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Predicting response to cognitive behavioral therapy in contamination-based obsessive–compulsive disorder from functional magnetic resonance imaging

Published online by Cambridge University Press:  12 November 2013

B. O. Olatunji ,
R. Ferreira-Garcia ,
X. Caseras ,
M. A. Fullana ,
S. Wooderson ,
A. Speckens ,
N. Lawrence ,
V. Giampietro ,
M. J. Brammer  and
M. L. Phillips
...Show all authors
B. O. Olatunji*
Affiliation:
Department of Psychology and Psychiatry, Vanderbilt University, Nashville, TN, USA
R. Ferreira-Garcia
Affiliation:
Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
X. Caseras
Affiliation:
MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, UK
M. A. Fullana
Affiliation:
Departments of Psychology and Psychosis Studies, Institute of Psychiatry, King's College London, UK
S. Wooderson
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, King's College London, UK
A. Speckens
Affiliation:
Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
N. Lawrence
Affiliation:
School of Psychology, University of Exeter, UK
V. Giampietro
Affiliation:
Department of Neuroimaging, Institute of Psychiatry, King's College London, UK
M. J. Brammer
Affiliation:
Department of Neuroimaging, Institute of Psychiatry, King's College London, UK
M. L. Phillips
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
L. F. Fontenelle
Affiliation:
Institute of Psychiatry, Federal University of Rio de Janeiro, Brazil
D. Mataix-Cols
Affiliation:
Departments of Psychology and Psychosis Studies, Institute of Psychiatry, King's College London, UK
*
* Address for correspondence: B. O. Olatunji, Ph.D., Associate Professor, Director of Clinical Training, Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN 37203, USA. (Email: olubunmi.o.olatunji@vanderbilt.edu)
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Abstract

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.

Method

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.

Keywords

Cognitive behavioral therapycontaminationfMRIobsessive–compulsive disorderpredictorssymptom dimensionswashing
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 10 , July 2014 , pp. 2125 - 2137
Copyright
Copyright © Cambridge University Press 2013 

