title: Discontinuous patterns of brain activation in the psychotherapy process of obsessive-compulsive disorder: converging results from repeated FMRI and daily self-reports.
abstract: This study investigates neuronal activation patterns during the psychotherapeutic process, assuming that change dynamics undergo critical instabilities and discontinuous transitions. An internet-based system was used to collect daily self-assessments during inpatient therapies. A dynamic complexity measure was applied to the resulting time series. Critical phases of the change process were indicated by the maxima of the varying complexity. Repeated functional magnetic resonance imaging (fMRI) measurements were conducted over the course of the therapy. The study was realized with 9 patients suffering from obsessive-compulsive disorder (subtype: washing/contamination fear) and 9 matched healthy controls. For symptom-provocative stimulation individualized pictures from patients' personal environments were used. The neuronal responses to these disease-specific pictures were compared to the responses during standardized disgust-provoking and neutral pictures. Considerably larger neuronal changes in therapy-relevant brain areas (cingulate cortex/supplementary motor cortex, bilateral dorsolateral prefrontal cortex, bilateral insula, bilateral parietal cortex, cuneus) were observed during critical phases (order transitions), as compared to non-critical phases, and also compared to healthy controls. The data indicate that non-stationary changes play a crucial role in the psychotherapeutic process supporting self-organization and complexity models of therapeutic change.
authors: Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University, Christian Doppler University Hospital, Salzburg, Austria.
authors: Günter
authors: G
authors: Schiepek
authors: Igor
authors: I
authors: Tominschek
authors: Stephan
authors: S
authors: Heinzel
authors: Martin
authors: M
authors: Aigner
authors: Markus
authors: M
authors: Dold
authors: Annemarie
authors: A
authors: Unger
authors: Gerhard
authors: G
authors: Lenz
authors: Christian
authors: C
authors: Windischberger
authors: Ewald
authors: E
authors: Moser
authors: Martin
authors: M
authors: Plöderl
authors: Jürgen
authors: J
authors: Lutz
authors: Thomas
authors: T
authors: Meindl
authors: Michael
authors: M
authors: Zaudig
authors: Oliver
authors: O
authors: Pogarell
authors: Susanne
authors: S
authors: Karch
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002540:Cerebral Cortex / Q000503:physiopathology*; D015928:Cognitive Behavioral Therapy; D005260:Female; D059907:Functional Neuroimaging; D006801:Humans; D007171:Implosive Therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000503:physiopathology / Q000628:therapy*; D011613:Psychotherapy; D057566:Self Report; D016896:Treatment Outcome; D055815:Young Adult
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