Does cognitive flexibility predict treatment gains in Internet-delivered psychological treatment of social anxiety disorder, depression, or tinnitus?

Per Carlbring,Robert Johansson,Vendela Zetterqvist Westin,Stephanie Poysti,Erik Flodman,Thomas Berger,Gerhard Andersson,Philip Lindner,Amanda Hebert,Filip Hagkvist

doi:10.7717/peerj.1934

Abstract

Little is known about the individual factors that predict outcomes in Internet-administered psychological treatments. We hypothesized that greater cognitive flexibility (i.e. the ability to simultaneously consider several concepts and tasks and switch effortlessly between them in response to changes in environmental contingencies) would provide a better foundation for learning and employing the cognitive restructuring techniques taught and exercised in therapy, leading to greater treatment gains. Participants in three trials featuring Internet-administered psychological treatments for depression (n = 36), social anxiety disorder (n = 115) and tinnitus (n = 53) completed the 64-card Wisconsin Card Sorting Test (WCST) prior to treatment. We found no significant associations between perseverative errors on the WCST and treatment gains in any group. We also found low accuracy in the classification of treatment responders. We conclude that lower cognitive flexibility, as captured by perseverative errors on the WCST, should not impede successful outcomes in Internet-delivered psychological treatments.

Highlights

Mounting evidence suggests that Internet-delivered psychological treatment programs based on cognitive behavioral therapy (CBT) (Andersson, 2009; Andersson, 2014) are effective treatments of mood disorders, anxiety disorders, and somatic disorders like tinnitus (Andersson et al, 2013)
Data for the current study was collected as part of three randomized trials: therapistguided CBT for social anxiety disorder (SAD) (Boettcher et al, 2014), psychodynamic treatment for major depressive disorder (MDD) (Johansson et al, 2012) and CBT or Acceptance and Commitment Therapy (ACT) for tinnitus (Hesser et al, 2012), all Internet-delivered
Samples Because the aim of the current study was not to evaluate treatment efficacy, analyses were conducted per protocol: participants classified as treatment dropouts and/or had incomplete post-treatment data were not included in analyses

Summary

Introduction

Mounting evidence suggests that Internet-delivered psychological treatment programs based on cognitive behavioral therapy (CBT) (Andersson, 2009; Andersson, 2014) are effective treatments of mood disorders, anxiety disorders, and somatic disorders like tinnitus (Andersson et al, 2013). The patient is taught to identify negative automatic thoughts, find ways to reality-test these thoughts, and develop novel, more functional ways of interpreting the situation (Johnco, Wuthrich & Rapee, 2014) This conceptual overlap between CF and cognitive restructuring techniques suggests that pre-treatment CF abilities may predict the successful acquisition and use of CF strategies in CBT, leading to greater treatment gains. Emerging findings have implicated abnormal cognitive processes in tinnitus (Andersson & McKenna, 2006), and cognitive restructuring is a key part of CBT treatment of this condition (Hesser et al, 2012) Despite these findings associating CF and mental distress, there is limited research on whether CF predicts psychotherapy outcomes for mental disorders, and the few findings that are available have been mixed (Mohlman & Gorman, 2005; Moritz et al, 2005; D’Alcante et al, 2012). One previous study found an association between cognitive flexibility and cognitive restructuring skill acquisition (Johnco, Wuthrich & Rapee, 2013), while another failed to find such an association (Johnco, Wuthrich & Rapee, 2014)

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