Deficits of and Training-induced Changes in Neurocognitive Adaptivity in Patients with Obsessive-compulsive Disorder

Obsessive-compulsive disorder (OCD) is associated with severe impairment and suffering and significant economic burden. Cognitive-behavioural therapy has established as an effective treatment. However, about 50% of OCD patients discontinue treatment prematurely or do not sufficiently profit from treatment. Therefore, there is a substantial need for additional augmentative therapy strategies. OCD patients often exhibit deficits in executive functions, especially in working memory and performance monitoring. Furthermore, the extent of executive dysfunction at baseline has been found to influence therapy outcome. Deficits in executive functions in OCD are characterized by reduced neurocognitive adaptivity, which is associated with altered neuronal activation patterns. In comparison to healthy control participants, OCD patients show stronger activity of task-relevant brain structures at comparably low difficulty levels. Opposed to this, reduced activity and impaired performance were observed for higher difficulty levels in OCD patients. The central aim of the present research project is to further characterize reduced neurocognitive adaptivity in OCD by using difficulty-modulated working memory and performance monitoring tasks. Additionally it will be tested, whether neurocognitive adaptivity can be improved in OCD through a specific cognitive training. The project allows to investigate the training-induced plasticity of neurocognitive processes in OCD for the first time. Specific cognitive training is expected to increase neurocognitive adaptivity of executive functions in OCD patients. Furthermore, some theoretical accounts, as the endophenotype concept, assume that deficits in performance monitoring and working memory play a causal role in generating OCD symptoms. Hence, the present project tests whether training-induced increase of neurocognitive adaptivity in OCD leads to reduction in OCD symptoms. Taken together, the present project will contribute to a better understanding of neurocognitive factors contributing to OCD and will yield information for the development of additional augmentative therapeutic strategies.