Rigidly Applied Rules? Revisiting Inflexibility in Obsessive Compulsive Disorder Using Multilevel Meta-Analysis

Abstract

Several recent models of obsessive compulsive disorder (OCD) consider it to be a neurocognitive disorder involving inflexibility and disinhibition. Indeed, previous reviews of neuropsychological functioning in OCD suggested impaired performance in flexibility tasks. The current meta-analysis examines whether the reported differences in flexibility can be explained by general underperformance unrelated to flexibility. In addition, the role of feedback processing in inflexibility is investigated. To this end, we integrated evidence from 75 studies that compared patients with OCD with nonpsychiatric controls on at least one flexibility measure, while applying a novel approach in which task scores measuring flexibility were compared with control scores from the same tasks measuring other confounding processes. The results revealed no evidence for inflexibility in OCD, with patients’ performance most parsimoniously explained by nonspecific factors. These results challenge models stressing inflexibility as an endophenotype of OCD. Methodological implications for reviewing cognitive deficits in psychopathology are discussed.

Dysfunction between dorsal caudate and salience network associated with impaired cognitive flexibility in obsessive-compulsive disorder: A resting-state fMRI study

“…Therefore, it has been criticized for its non-specificity (Meiran et al, 2011). Moreover, a recent meta-analysis revealed a possibility that previous neuropsychological findings were not adequate to infer specific cognitive flexibility (Fradkin et al, 2018). In consideration of the difficulty of measuring cognitive flexibility, future work using the many types of cognitive functions that compose cognitive flexibility is needed.…”

Modeling a multidimensional model of memory performance in obsessive-compulsive disorder: A multilevel meta-analytic review.

“…The EBL taxonomy creates a set of multidimensional and interrelated moderators, which poses a challenge for traditional two-level models of meta-analysis (e.g., dependence between effect sizes). As such the present review utilises a three-level approach (for review see Cheung, 2014), recently used in the OCD literature by Fradkin, Strauss, Pereg, and Huppert (2018). This approach offers us three main methodological advantages of specific relevance to the present review.…”

“…We provide detailed information on the analysis for the present study in the methods section. As noted, comparing effect sizes of tasks within the same domain with tasks completed by the same participants provides the analysis with greater sensitivity to identify specific deficits (Fradkin, et al, 2018). Second, Fradkin and colleagues highlighted why a meta-analysis of the proposed EBL taxonomy is possible as they noted that cognitive tasks "often include a complex set of scores and outcomes, and these complex structures are often difficult to integrate in quantitative and qualitative reviews" (p. 497).…”

The application of meta-analytic (multi-level) models with multiple random effects: A systematic review

“…Four-level models were typically applied to treat additional sources of dependencies within outcomes, such as dependency among comparisons between several treatment groups (e.g., Krieger, 2010;Lehtonen, Soveri, Laine, Järvenpää, de Bruin & Antfolk, 2018;Schoenfeld, Ogborn, & Krieger, 2015) or dependency of effect sizes across sub-scores and tasks (Fradkin, Strauss, Pereg, & Huppert, 2018), and to treat dependency across studies. For instance, studies could be grouped within higher-level clusters such as culture (e.g., Kende, Phalet, Van den Noortgate, Kara, & Fischer, 2017), laboratory (e.g., Martineau, Ouellet, Kebreab, & Lapierre, 2016) or sub-region (e.g., De Noordhout et al, 2014).…”