Cognitive Load and Attentional Control in Puerto Ricans with Obsessive-Compulsive Disorder

Carga cognitiva y control atencional en puertorriqueños con trastorno obsesivocompulsivo

Contenido principal del artículo

Stephanie Santiago-Mejias
Karen G. Martinez
Frances Centeno
Carlos Sellas

Background: The executive control of attention involves problem solving and voluntary action and has been implicated in emotion regulation. Some researchers have reported that attentional control is impaired in individuals with obsessive-compulsive disorder (OCD). However, influence of cognitive load and distraction on task performance has not been considered, which may have an impact on the control of attention. In this study, we evaluated if low and high cognitive load influences attentional control in individuals with OCD, compared to healthy controls.Methods: A total of 41 Puerto Rican adults participated in the study, 15 with OCD (M=31.60, SD=10.70) and 26 healthy controls (M=28.42, SD=10.73). A psychological evaluation was completed using structured interviews and self-reports. The Attention Network Test and a cognitive load task were performed to assess attentional control. Results: No significant differences in alerting, orienting, and attentional control scores were observed between groups on both cognitive load conditions (p>0.05). A significant difference was only observed in the attentional control of OCD (z= -1.99, p=0.047) and healthy participants (z= -2.83, p=0.005) between low and high cognitive load. Conclusions: OCD and healthy participants experienced decreased interference from distractors under high cognitive load, suggesting increased attentional control during this condition. It is possible that increasing cognitive load can reduce distraction in OCD and healthy Puerto Ricans. Considering load may facilitate cognitive training for the control of attention and increase cognitive flexibility, enhancing treatment response.

Palabras clave


Los datos de descargas todavía no están disponibles.

Detalles del artículo


Abe, Y., Sakai, Y., Nishida, S., Nakamae, T., Yamada, K., Fukui, K., & Narumoto, J. (2015).

Hyper-influence of the orbitofrontal cortex over the ventral striatum in obsessive compulsive disorder. European Neuropsychopharmacology, 25(11), 1898-1905.

Abramovitch, A., & Cooperman, A. (2015). The cognitive neuropsychology of obsessive-compulsive disorder: A critical review. Journal of Obsessive-Compulsive and Related Disorders, 5, 24-36.

Abramovitch, A., Mittelman, A., Tankersley, A. P., Abramowitz, J. S., & Schweiger, A. (2015). Neuropsychological investigations in obsessive–compulsive disorder: A systematic review of methodological challenges. Psychiatry Research, 228(1), 112-120.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Amir, N., Najmi, S., & Morrison, A. S. (2009). Attenuation of attention bias in obsessive–compulsive disorder. Behaviour Research and Therapy, 47(2), 153-157.

Andrés-Perpiñá, S., Lázaro-García, L., Canalda-Salhi, G., & Boget-Llucia, T. (2002). Aspectos neuropsicológicos del trastorno obsesivo compulsivo. Revista de Neurología, 35(10), 959-963.

Armstrong, T., Zald, D. H., & Olatunji, B. O. (2011). Attentional control in OCD and GAD: Specificity and associations with core cognitive symptoms. Behaviour Research and Therapy, 49(11), 756-762.

Aydin, P. C., Koybasi, G. P., Sert, E., Mete, L., & Oyekcin, D. G. (2014). Executive functions and memory in autogenous and reactive subtype of obsessive-compulsive disorder patients. Comprehensive Psychiatry, 55(4), 904-911.

Bechara, A. (2000). Emotion, Decision Making and the Orbitofrontal Cortex. Cerebral Cortex, 10(3), 295-307.

Beck, A. T., Epstein, N., Brown, G., & Steer, R. (1988). Beck Anxiety Inventory. PsycTESTS Dataset.

Behzadpoor, S., Sohrabi, F., & Borjali, A. (2016). The role of attentional control and resilience in predicting the rumination in patients with obsessive-compulsive disorder. Zahedan Journal of Research in Medical Sciences, 18(3).

Berggren, N., & Derakshan, N. (2013). Attentional control deficits in trait anxiety: Why you see them and why you don’t. Biological Psychology, 92, 440-446.

Berggren, N., Richards, A., Taylor, J., & Derakshan, N. (2013). Affective attention under cognitive load: Reduced emotional biases but emergent anxiety-related costs to inhibitory control. Frontiers in Human Neuroscience,7.

