The null effect of stress on cognitive flexibility in individuals with and without alcohol use disorder

Stress is a prominent motivator for drinking. Both stress and addiction are associated with impairments in cognitive flexibility. Preclinical work has explored the effect of stress on cognitive flexibility, but this has not been translated to clinical samples. Therefore, the present study tested whether acute stress decreased cognitive flexibility in individuals with and without AUD. It also explored if individuals with and without AUD recruit similar neurocircuitry during an acute stress provocation.

Sixty-five participants (AUD: N = 34; Control: N = 31) completed the Wisconsin Card Sorting Task at baseline, immediately prior to stress, and immediately following stress. Participants underwent the Montreal Imaging Stress Task during an fMRI scan to induce stress. Repeated measure ANCOVAs assessed the effects of stress, group, and stress X group interactions on ratings of stress and cognitive flexibility outcomes. Whole brain analyses examined group differences in the neural response to stress.

Both groups reported increases in subjective stress following the stress-induction task (p's < 0.04), but there were no stress X group interactions. There were no significant effects of stress, group, or stress X group interactions on cognitive flexibility measures (p's > 0.09). The control group had significantly greater activation in the anterior cingulate cortex during stress compared to individuals with AUD (p = 0.002).

There were no significant effects of acute stress on cognitive flexibility in individuals with or without AUD. However, individuals with AUD had lower anterior cingulate activation during acute stress compared to matched controls, possibly indicating that the control group recruited more top-down processing during stress.