Cognitive Science
Understanding Cognitive Flexibility in Trauma Recovery 

Understanding Cognitive Flexibility in Trauma Recovery 

Adaptation and Thriving in a Dynamic Environment: Cognitive Flexibility

Cognitive flexibility involves selectively switching between appropriate behavioral responses relevant to environmental changes. Therefore, this mechanism allows individuals to efficiently disengage from previous tasks, reorganize their responses, and integrate them into new tasks. A greater degree of cognitive flexibility is correlated with enhanced reading skills in childhood, creativity and an increased resiliency to stress in adulthood, and an overall greater quality of life. The fact remains, however, that it develops over time, and is susceptible to and may be potentially affected by neurodevelopmental disorders, as well as post-traumatic stress disorder (PTSD) (Dajani & Uddin, 2017). 

Cognitive Flexibility and Executive Functioning in PTSD

PTSD is characterized by intrusive memories and flashbacks, emotional numbness, mood changes, difficulty concentrating, and disturbed sleep. Furthermore, it also leads to cognitive impairments such as poor attention, memory, and executive functioning (Popescu et al., 2022). PTSD and these cognitive impairments have the same neurological basis, illustrating that emotional and mental challenges are intertwined. Cognitive flexibility is one of the cognitive attributes characterized by deficits in executive functioning resulting from PTSD. Based on a meta-analysis by Polak and colleagues, cognitive flexibility performance was more pronounced among PTSD patients than trauma-exposed patients without PTSD. Trauma-exposed patients without PTSD showed greater cognitive flexibility due to their coping strategies and resilience. Furthermore, it suggests that PTSD may be associated with impaired cognitive flexibility (Popescu et al., 2022).

Neurocognitive Interventions for PTSD and Cognitive Flexibility

 Another study by Ben-zion et al. (2018) aimed to investigate the relationship between PTSD and cognitive flexibility. They assessed 181 trauma-exposed individuals at three different time points after their trauma exposure: one month, six months, and 14 months following exposure (Ben-zion et al., 2018). The results indicated that individuals who had better cognitive flexibility one month following trauma exposure showed significantly less severe symptoms of PTSD when they were assessed after 13 months. This further indicates that cognitive flexibility may be a significant predictor of PTSD symptom severity (Ben-zion et al., 2018).

Furthermore, this association inspired Ben-zion et al. (2018) to determine whether neurocognitive interventions aiming to improve cognitive flexibility improved PTSD symptoms in individuals with PTSD. They allocated a group of 50 trauma-exposed individuals to 30 days of a web-based neurocognitive intervention, and another group of 47 trauma-exposed individuals to control tasks (Ben-zion et al., 2018). Their results showed that the group that completed the neuro-cognitive task showed significant improvement in their cognitive flexibility, and more importantly lower PTSD symptoms (Ben-zion et al., 2018). These results suggest that interventions targeting the cognitive flexibility of individuals exposed to traumatic events, such as the Beirut blast, may be effective in reducing their PTSD symptoms. 

Implications for Treatment

In conclusion, cognitive flexibility facilitates adaptation to dynamic environments and illustrates influences on PTSD symptoms. As opposed to PTSD patients, those without PTSD had high cognitive flexibility levels. Ben-zion et al. (2018) determined that better cognitive flexibility shortly after trauma exposure was associated with less severe PTSD symptoms over the long run. It is therefore crucial to enhance this mechanism through targeted interventions to promote patient adaptation and improve overall health.

References 

  • Ben-Zion, Z., Fine, N. B., Keynan, N. J., Admon, R., Green, N., Halevi, M., Fonzo, G. A., Achituv, M., Merin, O., Sharon, H., Halpern, P., Liberzon, I., Etkin, A., Hendler, T., & Shalev, A. Y. (2018). Cognitive flexibility predicts PTSD symptoms: Observational and interventional studies. Frontiers in Psychiatry, 9, 477–477. https://doi.org/10.3389/fpsyt.2018.00477 
  • Dajani, D. R., & Uddin, L. Q. (2015). Demystifying cognitive flexibility: Implications for clinical and developmental neuroscience. Trends in Neurosciences (Regular Ed.), 38(9), 571–578. https://doi.org/10.1016/j.tins.2015.07.003
  • Popescu, M., Popescu, E.-A., DeGraba, T. J., & Hughes, J. D. (2023). Cognitive flexibility in post-traumatic stress disorder: Sustained interference associated with altered modulation of cortical oscillatory activity during task-switching. NeuroImage Clinical, 37. https://doi.org/10.1016/j.nicl.2022.103297