Beucke, J. C., Sepulcre, J., Talukdar, T., Linnman, C., Zschenderlein, K., Endrass, T., Kaufmann, C., Kathmann, N. (2013). Abnormally high degree connectivity of the orbitofrontal cortex in obsessive-compulsive disorder. JAMA Psychiatry, 70(6), 619.

Bishop, S. J. (2008). Neural mechanisms underlying selective attention to threat. Annals of the New York Academy of Sciences, 1129(1), 141-152.

Canino, G. J., Bird, H.R., Shrout, P.E., Rubio-Stipec, M., Bravo, M., Martinez, R., Sesman, M., & Guevara, L.M. (1987). The Prevalence of specific psychiatric disorders in Puerto Rico. Archives of General Psychiatry, 44(8), 727.

Canino, G., Shrout, P.E., NeMoyer, A., Vila, D., Santiago, K.M., Garcia, P., Quiñones, A., Cruz, V., & Alegria, M. (2019). A comparison of the prevalence of psychiatric disorders in Puerto Rico with the United States and the Puerto Rican population of the United States. Social Psychiatry and Psychiatric Epidemiology, 54(3):369-378.

Cintron, J., Carter, M., & Sbrocco, T. (2006). Ataques de nervios in relation to anxiety sensitivity among island Puerto Ricans. Culture Medicine and Psychiatry, 29(4): 415-31.

D’Alcante, C.C., Diniz, J.B., Fossaluza, V., Batistuzzo, M.C., Lopes, A.C., Shavitt, R.G., Deckersbach, T., Malloy-Diniz, L., Miguel, E.C., & Hoexter, M.Q. (2012). Neuropsychological predictors of response to randomized treatment in obsessive-compulsive disorder. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 39(2): 310-317.

Derryberry, D., & Reed, M. A. (2002). Anxiety-related attentional biases and their regulation by attentional control. Journal of Abnormal Psychology,111(2), 225-236.

Dittrich, W. H., & Johansen, T. (2013). Cognitive deficits of executive functions and decision-making in obsessive-compulsive disorder. Scandinavian Journal of Psychology, 54(5), 393-400.

Eisen, J. L., Mancebo, M. A., Pinto, A., Coles, M. E., Pagano, M. E., Stout, R., & Rasmussen, S. A. (2006). Impact of obsessive-compulsive disorder on quality of life. Comprehensive Psychiatry, 47(4), 270-275.

Engstrom, J., Markkula, G., Victor, T., & Merat, N. (2017). Effects of cognitive load on driving performance: The cognitive control hypothesis. Human Factors, 59(5), 734-764.

Eysenck, M. W., & Calvo, M. G. (1992). Anxiety and Performance: The Processing Efficiency Theory. Cognition & Emotion, 6(6), 409-434.

Eysenck, M. W., Derakshan, N., Santos, R., & Calvo, M. G. (2007). Anxiety and cognitive performance: Attentional control theory. Emotion, 7(2), 336-353.

Fan, J., McCandliss, B. D., Sommer, T., Raz, A., & Posner, M. I. (2002). Testing the efficiency and independence of attentional networks. Journal of Cognitive Neuroscience, 14(3), 340-347.

Fan, J., Gu, X., Guise, K. G., Liu, X., Fossella, J., Wang, H., & Posner, M. I. (2009). Testing the behavioral interaction and integration of attentional networks. Brain and Cognition, 70(2): 209-220.

Fenske, J.N., & Pettersen, K. (2015). Obsessive-Compulsive Disorder: Diagnosis and Management. American Family Physician, 92(10), 896-903. Retrieved from

First, MB., Spitzer, RL., Gibbon, M., & Williams, J. B.W.: Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition. (SCID-I/P) New York: Biometrics Research, New York State Psychiatric Institute, 2002.

Foa, E. B., Huppert, J. D., Leiberg, S., Langner, R., Kichic, R., Hajcak, G., & Salkovskis, P. M. (2002). The Obsessive-Complusive Inventory: Development and validation of a short version. Psychological Assessment,14(4), 485-495.

Fox, E., Dutton, K., Yates, A., Georgiou, G. A., & Mouchlianitis, E. (2015). Attentional control and suppressing negative thought intrusions in pathological worry. Clinical Psychological Science: A Journal of the Association for Psychological Science, 3(4), 593–606.