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References

Abramowitz, JS, Tolin, DF, Street, GP (2001). Paradoxical effects of thought suppression: a meta-analysis of controlled studies. Clinical Psychology Review 21, 683–703.Google Scholar
Alpers, GW, Sell, R (2008). And yet they correlate: psychophysiological activation predicts self-report outcomes of exposure therapy in claustrophobia. Journal of Anxiety Disorders 22, 1101–1109.Google Scholar
Aupperle, RL, Allard, CB, Grimes, EM, Simmons, AN, Flagan, T, Behrooznia, M, Cissell, SH, Twamley, EW, Thorp, SR, Norman, SB, Paulus, MP, Stein, MB (2012). Dorsolateral prefrontal cortex activation during emotional anticipation and neuropsychological performance in posttraumatic stress disorder. Archives of General Psychiatry 69, 360–371.Google ScholarPubMed
Basoglu, M, Lax, T, Kasvikis, Y, Marks, IM (1988). Predictors of improvement in obsessive-compulsive disorder. Journal of Anxiety Disorders 2, 299–317.CrossRefGoogle Scholar
Beck, AT, Ward, CH, Mendelson, M, Mock, J, Erbaugh, J (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561–571.Google Scholar
Brammer, MJ, Bullmore, ET, Simmons, A, Williams, SC, Grasby, PM, Howard, RJ, Woodruff, PW, Rabe-Hesketh, S (1997). Generic brain activation mapping in functional magnetic resonance imaging: a nonparametric approach. Magnetic Resonance Imaging 15, 763–770.Google Scholar
Breakspear, M, Brammer, MJ, Robinson, PA (2003). Construction of multivariate surrogate sets from nonlinear data using the wavelet transform. Physica D: Nonlinear Phenomena 182, 1–22.CrossRefGoogle Scholar
Brody, AL, Saxena, S, Schwartz, JM, Stoessel, PW, Maidment, K, Phelps, ME, Baxter, LR Jr. (1998). FDG-PET predictors of response to behavioral therapy and pharmacotherapy in obsessive compulsive disorder. Psychiatry Research: Neuroimaging 84, 1–6.Google Scholar
Bullmore, ET, Brammer, MJ, Rabe-Hesketh, S, Curtis, VA, Morris, RG, Williams, SC, Sharma, T, McGuire, PK (1999 a). Methods for the diagnosis and treatment of stimulus correlated motion in generic brain activation studies using fMRI. Human Brain Mapping 7, 38–48.3.0.CO;2-Q>CrossRefGoogle ScholarPubMed
Bullmore, ET, Long, C, Suckling, J, Fadili, J, Calvert, GA, Zelaya, F, Carpenter, TA, Brammer, M (2001). Coloured noise and computational inference in neurophysiological (fMRI) time series analysis: resampling methods in time and wavelet domains. Human Brain Mapping 12, 61–78.Google Scholar
Bullmore, ET, Suckling, J, Overmeyer, S, Rabe-Hesketh, S, Taylor, E, Brammer, MJ (1999 b). Global, voxel and cluster tests, by theory and permutation, for a difference between two groups of structural MR images of the brain. IEEE Transactions on Medical Imaging 18, 32–42.Google Scholar
Caseras, X, Mataix-Cols, D, Trasovares, MV, López-Solà, M, Ortriz, H, Pujol, J, Soriano-Mas, C, Giampietro, V, Brammer, MJ, Torrubia, R (2010). Dynamics of brain responses to phobic-related stimulation in specific phobia subtypes. European Journal of Neuroscience 32, 1414–1422.Google Scholar
Christensen, H, Hadzai-Pavlovic, D, Andrews, G, Mattick, R (1987). Behavior therapy and tricyclic medication in the treatment of obsessive-compulsive disorder: a quantitative review. Journal of Consulting and Clinical Psychology 55, 701–711.Google Scholar
Doehrmann, O, Ghosh, SS, Polli, FE, Reynolds, GO, Horn, F, Keshavan, A, Triantafyllou, C, Saygin, ZM, Whitfield-Gabrieli, S, Hofmann, SG, Pollack, M, Gabrieli, JD (2013). Predicting treatment response in social anxiety disorder from functional magnetic resonance imaging. Archives of General Psychiatry 70, 87–97.Google Scholar
