People with obsessive-compulsive disorder (OCD) or an eating disorder, such as anorexia nervosa, can become trapped in persistent thoughts and fixed habits. This thesis investigated whether training in cognitive flexibility – the ability to think differently or adapt one’s behaviour when a situation requires it – can improve treatment. It also examined whether people who are less cognitively flexible benefit less from treatment. The results show that OCD and eating disorders share several similarities, but that not everyone with these conditions is less cognitively flexible. It also emerged that Cognitive Remediation Therapy (CRT), a programme designed to increase cognitive flexibility, was no more effective than the control treatment. Strikingly, people with OCD actually benefited slightly more from the control treatment. This consisted of simple and playful tasks, such as puzzles and games. Although these activities were not specifically designed for OCD, they appear to help people rediscover enjoyment, gain greater confidence in the treatment and be better prepared to begin symptom-focused treatment. Furthermore, it emerged that people with both OCD and an eating disorder, despite having more severe symptoms at the outset, recover just as well in the long term as people with OCD alone. The results show that a treatment tailored to the individual patient is likely to yield better results than a standardised approach applied to everyone.
Boris van Passel is a psychiatrist, cognitive behavioural therapist and medical director with over twenty years’ experience in specialist mental health care. Since 2005, he has been working at TopGGz Overwaal, a centre of expertise for anxiety, obsessive-compulsive and trauma-related disorders. As the clinical coordinator and figurehead of the clinic, whilst working part-time, he plays a key role in the development, implementation and quality assurance of highly specialised treatment programmes and contributes to raising the centre’s profile. In addition, he is medical director at Pro Persona, where his areas of focus include quality of care, network collaboration and the implementation of the Compulsory Mental Health Care Act. He is also active in the training of psychiatrists, psychologists and GPs, and mentors young professionals. In the coming years, Boris intends to remain actively involved in research, with a specific focus on (neurobiological) enhancers for obsessive-compulsive disorder, with a view to further improving treatment outcomes.