predict outcomes in OCD and AN, evaluates whether changes in these measures contribute to treatment outcome, and evaluates the effectiveness of adjunctive cognitive remediation therapy (CRT) in improving cognitive flexibility.
This secondary analysis utilized linear mixed model analysis on data from a randomized controlled multicenter clinical trial involving adult participants with OCD (n=71) AND AN (n=61). Participants underwent 10 twice-weekly sessions of either CRT or a non-specific active control intervention (specialized attention therapy; SAT), followed by treatment as usual. Assessments using Yale-Brown Obsessive Compulsive Scale and the Eating Disorder Examination Questionnaire were conducted at baseline, post-CRT/SAT and at 6 and 12 months. Cognitive flexibility was evaluated through the Trail Making Test (TMT), the Color-Word Interference Test (CWIT) and the Detail and Flexibility Questionnaire (DFlex).
Levels of cognitive flexibility at baseline did not predict or moderate treatment outcome, nor did change in cognitive flexibility (baseline post-CRT/SAT) mediate treatment outcome, with CRT providing no greater improvement in measures of cognitive flexibility than SAT.
This study failed to find any relationship between measures of cognitive flexibility and treatment outcome in OCD and AN, and thus questions hypothetical associations between measures of cognitive flexibility and mechanisms of change in patients with OCD and AN.
强迫症（OCD）和神经性厌食症（AN）与认知灵活性差有关，认知灵活性被认为是干扰治疗的一个因素，但关于认知灵活性与治疗结果之间关系的研究有限。本研究探讨认知灵活性的基线测量是否能预测强迫症和神经性厌食症的治疗结果，评估这些测量指标的变化是否有助于治疗结果，并评估辅助认知康复治疗（CRT）在改善认知灵活性方面的有效性。
这项二次分析对一项随机对照多中心临床试验的数据进行线性混合模型分析，该试验涉及成年强迫症患者（n = 71）和神经性厌食症患者（n = 61）。参与者接受了10次每周两次的CRT或非特异性积极对照干预（专门注意力治疗；SAT），然后是常规治疗。在基线、CRT/SAT后以及6个月和12个月时，使用耶鲁-布朗强迫症量表和饮食失调检查问卷进行评估。通过连线测验（TMT）、色词干扰测验（CWIT）和细节与灵活性问卷（DFlex）评估认知灵活性。
基线时的认知灵活性水平既不能预测也不能调节治疗结果，认知灵活性的变化（基线至CRT/SAT后）也不能介导治疗结果，CRT在认知灵活性测量方面的改善并不比SAT更大。
本研究未能发现强迫症和神经性厌食症患者认知灵活性测量与治疗结果之间存在任何关系，因此对认知灵活性测量与强迫症和神经性厌食症患者变化机制之间的假设关联提出了质疑。
