Shifting to task-switching: re-evaluating cognitive flexibility in bulimia nervosa

Sophie Rose Abber

doi:10.17918/00000685

Though cognitive behavioral therapy (CBT) is moderately effective for the treatment of bulimia nervosa (BN), many patients continue to persistently engage in dietary restraint and compensatory behaviors after treatment. One explanation for this rigid persistence is an underlying impairment in cognitive flexibility (i.e., the ability to adapt behavior in response to the environment). Despite strong theoretical support for cognitive flexibility deficits in BN, prior findings have been mixed, most likely resulting from a combination of three factors: (1) a mismatch between construct and measurement; (2) insufficient accounting for potential confounding variables; and (3) the possibility that cognitive flexibility deficits are constrained to disorder-specific stimuli. Thus, the present study aimed to re-evaluate cognitive flexibility in BN by using a paradigm which can effectively isolate cognitive flexibility (i.e., a task-switching paradigm), accounting for confounding variables, and developing a novel food-specific cognitive flexibility measure. In Phase I, we developed and validated a novel food-specific task-switching paradigm in an undergraduate sample (N = 50). In Phase II, we compared BN (N = 28) and healthy control (HC; N = 39) performance on a general and food-specific task-switching paradigm, with the aims of assessing: 1) whether BN has poorer cognitive flexibility than HC in terms of switch costs (i.e., impaired ability to switch between tasks), mix costs (i.e., impaired performance on the same task after a switch), and switching between healthy and unhealthy food stimuli on the food-specific task; 2) whether BN has poorer food-specific versus general cognitive flexibility; and 3) whether self-reported behavioral flexibility mediates the relationship between BN status and cognitive flexibility. Findings did not support the presence of cognitive flexibility deficits in BN, but did tentatively support other neurocognitive impairments (e.g., goal maintenance, attention) though these effects were reduced when accounting for other, potentially confounding psychiatric disorders. While participants with BN performed more poorly than HC on the general and food-specific paradigms, this difference in performance was not attributable to increased switch costs, mix costs, or impaired switching between healthy and unhealthy food stimuli. Furthermore, BN did not perform more poorly on the food-specific versus general task. Findings also did not support the hypothesis that behavioral flexibility mediates the relationship between BN status and cognitive flexibility. Potential explanations for poor BN performance on task-switching paradigms in the absence of cognitive flexibility deficits and ideas for future iterations of the food-specific task-switching paradigm are discussed.

Shifting to task-switching: re-evaluating cognitive flexibility in bulimia nervosa

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Shifting to task-switching: re-evaluating cognitive flexibility in bulimia nervosa

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