Brain activation of patients with obsessive-compulsive disorder during neuropsychological and symptom provocation tasks before and after symptom improvement: A functional magnetic resonance imaging study

Nakao, Tomohiro; Nakagawa, Akiko; Yamada, Takashi; Nakatani, Eriko; Nabeyama, Maiko; Yoshizato, Chika; Kudoh, Akiko; Tada, Kyoko; Yoshioka, Kazuko; Kawamoto, Midori; Togao, Osamu; Kanba, Shigenobu

doi:10.1016/j.biopsych.2004.12.039

Cited by 277 publications

(214 citation statements)

References 45 publications

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“…Treatment with CBT appears to enhance dACC activation in OCD patients during certain cognitive tasks. 44,45 Moreover, a significant increase in glucose metabolism in the dACC was seen in responders to CBT for major depression. 46 Taken together with these prior findings, our results suggest that dACC activation might be a common mechanism of action required for response to CBT across disorders.…”

Section: Discussionmentioning

confidence: 99%

Rapid effects of brief intensive cognitive-behavioral therapy on brain glucose metabolism in obsessive-compulsive disorder

Saxena

Gorbis²,

O’Neill³

et al. 2008

Mol Psychiatry

127

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Brief intensive cognitive-behavioral therapy (CBT) using exposure and response prevention significantly improves obsessive-compulsive disorder (OCD) symptoms in as little as 4 weeks. However, it has been thought that much longer treatment was needed to produce the changes in brain function seen in neuroimaging studies of OCD. We sought to elucidate the brain mediation of response to brief intensive CBT for OCD and determine whether this treatment could induce functional brain changes previously seen after longer trials of pharmacotherapy or standard CBT. [ 18 F]-fluorodeoxyglucose positron emission tomography brain scans were obtained on 10 OCD patients before and after 4 weeks of intensive individual CBT. Twelve normal controls were scanned twice, several weeks apart, without treatment. Regional glucose metabolic changes were compared between groups. OCD symptoms, depression, anxiety and overall functioning improved robustly with treatment. Significant changes in normalized regional glucose metabolism were seen after brief intensive CBT (P = 0.04). Compared to controls, OCD patients showed significant bilateral decreases in normalized thalamic metabolism with intensive CBT but had a significant increase in right dorsal anterior cingulate cortex activity that correlated strongly with the degree of improvement in OCD symptoms (P = 0.02). The rapid response of OCD to intensive CBT is mediated by a distinct pattern of changes in regional brain function. Reduction of thalamic activity may be a final common pathway for improvement in OCD, but response to intensive CBT may require activation of dorsal anterior cingulate cortex, a region involved in reappraisal and suppression of negative emotions.

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Section: Discussionmentioning

confidence: 99%

Rapid effects of brief intensive cognitive-behavioral therapy on brain glucose metabolism in obsessive-compulsive disorder

Saxena

Gorbis²,

O’Neill³

et al. 2008

Mol Psychiatry

127

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“…The persistence of enhanced performance monitoring after symptom reduction is remarkable given some findings suggesting that hyperactivity of fronto-striatal brain circuits in OCD patients during resting state and after symptom provocation normalizes, at least in part, with symptom reduction during psychological or pharmacological treatment (2,32). Brain structures showing such functional normalization include the nucleus caudatus (33), the thalamus (28), and the anterior cingulate cortex (e.g., references 34,35). Although state-dependent variations in anterior cingulate functions have been shown, overactive performance monitoring, which has been linked to activity in this region, appears to be independent of current symptom state (17,18).…”

Section: Discussionmentioning

confidence: 99%

Overactive Performance Monitoring as an Endophenotype for Obsessive-Compulsive Disorder: Evidence From a Treatment Study

