Measuring Cognitive Flexibility in Chinese Individuals with Obsessive-Compulsive Disorder: Psychometric Validation...

Impaired cognitive flexibility is a core feature of obsessive-compulsive disorder (OCD) and may contribute to symptom persistence and variabe therapeutic outcomes. However, traditional measures may adequately capture how cognitive flexibility manifests in daily life. The Flexibility in Daily Life scale (FIDL) is a novel developed self-report instrument assessing multidimensional facets of cognitive flexibility. The present study sought to determine the psychometric structure of the Chinese version of the FIDL and its suitability for individuals within an OCD population.

The 37-item FIDL underwent forward-back translation and cross-cultural adaptation. The baseline comprised 157 participants (76 individuals with OCD and 81 healthy controls), with an OCD subsample(N=54) completing a one-month retest. Confirmatory factor analysis (CFA) initially evaluated the established 21-item five-factor model in the full sample. Alternative structures (one-, two-, and correlated three-factor models) were also examined. Given suboptimal model fit indices, exploratory factor analysis (EFA) was subsequently performed in the OCD sample (N=76) to derive a structure more representative of clinical characteristics. Finally, Bayesian exploratory factor analysis (BEFA) was applied to ascertain factor stability.

The established 21-item five-factor model demonstrated suboptimal fit in the Chinese OCD sample (N=157; CFI=0.791, TLI=0.822, RMSEA=0.087, SRMR=0.082). EFA identified a revised 25-item three-factor structure, labeled Contextual Adaptability, Cognitive-Behavioral Rigidity, and Routine/Control, which was corroborated by BEFA. The revised scale exhibited satisfactory internal consistency (Cronbach's α=0.699-0.838; McDonald's ω=0.721-0.846) and acceptable test-retest reliability (r=0.777-0.844). The three-factor model failed to demonstrate adequate fit (χ²/df = 2.095, CFI = 0.708, TLI = 0.678, RMSEA = 0.121, SRMR = 0.146), and BEFA further revealed excessive inter-factor overlap, with correlations ranging from 0.969 to 0.987.

The findings provide preliminary evidence that the Chinese FIDL may capture clinically relevant aspects of daily-life cognitive flexibility in OCD populations. The revised three-factor structure offers a potential framework for assessing specific inflexibility profiles and identifying potential intervention targets, including contextual adjustment difficulties, rigid cognitive-behavioral responding, and over-reliance on routine/control. These findings underscore the importance of considering clinical and cultural context when evaluating cognitive flexibility constructs. However, given the exploratory design, limited sample size, and excessive inter-factor overlap, further validation in larger, independent cohorts is warranted.