Etkin, A, Egner, T, Kalisch, R (2011). Emotional processing in anterior cingulate and medial prefrontal cortex. Trends in Cognitive Sciences 15, 85–93.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1996). Structured Clinical Interview for DSM-IW Axis I Disorders, Clinician Version (SCID-CV). American Psychiatric Press, Inc.: Washington, DC.Google Scholar
Foa, EB, Goldstein, AJ (1978). Continuous exposure and complete response prevention in the treatment of obsessive compulsive disorder. Behavior Therapy 9, 821–829.Google Scholar
Foa, EB, Kozak, MJ (1986). Emotional processing of fear: exposure to corrective information. Psychological Bulletin 99, 20–35.CrossRefGoogle ScholarPubMed
Foa, EB, McNally, RJ (1996). Mechanisms of change in exposure therapy. In Current Controversies in the Anxiety Disorders (ed. Rapee, R. M.), pp. 329–343. Guilford Press: New York.Google Scholar
Fontenelle, LF, Mendlowicz, MV, Versiani, M (2006). The descriptive epidemiology of obsessive-compulsive disorder. Progress in Neuropsychopharmacology and Biological Psychiatry 30, 327–337.Google Scholar
Fu, CHY, Williams, SCR, Cleare, AJ, Scott, J, Mitterschiffthaler, MT, Walsh, ND, Donaldson, C, Suckling, J, Andrew, C, Steiner, H, Murray, RM (2008). Neural responses to sad facial expressions in major depression following cognitive behavioural therapy. Biological Psychiatry 64, 505–512.Google Scholar
Goldin, PR, Manber Ball, T, Werner, K, Heimberg, RG, Gross, JJ (2009). Neural mechanisms of cognitive reappraisal of negative self beliefs in social anxiety disorder. Biological Psychiatry 66, 1091–1099.CrossRefGoogle ScholarPubMed
Goldin, PR, McRae, K, Ramel, W, Gross, JJ (2008). The neural bases of emotion regulation: reappraisal and suppression of negative emotion. Biological Psychiatry 63, 577–586.Google Scholar
Goodman, WK, Price, LH, Rasmussen, SA, Mazure, C, Delgado, P, Heninger, GR, Charney, DS (1989 a). The Yale-Brown Obsessive Compulsive Scale (Y-BOCS): II. Validity. Archives of General Psychiatry 46, 1012–1016.Google Scholar
Goodman, WK, Price, LH, Rasmussen, SA, Mazure, C, Fleischmann, RL, Hill, CL, Heninger, GR, Charney, DS (1989 b). The Yale-Brown Obsessive Compulsive Scale (Y-BOCS): I. Development, use, and reliability. Archives of General Psychiatry 46, 1006–1011.Google Scholar
Greist, JH, Jefferson, JW, Kobak, KA, Katzelnick, DJ, Serlin, RC (1995). Efficacy and tolerability of serotonin transport inhibitors in obsessive-compulsive disorder. A meta-analysis. Archives of General Psychiatry 52, 53–60.Google Scholar
Greist, JH, Marks, IM, Baer, L, Kobak, KA, Wenzel, KW, Hirsch, MJ, Mantle, JM, Clary, CM (2002). Behavior therapy for obsessive compulsive disorder guided by a computer or by a clinician compared with relaxation as a control. Journal of Clinical Psychiatry 63, 138–145.Google Scholar
Hariri, AR, Matay, VS, Tessitore, A, Fera, F, Weinberger, DR (2003). Neocortical modulation of the amygdala response to fearful stimuli. Biological Psychiatry 53, 494–501.CrossRefGoogle ScholarPubMed
Harrison, BJ, Pujol, J, Cardoner, N, Deus, J, Alonso, P, López-Solà, M, Contreras-Rodríguez, O, Real, E, Segalàs, C, Blanco-Hinojo, L, Menchon, JM, Soriano-Mas, C (2013). Brain corticostriatal systems and the major clinical symptom dimensions of obsessive-compulsive disorder. Biological Psychiatry 73, 321–328.CrossRefGoogle ScholarPubMed
Hoexter, MQ, Dougherty, DD, Shavitt, RG, D'Alcante, CC, Duran, FBS, Lopes, AC, Diniz, JB, Batistuzzo, MC, Evans, KC, Bressan, RA, Busatto, GF, Miguel, EC (2013). Differential prefrontal gray matter correlates of treatment response to fluoxetine or cognitive-behavioral therapy in obsessive-compulsive disorder. European Neuropsychopharmacology 23, 569–580.Google Scholar
Husted, DS, Shapira, NA, Goodman, WK (2006). The neurocircuitry of obsessive-compulsive disorder and disgust. Progress in Neuropsychopharmacology and Biological Psychiatry 30, 389–399.CrossRefGoogle ScholarPubMed
