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PeerJ. 2016 Apr 18;4:e1934. doi: 10.7717/peerj.1934. eCollection 2016.

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

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Department of Psychology, Stockholm University, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
Department of Psychology, Stockholm University , Stockholm , Sweden.
Department of Behavioural Sciences and Learning, Linköping University , Linköping , Sweden.
NeuroVux Clinic, Norrbotten County Council , Luleå , Sweden.
Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden; Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
Department of Neuroscience, Uppsala University , Uppsala , Sweden.
Department of Clinical Psychology and Psychotherapy, University of Bern , Bern , Switzerland.


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.


Internet; Perseveration; Prediction; Psychotherapy; Wisconsin Card Sorting Test

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