Cognitive retraining for organizational impairment in obsessive–compulsive disorder Ulrike Buhlmann a, * , Thilo Deckersbach a , Iris Engelhard b , Laura M. Cook a , Scott L. Rauch a , Norbert Kathmann c , Sabine Wilhelm a , Cary R. Savage d a Department of Psychiatry/OCD Clinic, Massachusetts General Hospital, Harvard Medical School, 185 Cambridge Street, Boston, MA 02114, USA b Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands c Department of Clinical Psychology, Humboldt University of Berlin, Berlin, Germany d Hoglund Brain Imaging Center and Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, Kansas City, KS, USA Received 14 March 2005; received in revised form 26 August 2005; accepted 27 October 2005 Abstract Individuals with obsessive–compulsive disorder (OCD) have difficulties in organizing information during encoding associated with subsequent memory impairments. This study was designed to investigate whether impairments in organization in individuals with OCD can be alleviated with cognitive training. Thirty-five OCD subjects and 36 controls copied and recalled the Rey– Osterrieth Complex Figure Test (RCFT) [Osterrieth, P.A., 1944. Le test de copie d’une figure complexe: Contribution a l’e ´tude de la perception et de la memoire (The test of copying a complex figure: A contribution to the study of perception and memory). Archive de Psychologie 30, 286-350.] before being randomly assigned to a training or non-training condition. The training condition was designed to improve the ability to organize complex visuospatial information in a meaningful way. The intervention phase was followed by another copy and recall trial of the RCFT. Both OCD and control subjects who underwent training improved more in organization and memory than subjects who did not receive organizational training, providing evidence that the training procedure was effective. OCD subjects improved more in organizational during encoding than control subjects, irrespective of whether or not they had received training. This suggests that organization impairment in OCD affects primarily the ability to spontaneously utilize strategies when faced with complex, ambiguous information but that the ability to implement such strategies when provided with additional trials is preserved. These findings support a distinction in OCD between failure to utilize a strategy and incapacity to implement a strategy. D 2005 Elsevier Ireland Ltd. All rights reserved. Keywords: Obsessive–compulsive disorder; Neuropsychology; Nonverbal memory; Organization; Recall; Rey–Osterrieth Complex Figure; Taylor Complex Figure 1. Introduction Obsessive–compulsive disorder (OCD) is character- ized by recurrent obsessions and compulsions that cause marked distress and/or interfere with daily func- tioning (American Psychiatric Association, 1994). Des- 0165-1781/$ - see front matter D 2005 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.psychres.2005.10.012 * Corresponding author. Tel.: +1 617 726 5374; fax: +1 617 643 3080. E-mail address: buhlmann@psych.mgh.harvard.edu (U. Buhlmann). Psychiatry Research 144 (2006) 109 – 116 www.elsevier.com/locate/psychres