Larson, CL, Schaefer, HS, Siegle, GJ, Jackson, CA, Anderle, MJ, Davidson, RJ (2006). Fear is fast in phobic individuals: amygdala activation in response to fear-relevant stimuli. Biological Psychiatry 15, 410–417.Google Scholar
Mataix-Cols, D, Cullen, S, Lange, K, Zelaya, F, Andrew, C, Amaro, E, Brammer, MJ, Williams, SC, Speckens, A, Phillips, ML (2003). Neural correlates of anxiety associated with obsessive-compulsive symptom dimensions in normal volunteers. Biological Psychiatry 53, 482–493.CrossRefGoogle ScholarPubMed
Mataix-Cols, D, Lawrence, NS, Wooderson, S, Speckens, A, Phillips, ML (2009). The Maudsley Obsessive-Compulsive Stimuli Set: validation of a standardized paradigm for symptom-specific provocation in obsessive-compulsive disorder. Psychiatry Research 168, 238–241.Google Scholar
Mataix-Cols, D, Marks, IM, Greist, JH, Kobak, KA, Baer, L (2002). Obsessive-compulsive symptom dimensions as predictors of compliance with and response to behaviour therapy: results from a controlled trial. Psychotherapy and Psychosomatics 71, 255–262.Google Scholar
Mataix-Cols, D, Wooderson, S, Lawrence, N, Brammer, MJ, Speckens, A, Phillips, ML (2004). Distinct neural correlates of washing, checking, and hoarding symptom dimensions in obsessive-compulsive disorder. Archives of General Psychiatry 61, 564–576.Google Scholar
Milad, MR, Quinn, BT, Pitman, RK, Orr, SP, Fischl, B, Rauch, SL (2005). Thickness of ventromedial prefrontal cortex in humans is correlated with extinction memory. Proceedings of the National Academy of Sciences USA 102, 10706–10711.Google Scholar
Milad, MR, Quirk, GJ (2002). Neurons in medial prefrontal cortex signal memory for fear extinction. Nature 42, 70–74.CrossRefGoogle Scholar
Mourão-Miranda, J, Volchan, E, Moll, J, de Oliveira-Souza, R, Oliveira, L, Bramati, I, Gattass, R, Pessoa, L (2003). Contributions of stimulus valence and arousal to visual activation during emotional perception. NeuroImage 20, 1955–1963.Google Scholar
NICE (2006). Obsessive-Compulsive Disorder. Core Interventions in the Treatment of Obsessive-Compulsive Disorder and Body Dysmorphic Disorder. National Institute for Health and Clinical Excellence (NICE) Clinical Guidelines, No. 31. British Psychological Society: Leicester, UK (www.nice.org.uk).Google Scholar
Ochsner, KN, Bunge, SA, Gross, JJ, Gabriele, JD (2002). Rethinking feelings: an fMRI study of the cognitive regulation of emotion. Journal of Cognitive Neuroscience 14, 1215–1229.CrossRefGoogle ScholarPubMed
Olatunji, BO, Cisler, JM, Tolin, DF (2007). Quality of life in the anxiety disorders: a meta-analytic review. Clinical Psychology Review 27, 572–581.Google Scholar
Olatunji, BO, Davis, M, Powers, M, Smits, JAJ (2012). Cognitive-behavioral therapy for obsessive-compulsive disorder: a meta-analysis of treatment outcome and moderators. Journal of Psychiatric Research 47, 33–41.CrossRefGoogle ScholarPubMed
Phelps, EA, Delgado, MR, Nearing, KI, LeDoux, JE (2004). Extinction learning in humans: role of the amygdala and vmPFC. Neuron 43, 897–905.Google Scholar
Phillips, ML, Ladouceur, CD, Drevets, WC (2008). The neural basis of voluntary and automatic emotion regulation: implications for understanding the neurodevelopment of bipolar disorder. Molecular Psychiatry 13, 833–857.Google Scholar
Phillips, ML, Marks, IM, Senior, C, Lythgoe, D, O'Dwyer, A-M, Meehan, O, Williams, SC, Brammer, MJ, Bullmore, ET, McGuire, PK (2000). A differential neural response in obsessive-compulsive disorder patients with washing compared with checking symptoms to disgust. Psychological Medicine 30, 1037–1050.Google Scholar
Rachman, S (2004). Fear of contamination. Behaviour Research and Therapy 42, 1227–1255.Google Scholar
