Predicting response to cognitive behavioral therapy in contamination-based obsessive-compulsive disorder from functional magnetic resonance imaging.
BACKGROUND
Although cognitive behavioral therapy (CBT) is an effective treatment for obsessive-compulsive disorder (OCD), few reliable predictors of treatment outcome have been identified. The present study examined the neural correlates of symptom improvement with CBT among OCD patients with predominantly contamination obsessions and washing compulsions, the most common OCD symptom dimension.


METHODS
Participants consisted of 12 OCD patients who underwent symptom provocation with contamination-related images during functional magnetic resonance imaging (fMRI) scanning prior to 12 weeks of CBT.


RESULTS
Patterns of brain activity during symptom provocation were correlated with a decrease on the Yale-Brown Obsessive Compulsive Scale (YBOCS) after treatment, even when controlling for baseline scores on the YBOCS and the Beck Depression Inventory (BDI) and improvement on the BDI during treatment. Specifically, activation in brain regions involved in emotional processing, such as the anterior temporal pole and amygdala, was most strongly associated with better treatment response. By contrast, activity in areas involved in emotion regulation, such as the dorsolateral prefrontal cortex, correlated negatively with treatment response mainly in the later stages within each block of exposure during symptom provocation.


CONCLUSIONS
Successful recruitment of limbic regions during exposure to threat cues in patients with contamination-based OCD may facilitate a better response to CBT, whereas excessive activation of dorsolateral prefrontal regions involved in cognitive control may hinder response to treatment. The theoretical implications of the findings and their potential relevance to personalized care approaches are discussed.
Department of Psychology and Psychiatry,Vanderbilt University,Nashville, TN,USA.
B O
BO
Olatunji
Institute of Psychiatry,Federal University of Rio de Janeiro,Brazil.
R
R
Ferreira-Garcia
MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences,Cardiff University,UK.
X
X
Caseras
Departments of Psychology and Psychosis Studies, Institute of Psychiatry,King's College London,UK.
M A
MA
Fullana
Department of Psychological Medicine, Institute of Psychiatry,King's College London,UK.
S
S
Wooderson
Department of Primary and Community Care,Radboud University Nijmegen Medical Centre,Nijmegen,The Netherlands.
A
A
Speckens
School of Psychology,University of Exeter,UK.
N
N
Lawrence
Department of Neuroimaging, Institute of Psychiatry,King's College London,UK.
V
V
Giampietro
Department of Neuroimaging, Institute of Psychiatry,King's College London,UK.
M J
MJ
Brammer
Department of Psychiatry,University of Pittsburgh School of Medicine,Pittsburgh, PA,USA.
M L
ML
Phillips
Institute of Psychiatry,Federal University of Rio de Janeiro,Brazil.
L F
LF
Fontenelle
Departments of Psychology and Psychosis Studies, Institute of Psychiatry,King's College London,UK.
D
D
Mataix-Cols
D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008032:Limbic System / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000503:physiopathology* / Q000628:therapy*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D017397:Prefrontal Cortex / Q000503:physiopathology*; D055815:Young Adult