Friedlander, L., & Desrocher, M. (2006). Neuroimaging studies of obsessive–compulsive disorder in adults and children. Clinical Psychology Review,26(1), 32-49.

Fungueirino, M.T., Fernandez-Prieto, M., Carvalho, S., Leite, J., Carracedo, A., & Goncalves, O.F. (2020). Executive impairments in obsessive-compulsive disorder: A systematic review with emotional and non-emotional paradigms. Psicothema, 32(1): 24-32.

Geller, D.A., McGuire, J.F., Orr, S.P., Small, B.J., Murphy, T.K., Trainor, K., Porth, R., Wilhelm, S., & Storch, E.A. (2019). Fear extinction learning as a predictor of response to cognitive behavioral therapy for pediatric obsessive compulsive disorder. Journal of Anxiety Disorders, 64: 1-8.

Goncalves, O.F., Carvalho, S., Leite, J., Fernandes-Goncalves, A., Carracedo, A., Sampaio, A. (2016). Cognitive and emotional impairments in obsessive-compulsive disorder. Evidence from functional brain alterations. Porto Biomedical Journal, 1(3): 92-105.

Goodman, W. K. (1989). The Yale-Brown Obsessive Compulsive Scale. Archives of General Psychiatry, 46(11), 1006.

Grassi, G., Pallanti, S., Righi, L., Figee, M., Mantione, M., Denys, D., Piccagliani, D., Rossi, A., & Stratta, P. (2015). Think twice: Impulsivity and decision making in obsessive–compulsive disorder. Journal of Behavioral Addictions, 4(4), 263-272.

Greisberg, S., & Mckay, D. (2003). Neuropsychology of obsessive-compulsive disorder: A review and treatment implications. Clinical Psychology Review,23(1), 95-117.

Gruner, P., & Pittenger, C. (2017). Cognitive inflexibility in obsessive-compulsive disorder. Neuroscience, 345, 243–255. Retrieved from

Guzick, A.G., Cooke, D., Gage, N., & McNamara, J. (2018). CBT-Plus: A meta-analysis of cognitive behavioral therapy augmentation strategies for obsessive-compulsive disorder. Journal of Obsessive-Compulsive and Related Disorders, 19: 6-14.

Haber, S. N., & Heilbronner, S. R. (2013). Translational Research in OCD: Circuitry and Mechanisms. Neuropsychopharmacology, 38(1), 252-253.

Hernández-Sampieri, Fernández-Collado, & Baptista-Lucio. (2010). Metodología de la investigación. (Ed. 5). México, DF: McGraw Hill.

Hinton, D., Chong, R., Pollack, M., David, B., & McNally, R. (2008). Ataque de nervios:

Relationship to anxiety sensitivity and dissociation predisposition. Depression and Anxiety,

(6): 489-495.

Hybel, K.A., Mortensen, E.L., Lambek, R., Hojgaard, D.R.M.A., Thomsen, P.H. (2017). Executive

function predicts cognitive-behavioral therapy response in childhood obsessive-compulsive

disorder. Behaviour Research and Therapy, 99:11-18.

International OCD Foundation. (2018). What is OCD? Retrieved from

Jonnal, A. H., Gardner, C. O., Prescott, C. A., & Kendler, K. S. (2000). Obsessive and compulsive symptoms in a general population sample of female twins. American Journal of Medical Genetics, 96(6), 791-796.;2-c

Judah, M. R., Grant, D. M., Lechner, W. V., & Mills, A. C. (2013). Working memory load moderates late attentional bias in social anxiety. Cognition & Emotion, 27(3), 502-511.

Kashyap, H., Reddy, P., Mandadi, S., & Narayanaswamy, J. (2019). Cognitive training for neurocognitive and functional impairments in obsessive-compulsive disorder: A case report.

Lavie, N., & Dalton, P. (2014). Load theory of attention and cognitive control. In A. C. Nobre & S. Kastner (Eds.), Oxford library of psychology. The Oxford handbook of attention (p. 56–75). Oxford University Press.

Lavie, N., Hirst, A., Fockert, J. W., & Viding, E. (2004). Load theory of selective attention and cognitive control. Journal of Experimental Psychology: General, 133(3), 339-354.

