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

Abstract

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.

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

“…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).…”

“…Eye movement and blink artifacts were corrected using the multiple-source eye-correction method implemented in BESA, Version 5.2 ([Brain Electrical Source Analysis] MEGIS Epochs containing a voltage step of more than 50 mV between consecutive data points or a voltage difference of 200 mV were rejected from averaging. Event-related potentials were quantified for correct (i.e., correct-related negativity) and erroneous (i.e., error-related negativity) reactions as the difference between the most negative peak occurring in a 150-ms epoch following the response and the immediately preceding positive peak at electrode FCz (28). Statistical analyses were conducted using SPSS (version 20.0, SPSS, Armonk, N.Y.).…”

A psicologia como neurociência cognitiva: Implicações para a compreensão dos processos básicos e suas aplicações

“…Ambos os circuitos implicam estruturas que ou são puramente subcorticais, ou que mesmo fazendo parte do córtice, a sua localização é tão medial, que se tornam de difícil acesso através de métodos não invasivos. Quer a ETCC, quer a rTMS possuem como locus primordial efeitos a nível cortical (Kobayashi & Pascual-Leone, 2003), podendo apresentar séries limitações a nível de eficácia, numa patologia predominantemente cortico-subcortical, como é a POC (Pujol et al, 2004;Rauch et al, 1994;Saxena et al, 2008).…”

Die Bedeutung der Neurobiologie für die Kinder- und Jugendlichentherapie

“…2008 berichten Saxena et al (2008), dass sie bei erfolgreich über vier Wochen mit täglichen psychotherapeutischen Sitzungen behandelten Zwangspatienten eine Normalisierung des Energieverbrauchs im Th alamus, einem Zentrum, das bei Zwangskranken gewöhnlich überaktiv ist, beobachtet hätten. Dagegen sei die Aktivität rechtseitig im vorderen cingulären Kortex angestiegen.…”