Riesel¹,

Endraß²,

Auerbach³

et al. 2015

AJP

108

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Objective: Overactive performance monitoring, as measured by the error-related negativity in the event-related brain potential, represents one of the most robust psychophysiological alterations in obsessive-compulsive disorder (OCD). It has been proposed as an endophenotype for OCD because it is heritable and more prevalent in families of OCD patients. Consistent with this notion, it is also independent of symptom profile and symptom severity in cross-sectional studies. Longitudinally, it has been shown to be state independent in pediatric patients with OCD. The purpose of the present study was to investigate the state dependency of error monitoring by examining adult OCD patients before and after symptom reduction through cognitive-behavioral therapy (CBT).Method: Error-related and correct-related negativity as electrophysiological indicators of performance monitoring were recorded from 45 OCD patients and 39 healthy comparison subjects while performing a flanker task. Patients were assessed before starting and after completing a standard 30-session CBT, including exposure and response prevention, and healthy comparison subjects were tested after a comparable time interval.Results: Pretreatment, patients with OCD were characterized by enhanced error-related and correct-related negativity compared with healthy comparison subjects. This difference persisted after treatment when symptoms were substantially reduced. There was no significant correlation between symptom improvement and changes in performance monitoring and no difference in performance monitoring between treatment responders and nonresponders.Conclusions: This is the first longitudinal study in adult OCD patients showing stability of enhanced error monitoring following successful symptom reduction through CBT. It supports the hypothesis that overactive performance monitoring is an endophenotype that indicates vulnerability for OCD.

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“…The only fMRI study of CBT effects in OCD 29 assessed both effects on symptom provocation and on activation during a cognitive task (the Stroop task). Unfortunately, in this study, data from the CBT and the SSRI group had to be pooled because of otherwise insufficient power, which made a comparison between pharmaco-and psychotherapy impossible.…”

Section: Functional Imaging Studies Of Psychotherapy Effectsmentioning

confidence: 99%

How psychotherapy changes the brain – the contribution of functional neuroimaging

2006

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A thorough investigation of the neural effects of psychotherapy is needed in order to provide a neurobiological foundation for widely used treatment protocols. This paper reviews functional neuroimaging studies on psychotherapy effects and their methodological background, including the development of symptom provocation techniques. Studies of cognitive behavioural therapy (CBT) effects in obsessive-compulsive disorder (OCD) were consistent in showing decreased metabolism in the right caudate nucleus. Cognitive behavioural therapy in phobia resulted in decreased activity in limbic and paralimbic areas. Interestingly, similar effects were observed after successful intervention with selective serotonin reuptake inhibitors (SSRI) in both diseases, indicating commonalities in the biological mechanisms of psycho-and pharmacotherapy. These findings are discussed in the context of current neurobiological models of anxiety disorders. Findings in depression, where both decreases and increases in prefrontal metabolism after treatment and considerable differences between pharmacological and psychological interventions were reported, seem still too heterogeneous to allow for an integrative account, but point to important differences between the mechanisms through which these interventions attain their clinical effects. Further studies with larger patient numbers, use of standardised imaging protocols across studies, and ideally integration with molecular imaging are needed to clarify the remaining contradictions. This effort is worthwhile because functional imaging can then be potentially used to monitor treatment effects and aid in the choice of the optimal therapy. Finally, recent advances in the functional imaging of hypnosis and the application of neurofeedback are evaluated for their potential use in the development of psychotherapy protocols that use the direct modulation of brain activity as a way of improving symptoms.

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Brain activation of patients with obsessive-compulsive disorder during neuropsychological and symptom provocation tasks before and after symptom improvement: A functional magnetic resonance imaging study

Cited by 277 publications

References 45 publications

Rapid effects of brief intensive cognitive-behavioral therapy on brain glucose metabolism in obsessive-compulsive disorder

Rapid effects of brief intensive cognitive-behavioral therapy on brain glucose metabolism in obsessive-compulsive disorder

Overactive Performance Monitoring as an Endophenotype for Obsessive-Compulsive Disorder: Evidence From a Treatment Study

How psychotherapy changes the brain – the contribution of functional neuroimaging

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