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Frontostriatal activation in patients with obsessive–compulsive disorder before and after cognitive behavioral therapy

Published online by Cambridge University Press:  18 March 2010

T. Freyer ,
S. Klöppel ,
O. Tüscher ,
A. Kordon ,
B. Zurowski ,
A.-K. Kuelz ,
O. Speck ,
V. Glauche  and
U. Voderholzer
T. Freyer
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center, Albert-Ludwigs-University Freiburg, Germany
S. Klöppel
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center, Albert-Ludwigs-University Freiburg, Germany
O. Tüscher
Affiliation:
Department of Neurology, University Medical Center, Albert-Ludwigs-University Freiburg, Germany
A. Kordon
Affiliation:
Department of Psychiatry and Psychotherapy, University of Luebeck, Germany
B. Zurowski
Affiliation:
Department of Psychiatry and Psychotherapy, University of Luebeck, Germany
A.-K. Kuelz
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center, Albert-Ludwigs-University Freiburg, Germany
O. Speck
Affiliation:
Department of Biomedical Magnetic Resonance, Institute for Experimental Physics, Otto-von-Guericke-University Magdeburg, Germany
V. Glauche
Affiliation:
Department of Neurology, University Medical Center, Albert-Ludwigs-University Freiburg, Germany
U. Voderholzer*
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center, Albert-Ludwigs-University Freiburg, Germany Medical-Psychosomatic Hospital Roseneck, Prien, Germany
*
*Address for correspondence: Professor U. Voderholzer, M.D., Medical-Psychosomatic Clinic, Roseneck, Germany. (Email: ulrich.voderholzer@uniklinik-freiburg.de)
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Abstract

Background

Cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) is the psychotherapeutic treatment of choice for obsessive–compulsive disorder (OCD). However, little is known about the impact of CBT on frontostriatal dysfunctioning, known to be the neuronal correlate of OCD.

Method

A probabilistic reversal learning (RL) task probing adaptive strategy switching capabilities was used in 10 unmedicated patients with OCD and 10 healthy controls during an event-related functional magnetic resonance imaging (fMRI) experiment. Patients were scanned before and after intensive CBT, controls twice at comparable intervals.

Results

Strategy change within the RL task involved activity in a broad frontal network in patients and controls. No significant differences between the groups or in group by time interactions were detected in a whole-brain analysis corrected for multiple comparisons. However, a reanalysis with a more lenient threshold revealed decreased responsiveness of the orbitofrontal cortex and right putamen during strategy change before treatment in patients compared with healthy subjects. A group by time effect was found in the caudate nucleus, demonstrating increased activity for patients over the course of time. Patients with greater clinical improvement, reflected by greater reductions in Yale–Brown Obsessive Compulsive Scale (YBOCS) scores, showed more stable activation in the pallidum.

Conclusions

Although these findings are preliminary and need to be replicated in larger samples, they indicate a possible influence of psychotherapy on brain activity in core regions that have been shown to be directly involved both in acquisition of behavioral rules and stereotypes and in the pathophysiology of OCD, the caudate nucleus and the pallidum.

Keywords

Cognitive behavioral therapyfrontostriatal dysfunctionfunctional brain imagingobsessive–compulsive disorder
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 1 , January 2011 , pp. 207 - 216
Copyright
Copyright © Cambridge University Press 2010

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