Luo, X., Zhang, L., & Wang, J. (2017). The benefits of working memory capacity on attentional control under pressure. Frontiers in Psychology, 8: 1-15.

MacNamara, A., & Proudfit, G. H. (2014). Cognitive load and emotional processing in generalized anxiety disorder: Electrocortical evidence for increased distractibility. Journal of Abnormal Psychology, 123(3), 557-565.

Manjula, M., & Sudhir, P.M. (2019). New-wave behavioral therapies in obsessive-compulsive disorder: Moving toward integrated behavioral therapies. Indian Journal of Psychiatry, 61(1):S104-S113.

Menzies, L., Chamberlain, S. R., Laird, A. R., Thelen, S. M., Sahakian, B. J., & Bullmore, E. T. (2008). Integrating evidence from neuroimaging and neuropsychological studies of obsessive-compulsive disorder: The orbitofronto-striatal model revisited. Neuroscience & Biobehavioral Reviews,32(3), 525-549.

Millet, B., Dondaine, T., Reymann, J., Bourguignon, A., Naudet, F., Jaafari, N., . . . Jeune, F. L. (2013). Obsessive compulsive disorder networks: Positron Emission Tomography and neuropsychology provide new insights. PLoS ONE, 8(1).

Milliery, M., Bouvard, M., & Cottraux, J. (2000). Sustained attention in patients with obsessive-compulsive disorder: A controlled study. Psychiatry Research, 96(3): 199-209.

Moradi, M., Fata, L., Abhari, AA., & Abbasi, I. (2014). Comparing attentional control and intrusive thoughts in obsessive-compulsive disorder, generalized anxiety disorder and non clinical population. Iranian Journal of Psychiatry, 9(2), 69-75. Retrieved from

Murphy, G., Groeger, J. A., & Greene, C. M. (2016). Twenty years of load theory—Where are we now, and where should we go next? Psychonomic Bulletin & Review, 23(5), 1316-1340.

Najmi, S., Amir, N., Frosio, K. E., & Ayers, C. (2015). The effects of cognitive load on attention control in subclinical anxiety and generalised anxiety disorder. Cognition and Emotion, 29(7), 1210-1223.

Nakao, T., Okada, K., & Kanba, S. (2014). Neurobiological model of obsessive-compulsive disorder: Evidence from recent neuropsychological and neuroimaging findings. Psychiatry and Clinical Neurosciences, 68(8).

National Institute of Mental Health. (2019, October). Obsessive-Compulsive Disorder.

Nestadt, G., Grados, M., & Samuels, J. F. (2010). Genetics of Obsessive-Compulsive Disorder. Psychiatric Clinics of North America, 33(1), 141-158.

Nicolini, H., Salin-Pascual, R., Cabrera, B., & Lanzagorta, N. (2017). Influence of culture in obsessive-compulsive disorder and its treatment. Current Psychiatry Reviews, 13, 285-292.

Nogueira, B.L., de Jesus-Mari, J., & Razzouk, D. (2015). Culture-bound syndromes in Spanish speaking Latin America: The case of nervios, susto, and ataques de nervios. Archives of Clinical Psychiatry, 42(6): 171-8.

Novy, D. M., Stanley, M. A., Averill, P., & Daza, P. (2001). Psychometric comparability of English- and Spanish-language measures of anxiety and related affective symptoms. Psychological Assessment, 13(3), 347-355.

Ociskova, M., Prasko, J., Cerna, M., Jelenova, D., Kamaradova, D., Latalova, K., & Sedlackova, Z. (2013). Obsessive compulsive disorder and stigmatization. Activitas Nervosa Superior Rediviva, 55(1-2), 19-26. Retrieved from

Paas, F. G., Merriënboer, J. J., & Adam, J. J. (1994). Measurement of cognitive load in instructional research. Perceptual and Motor Skills, 79(1), 419-430.

Paas, F., Tuovinen, J. E., Tabbers, H., & Gerven, P. W. (2003). Cognitive load measurement as a means to advance cognitive load theory. Educational Psychologist, 38(1), 63-71.

Pacheco-Unguetti, A., Acosta, A., Lupiáñez, J., Román, N., & Derakshan, N. (2012). Response inhibition and attentional control in anxiety. Quarterly Journal of Experimental Psychology, 65(4), 646-660.

