Dissociating subjective and objective cognitive flexibility in fibromyalgia using a novel partial-contingency reversal learning task

Cognitive dysfunction (“fibrofog”) is a common symptom of fibromyalgia (FM) that includes subjective mental haze and measurable cognitive difficulties. Prior work suggests that subjective complaints may dissociate from objective cognitive performance in FM, yet most studies assessed subjective and objective cognition in separate contexts and timescales. We tested subjective and objective cognitive flexibility within the same behavioral context using a novel partial-contingency probabilistic reversal-learning task.

Specifically, 298 participants (169 FM; 129 healthy controls [HC]) completed an acquisition phase followed by a reversal phase, in which reward contingencies changed for one stimulus pair while remaining stable for another. Objective learning was quantified by choice accuracy, and subjective task knowledge by explicit reward probability estimates after each block. HC outperformed FM participants on objective choice accuracy while subjective reward-probability estimates showed differential patterns between groups.

Furthermore, while in HC objective accuracy and subjective estimates were positively correlated, no such association emerged in FM, suggesting altered coupling between behavioral adaptation and explicit contingency awareness. Depressive symptoms and overall FM impact did not moderate the relationship between objective and subjective indices in FM. Together, findings reveal reduced cognitive flexibility and partial dissociation between objective learning processes and subjective representations of learned contingencies in FM.

The authors would like to thank Eldad Rubinstein for his valuable assistance with programming the experimental task for this study. This research was supported by the United States - Israel Binational Science Foundation (BSF) (grant number 2022118) awarded to M.L.L, D.H., and R.A. Maggie Gilda and Shir Hanuka have contributed equally to this work.

School of Psychological Sciences, University of Haifa, 199 Aba Khoushy Ave. Mount Carmel, 31905, Haifa, Israel Maggie Gilda, Shir Hanuka, Noa Magal, Eden Eldar, Uri Hertz & Roee Admon Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel Department of Cognitive Sciences, University of Haifa, Haifa, Israel Institute of Information Processing and Decision Making, University of Haifa, Haifa, Israel Departments of Radiology and Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA The Integrated Brain and Behavior Research Center (IBBRC), University of Haifa, Haifa, Israel The authors declare no competing interests.

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