Daily fluctuations in OCD symptoms and metacognition

Mental health symptoms fluctuate substantially over time, along rapid timescales. In obsessive-compulsive disorder (OCD), symptoms are known to fluctuate even within a single day. However, it is unknown what drives these fluctuations. This is a major challenge because knowing when and how symptoms fluctuate is critical for delivering just-in-time interventions and preventing acute mental health crises.

Using a naturalistic at-home study where people with OCD reported their symptoms on a mobile phone app and also completed cognitive tests, I found that lowered confidence (metacognition), both in the self- and during a decision-making game, preceded when OCD symptoms would occur within the timescale of just a few hours!

This indicates the potential for tracing such cognitive fluctuations, which could pave way for delivering interventions to prevent symptoms from worsening when risk is highest.

Relevant publication:

Marzuki, A., Kosina, L., Dome, L., Hewitt, S., & Hauser, T. (2025). Metacognitive antecedents to states of mental ill-health: Drops in confidence precede symptoms of OCD. Research Square. Link