Neurostimulation to improve cognitive flexibility

Cognitive flexibility, the capacity to adapt behaviors in response to changing environments, is impaired across mental illnesses, including depression, anxiety, addiction, and obsessive–compulsive disorder. Cortico-striatal-cortical circuits are integral to cognition and goal-directed behavior, and disruptions in these circuits are linked to cognitive inflexibility in mental illnesses. We review evidence that neurostimulation of these circuits can improve cognitive flexibility and ameliorate symptoms and that this may be a mechanism of action of current clinical therapies. Furthermore, we discuss how animal models can offer insights into the mechanisms underlying cognitive flexibility and effects of neurostimulation. We review research from animal studies that may, if translated, yield better approaches to modulating flexibility. Future research should focus on refining definitions of cognitive flexibility, improving detection of impaired flexibility, and developing new methods for optimizing neurostimulation parameters. This could enhance neurostimulation therapies through more personalized treatments that leverage cognitive flexibility to improve patient outcomes.