Pallanti, S., Grassi, G., Sarrecchia, E. D., Cantisani, A., & Pellegrini, M. (2011). Obsessive–compulsive disorder comorbidity: Clinical assessment and therapeutic implications. Frontiers in Psychiatry, 2.

Park, H., Choe, Y., Na, Y., Nam, K. (2011). The changes in performance during cognitive load inducing tasks. In: Park, J.J., Yang, L.T., Lee, C. (Eds). Communications in Computer and Information Science, 185, 348-351.

Pauls, D. L., Abramovitch, A., Rauch, S. L., & Geller, D. A. (2014). Obsessive–compulsive disorder: An integrative genetic and neurobiological perspective. Nature Reviews Neuroscience, 15(6), 410-424.

Redick, T.S., & Engle, R.W. (2006). Working memory capacity and attention network test performance. Applied Cognitive Psychology, 20(5): 713-721.

Rossouw, P. (2012). The neurobiological roots of obsessive-compulsive disorder – Implications for treatment. Neuropsychotherapy, 2-6. Retrieved from

Ruscio, A. M., Stein, D. J., Chiu, W. T., & Kessler, R. C. (2010). The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Molecular Psychiatry, 15(1), 53-63.

SanMiguel, I., Corral, M.J., & Escera, C. (2008). When loading working memory reduces distraction: Behavioral and electrophysiological evidence from an auditory-visual distraction paradigm. Journal of Cognitive Neurosciences, 20(7): 1131-1145.

Santiago-Mejias, S., Lopez-Valentin, C.M., Gonzalez-Barrios, P., & Martinez, K. (2019). Evaluating the impact of ataques de nervios on cognitive functioning in Puerto Ricans with anxiety disorders: A pilot study. Puerto Rican Journal of Psychology, 30(2): 210-221. Retrieved from

Stefanopoulou, E., Hirsch, C.R., Hayes, S., Adlam, A., & Coker, S. (2014). Are attentional control resources reduced by worry in generalized anxiety disorder? Journal of Abnormal Psychology, 123(2), 330-335.

vanDillen, L.F., Heslenfeld, D.J., & Koole, S.L. (2009). Tuning down the emotional brain: An fMRI study of the effects of cognitive load on the processing of affective images. NeuroImage. 45(4). 1212-9.

Vega-Dienstmaier, JM., Sal Y Rosas, HJ., Mazzotti Suárez, G., Vidal, H., Guimas, B., Adrianzén, C., & Vivar, R. (2002). [Validation of a version in Spanish of the Yale-Brown Obsessive-Compulsive Scale]. Actas Españolas de Psiquiatría, 30(1), 30-35.

Vytal, K. E., Cornwell, B. R., Letkiewicz, A. M., Arkin, N. E., & Grillon, C. (2013). The complex interaction between anxiety and cognition: Insight from spatial and verbal working memory. Frontiers in Human Neuroscience, 7.

Weissman, M. M. (1998). Cross-National Epidemiology of Obsessive-Compulsive Disorder. CNS Spectrums, 3(S1), 6-9.

Wetterneck, C. T., Little, T. E., Rinehart, K. L., Cervantes, M. E., Hyde, E., & Williams, M. (2012). Latinos with obsessive-compulsive disorder: Mental healthcare utilization and inclusion in clinical trials. Journal of Obsessive-Compulsive and Related Disorders, 1(2), 85-97.

Williams, M. & Steever, A. (2015). Cultural manifestations of obsessive-compulsive disorder. In Lack, C.W. (Ed.), Obsessive-Compulsive Disorder: Etiology, Phenomenology, and Treatment. (pp. 63-84). Onus Books.

Williams, M., Powers, M., Yun, Y., & Foa, E. (2010). Minority participation in randomized controlled trials for obsessive–compulsive disorder. Journal of Anxiety Disorders, 24(2), 171-177.

Wilson, R. (2016). Stopping the noise in your head: The new way to overcome anxiety and worry. Healthy Communications Inc.

Wood, J., & Ahmari, S. E. (2015). A framework for understanding the emerging role of corticolimbic-ventral striatal networks in OCD-associated repetitive behaviors. Frontiers in Systems Neuroscience, 9.