Rauch, SL, Dougherty, DD, Cosgrove, GR, Cassem, EH, Alpert, NM, Price, BH, Nierenberg, AA, Mayberg, HS, Baer, L, Jenike, MA, Fischman, AJ (2001). Cerebral metabolic correlates as potential predictors of response to anterior cingulotomy for obsessive compulsive disorder. Biological Psychiatry 50, 659–667.Google Scholar
Rauch, SL, Dougherty, DD, Shin, LM, Alpert, NM, Manzo, P, Leahy, L, Fischman, AJ, Jenike, MA, Bare, L (1998). Neural correlates of factor-analyzed OCD symptom dimensions: a PET study. CNS Spectrums 3, 37–43.Google Scholar
Rauch, SL, Shin, LM, Dougherty, DD, Alpert, NM, Fischman, AJ, Jenike, MA (2002). Predictors of fluvoxamine response in contamination-related obsessive compulsive disorder: a PET symptom provocation study. Neuropsychopharmacology 27, 782–791.CrossRefGoogle ScholarPubMed
Salkovskis, PM (1999). Understanding and treating obsessive-compulsive disorder. Behaviour Research and Therapy 37, S29–S52.Google Scholar
Sanematsu, H, Nakao, T, Yoshiura, T, Nabeyama, M, Togao, O, Masuda, Y, Nakatani, E, Nakagawa, A, Kanba, S (2010). Predictors of treatment response to fluvoxamine in obsessive-compulsive disorder: an fMRI study. Journal of Psychiatric Research 44, 193–200.Google Scholar
Saxena, S, Brody, AL, Ho, ML, Zohrabi, N, Maidment, KM, Baxter, LR Jr. (2003). Differential brain metabolic predictors of response to paroxetine in obsessive-compulsive disorder versus major depression. American Journal of Psychiatry 160, 522–532.Google Scholar
Saxena, S, Brody, AL, Maidment, KM, Dunkin, JJ, Colgan, M, Alborzian, S, Phelps, ME, Baxter, LR Jr. (1999). Localized orbitofrontal and subcortical metabolic changes and predictors of response to paroxetine treatment in obsessive-compulsive disorder. Neuropsychopharmacology 21, 683–693.CrossRefGoogle ScholarPubMed
Schienle, A, Schafer, A, Stark, R, Walter, B, Vaitl, D (2005). Neural responses of OCD patients towards disorder-relevant, generally disgust-inducing and fear-inducing pictures. International Journal of Psychophysiology 57, 69–77.CrossRefGoogle ScholarPubMed
Sergerie, K, Chochol, C, Armony, JL (2008). The role of the amygdala in emotional processing: a quantitative meta-analysis of functional neuroimaging studies. Neuroscience and Biobehavioral Reviews 32, 811–830.Google Scholar
Siegle, GJ, Carter, CS, Thase, ME (2006). Use of fMRI to predict recovery from unipolar depression with cognitive behavior therapy. American Journal of Psychiatry 163, 735–738.Google Scholar
Steketee, G, Shapiro, LJ (1995). Predicting behavioral treatment outcome for agoraphobia and obsessive-compulsive disorder. Clinical Psychology Review 15, 315–346.Google Scholar
Swedo, SE, Pietrini, P, Leonard, HL, Schapiro, MB, Rettew, DC, Goldberger, EL, Rapoport, SI, Rapoport, JL, Grady, CL (1992). Cerebral glucose metabolism in childhood-onset obsessive-compulsive disorder. Revisualization during pharmacotherapy. Archives of General Psychiatry 49, 690–694.Google Scholar
Talairach, J, Tournoux, P (1988). Co-planar Stereotactic Atlas of the Human Brain. Thieme: Stuttgart.Google Scholar
van Balkom, AJLM, van Oppen, P, Vermeulen, AWA, van Dyck, R, Nauta, MCE, Vorst, HCM (1994). A meta-analysis on the treatment of obsessive compulsive disorder: a comparison of antidepressants, behavior and cognitive therapy. Clinical Psychology Review 14, 359–381.Google Scholar
van den Heuvel, OA, Remijnse, PL, Mataix-Cols, D, Vrenken, H, Groenewegen, HJ, Uylings, HB, van Balkom, AJ, Veltman, DJ (2009). The major symptom dimensions of obsessive-compulsive disorder are mediated by partially distinct neural systems. Brain 132, 853–868.Google Scholar
Visser, M, Jefferies, E, Lambon Ralph, MA (2009). Semantic processing in the anterior temporal lobes: a meta-analysis of the functional neuroimaging literature. Journal of Cognitive Neuroscience 22, 1083–1094.CrossRefGoogle Scholar