Mechanisms of cognitive-behavioral therapy for obsessive-compulsive disorder involve robust and extensive increases in brain network connectivity

Abstract

Cognitive-behavioral therapy (CBT) is effective for obsessive compulsive disorder (OCD); however, little is understood about its mechanisms related to brain network connectivity. We examined connectivity changes from resting-state functional magnetic resonance imaging data pre-to-post-CBT in 43 OCD participants, randomized to receive either 4 weeks of intensive CBT or 4 weeks waitlist followed by 4 weeks of CBT, and 24 healthy controls before and after 4 weeks of no treatment. Network-based-statistic analysis revealed large-magnitude increases in OCD connectivity in eight networks. Strongest increases involved connectivity between the cerebellum and caudate/putamen, and between the cerebellum and dorsolateral/ventrolateral prefrontal cortices. Connectivity increases were associated with increased resistance to compulsions. Mechanisms of CBT may involve enhanced cross-network integration, both within and outside of classical cortico-striatal-thalamo-cortical regions; those involving cerebellar to striatal and prefrontal regions may reflect acquisition of new non-compulsive goal-directed behaviors and thought patterns. Our findings have implications for identifying targets for enhancing treatment efficacy and monitoring treatment progress.

Neuroimaging findings in obsessive–compulsive disorder: A narrative review to elucidate neurobiological underpinnings

“…[113] Predictors of improvement with medication included pretreatment activation of the left superior temporal cortex and right cerebellum on symptom provocation task. [89] Studies investigating fMRI changes post-CBT have found improved connectivity between the cerebellum and widespread areas in the caudate, putamen, frontopolar cortex, DLPFC, and VLPFC[115] and normalization of increased left DLPFC and right OFC connectivity. [116] Predictors of improvement following CBT included baseline decreased basolateral amygdala (BLA)-VMPFC functional connectivity.…”

A voxel-based analysis of cerebral blood flow abnormalities in obsessive-compulsive disorder using pseudo-continuous arterial spin labeling MRI

“…The OCD patients in our present series also showed a focus of decreased rCBF in the frontal operculum compared to the controls. The frontal operculum correlates with resistance to compulsions in OCD patients [32]. A functional MRI study reported that OCD patients showed lower spontaneous brain activity in the Rolandic operculum compared to healthy controls [33].…”

Revisiting Imagery in Psychopathology: Why Mechanisms Are Important

“…Interestingly, research demonstrates that compulsions or irresistible urges to act (as observed in OCD) are linked to impaired attentional capacity (7). Furthermore, interventions (e.g., cognitive behavioral therapy) that increase neural connectivity in the dorsolateral and ventrolateral prefrontal cortices (networks crucial for inhibitory control) are associated with greater resistance to compulsion (26). Accordingly, if used appropriately and with patients with good imagery ability, imagery-related treatments may strengthen activity in networks mediating conscious cognitive control.…”