Kognitive Selbstaufmerksamkeit und neuropsychologische Leistungsdefizite bei Zwangserkrankungen

Neuropsychological functioning has been widely investigated in obsessivecompulsive disorder (OCD). One of the most consistently reported findings is an impairment in visual-spatial functioning, while verbal memory seems to be particularly reduced in tasks requiring that the learning material be semantically clustered for successful encoding so that demands on organizational capacity are high. Results concerning selective attention deficits are also rather mixed; there are both studies showing that people suffering from OCD have problems focussing their attention on relevant information while ignoring irrelevant one and studies that did not demonstrate such deficits. In addition, individuals suffering from OCD are characterized by a high need to focus on their thoughts and cognitive processes. It remains unclear whether this elevated level of cognitive self-consciousness acts as an underlying mechanism of these cognitive deficits. Hence, the aim of this publicationbased dissertation was to check for the presence of this causal relationship in OCD and to investigate whether cognitive self-consciousness and other maladaptive cognitive styles are associated with selective attention deficits. The first study dealt with the question whether experimentally heightened cognitive self-consciousness leads to poorer visual memory performance in OCD. For assessing visual memory, OCD participants and healthy controls were instructed to copy three variants of a complex geometric figure and to redraw it from memory after three minutes under three experimental conditions: in the first experimental condition the participants were asked to copy the complex figure and to simultaneously pay attention to upcoming thoughts, whereas in the second experimental condition they were asked to simultaneously focus on acoustic stimuli. In the third experimental condition no parallel task was presented. OCD participants reproduced fewer details of the figures when they had to simultaneously pay attention to upcoming thoughts or acoustic stimuli during copying of the figures in comparison to when no parallel task was presented. In the healthy control group, visual memory performance was only reduced when participants focused on acoustic stimuli during copying of the figures. The second study used the same experimental design to investigate the role of cognitive self-consciousness as a putative underlying mechanism of verbal memory deficits. To find out if this effect is specific for OCD or whether it can also be found in other mental disorders, individuals suffering from major depression were also investigated. Verbal memory performance was assessed with the California Verbal Learning Test in which participants are presented several times with a list of words that have to be reproduced later on. Independent of group membership, participants remembered fewer words when they were asked to pay attention to upcoming thoughts and acoustic stimuli during encoding of the material. Drop of memory performance was equally pronounced in all three groups. The third study investigated how dispositional cognitive self-consciousness and other maladaptive cognitive styles are related to selective attention performance in OCD. The ability to focus attention on relevant information while ignoring irrelevant one was assessed using the d2 test of attention. First, OCD participants were found to be impaired in selective attention in comparison to the healthy controls. Further it was demonstrated that age, intelligence and years in school taken together significantly predicted performance in selective attention in OCD. The predictive power of the regression model improved when cognitive self-consciousness, the tendency to ruminate and the tendency to worry were also used as predictor variables while the introduction of indicators of severity of OCD had no such effect. In summary, results confirm the assumption that high levels of cognitive selfconsciousness lead to reduced visual and verbal memory performance in OCD. Just as in case of a external secondary task like paying attention to acoustic stimuli, cognitive self-consciousness requires a high amount of cognitive resources which are then no longer available for the memory tasks. At least in case of verbal memory, this effect is not specific for OCD but seems to be a general mechanism that affects people regardless of their clinical status. Moreover, results support the assumption that cognitive self-consciousness and other maladaptive cognitive styles play an important role in the understanding of selective attention deficits in OCD. Due to the correlational nature of the present findings, it remains unclear if this is also a causal relationship.