Does Internal Preoccupation with Obsessive-Compulsive Themes Affect Externally Oriented Functioning in OCD?: Behavioral Results and Clinical Cases

Individuals with obsessive-compulsive disorder (OCD) exhibit nonspecific deficits in executive function. Internal preoccupations with obsessive-compulsive themes (OCs) may prevent individuals with OCD from fully engaging in externally oriented tasks, explaining these deficits - an executive overload model of OCD. This study reports data from 43 individuals with OCD and 54 healthy individuals collected using the revised Attention Network Test (ANT-R) that is consistent with predictions of the executive overload model. During ANT-R, externally orienting cues enhanced individual readiness to respond to external stimuli (alerting benefits), but alerting benefits were negatively associated with severity of internal preoccupations (e.g., neutralizing and obsessing symptoms). Alerting cues improved efficacy of conflict processing (executive benefits), more in individuals with OCD than in healthy controls. These executive benefits correlated positively with the severity of contamination. Internal preoccupation with OCs could also contribute to poor engagement with exposure and response prevention (ERP) exercises and, consequently, might explain the limited efficacy of ERP-based interventions in some patients. This study describes two clinical cases to illustrate how personalized externally orienting cues may augment ERP exercises to improve patients engagement in therapeutic interventions. The study concludes with discussion of broader implications of the results and with new hypotheses for future investigations. HighlightsO_LIInternal preoccupations negatively impact executive function in OCD. C_LIO_LIExternally orienting cues improve readiness to respond to external stimuli in OCD. C_LIO_LIExternally orienting cues improve efficacy of conflict processing in OCD. C_LIO_LIEffects of externally orienting cues vary across obsessive-compulsive themes. C_LIO_LIEfficacy of ERP could be improved by augmenting with externally orienting cues. C_LI