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

Abstract 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.