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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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