Cognitive retraining for organizational impairment in obsessive–compulsive disorder
Introduction
Obsessive–compulsive disorder (OCD) is characterized by recurrent obsessions and compulsions that cause marked distress and/or interfere with daily functioning (American Psychiatric Association, 1994). Despite effective pharmacologic and behavioral treatments, the course of OCD is often chronic with symptoms waxing and waning over time (Rasmussen and Eisen, 1990).
Neuropsychological studies of OCD have identified abnormalities in a variety of cognitive domains DSM-IV-Inpatient, including impairments in selective attention and visuospatial skills (e.g., Otto, 1992, Tallis, 1995, Alarcon et al., 1994), cognitive inhibition (e.g., Enright, 1996), and difficulties in executive functioning, such as goal setting or set-shifting (Christensen et al., 1992, Boone et al., 1991). One of the most consistently reported neuropsychological impairments in OCD is impairment in learning and episodic memory (Savage, 1998, Head et al., 1989), specifically the ability to encode and explicitly recollect information encountered in a previous study episode (e.g., Graf and Schacter, 1985). For an event to be remembered, it must be encoded, stored and consolidated over time, and then retrieved from storage (Kapur et al., 1996). Encoding refers to the processes that convert a perceived event into an enduring cognitive representation. Meaningful organization of information during encoding is known to enhance recollection. For example, verbal learning benefits from grouping items into semantic categories, or imposing a subjective structure on a set of words (Tulving, 1962). Likewise, organizing complex visuo-spatial information into meaningful perceptual units during encoding has been shown to enhance subsequent free recall from memory (Waber and Holmes, 1986, Shorr et al., 1992, Savage et al., 1999, Savage et al., 2000).
We have conducted a series of studies (Deckersbach et al., 2000, Mataix-Cols et al., 2003, Savage et al., 1999, Savage et al., 2000) that investigated the characteristics of memory impairment in individuals with OCD using the Rey–Osterrieth Complex Figure Test (Osterrieth, 1944) and the California Verbal Learning Test (CVLT; Delis et al., 1987). We found that OCD patients' impairment in learning new information was attributable to difficulties in organizing verbal and nonverbal information during encoding, whereas their ability to retain information once learned was preserved. For example, Deckersbach et al. (2000) and Savage et al., 1999, Savage et al., 2000 found that when asked to copy a complex geometric figure, OCD subjects, unlike healthy control subjects, did not organize the figure with respect to meaningful organizational units (e.g., a large rectangle, diagonals) while copying the figure. This accounted for subsequent difficulties redrawing the figure from memory (Deckersbach et al., 2000, Savage et al., 1999, Savage et al., 2000). These findings have recently been replicated and extended by other groups (Shin et al., 2004, Peñades et al., 2005). Similar results have been obtained in OCD using verbal information. For example, when asked to learn a list of shopping items, individuals with OCD have difficulties reorganizing the items into their respective categories (e.g., fruit, spices and herbs). This mediated subsequent difficulties recalling the words after a 20-min delay (Deckersbach et al., 2000, Savage et al., 2000).
The purpose of the present study was to determine whether impairment in organizational abilities in OCD can be remediated by a specific training procedure that aims to teach effective organizational strategies. Specifically, we investigated the effect of brief organizational training on strategy use and memory in individuals with OCD and matched healthy control subjects.
Section snippets
Subjects
Study subjects were 35 patients with DSM-IV OCD (17 females) and 36 healthy control subjects (22 females). Diagnostic status of patients and healthy control subjects was determined using the Structured Clinical Interview for DSM-IV-Inpatient Version (SCID-I/P; First et al., 1995). All subjects were right-handed, as determined by the Edinburgh Handedness Inventory (Oldfield, 1971). For OCD patients, comorbid diagnoses included panic disorder (n = 10), social phobia (n = 5), generalized anxiety
Results
Scores for copy organization, copy accuracy and recall for OCD and control subjects for the Training and Non-training groups are shown in Table 1.
Discussion
The purpose of the study was to investigate in individuals with OCD whether impairments in organization of information during encoding can be remediated using a training procedure designed to teach effective organizational skills. Our results indicate that subjects in the training condition (both OCD and control groups) improved more in organizational skills than subjects in the non-training condition. This indicated that the training was an effective means of improving organizational skills.
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