Olatunji B O, Ferreira-Garcia R, Caseras X, Fullana M A, Wooderson S, Speckens A, Lawrence N, Giampietro V, Brammer M J, Phillips M L, Fontenelle L F, Mataix-Cols D
Department of Psychology and Psychiatry,Vanderbilt University,Nashville, TN,USA.
Institute of Psychiatry,Federal University of Rio de Janeiro,Brazil.
Psychol Med. 2014 Jul;44(10):2125-37. doi: 10.1017/S0033291713002766. Epub 2013 Nov 12.
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.
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.
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.
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.
尽管认知行为疗法（CBT）是治疗强迫症（OCD）的有效方法，但很少有可靠的治疗结果预测指标被确定。本研究考察了以污染强迫观念和洗涤强迫行为（最常见的OCD症状维度）为主的OCD患者中，CBT治疗症状改善的神经相关性。
参与者包括12名OCD患者，他们在接受12周CBT治疗前，于功能磁共振成像（fMRI）扫描期间接受与污染相关图像的症状激发。
症状激发期间的脑活动模式与治疗后耶鲁-布朗强迫症量表（YBOCS）得分的降低相关，即使在控制了YBOCS和贝克抑郁量表（BDI）的基线分数以及治疗期间BDI的改善情况之后也是如此。具体而言，参与情绪处理的脑区（如颞极前部和杏仁核）的激活与更好的治疗反应最密切相关。相比之下，参与情绪调节的区域（如背外侧前额叶皮层）的活动与治疗反应呈负相关，主要在症状激发期间每个暴露阶段的后期。
在以污染为基础的OCD患者中，暴露于威胁线索期间边缘区域的成功募集可能有助于对CBT产生更好的反应，而参与认知控制的背外侧前额叶区域的过度激活可能会阻碍对治疗的反应。讨论了研究结果的理论意义及其与个性化护理方法的潜在相关性。
