Deep brain stimulation (DBS) for treatment-resistant obsessive-compulsive disorder (OCD) produces profound changes beyond symptom reduction, altering patients' entire way of being in the world. Standard psychiatric scales fail to capture these global effects. The authors propose an enactive, affordance-based model describing four aspects of the person-world interaction: the perceived field of affordances (width, depth, and height); self-experience including mood and feelings; the mode of relating to the world; and the existential stance—the second-order evaluation of these changes. This model aims to specify the phenomenological effects of DBS treatment.
This chapter introduces the skilled intentionality framework, a philosophical approach that adds an ecological dimension to 4E cognition (embodied, embedded, enactive, extended). Building on James Gibson's ecological psychology, the framework centers on affordances—opportunities for action in the environment. Skilled intentionality is defined as the selective, simultaneous engagement with multiple affordances in a concrete situation. The framework integrates insights from philosophy, ecological psychology, emotion psychology, and neurodynamics to explain how the situated and affective embodied mind works, particularly in skilled action.