A first-line therapy for obsessive-compulsive disorder (OCD) reshapes connectivity of the brain, according to a new study in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, published by Elsevier.

OCD is an anxiety disorder characterized by repetitive thoughts and behaviors that can be disruptive and even disabling. The first-line treatment for OCD, a form of cognitive-behavioral therapy called exposure and response prevention (EX/RP), is effective for many people with OCD, but how it works has remained unclear. This new study shows that EX/RP training reshapes brain activity for better cognitive control. 

In people with OCD, functional brain activity is affected in three neural networks that participate in cognitive control. The networks are the frontoparietal network (FPN), the cingulo-opercular network (CON), and the default mode network (DMN). For the new study, 111 adolescents and adults with OCD received either EX/RP, which is designed to build coping skills for a patient through gradual exposure,or stress management training as a control treatment. Then, participants underwent magnetic resonance imaging (MRI) while performing a cognitive task. After treatment, OCD participants who received EX/RP displayed strengthened connectivity between the cognitive control networks that was not seen in participants who had stress management.

Senior author Kate Fitzgerald, MD, at Columbia University, said the study “is important because it shows how EX/RP improves brain function to treat OCD. Specifically, EX/RP improved connectivity of brain circuits underlying cognitive control, the ability to adjust the repetitive thoughts and behaviors.” 

Leveraging the expertise of co-author Adriene Beltz, PhD, at the University of Michigan, the researchers used a sophisticated new analysis technique. Dr. Fitzgerald explained, “This allowed us to ‘see’ patient-specific brain changes with EX/RP that we were not able to uncover previously when using an older type of analysis that averages out brain differences between patients.”

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The article is "Changes in Brain Network Connections after Exposure and Response Prevention Therapy for OCD in Adolescents and Adults," by Hannah Becker, Adriene Beltz, Joseph Himle, James L. Abelson, Stefanie Russman Block, Stephan F. Taylor, and Kate D. Fitzgerald (https://doi.org/10.1016/j.bpsc.2023.09.009). It appears as an Article in Press in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, published by Elsevier.

Read the complete article in Elsevier