Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA.
Transl Psychiatry. 2017 Sep 5;7(9):e1230. doi: 10.1038/tp.2017.192.
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.
认知行为疗法（CBT）对强迫症（OCD）有效；然而，对于其与大脑网络连通性相关的机制知之甚少。我们从 43 名 OCD 参与者的静息态功能磁共振成像数据中检查了 CBT 前后的连通性变化，这些参与者被随机分配接受 4 周强化 CBT 或 4 周候补治疗，然后接受 4 周 CBT，以及 24 名健康对照在 4 周无治疗前后。基于网络的统计分析显示，八个网络中 OCD 连通性的幅度大幅增加。最强的增加涉及小脑和尾状核/壳核之间，以及小脑和背外侧/腹外侧前额叶皮质之间的连通性。连通性的增加与强迫的抵抗力增加有关。CBT 的机制可能涉及增强跨网络整合，包括经典皮质-纹状体-丘脑-皮质区域内和外的整合；那些涉及小脑到纹状体和前额叶区域的整合可能反映了获得新的非强迫性目标导向行为和思维模式。我们的发现对于确定增强治疗效果和监测治疗进展的目标具有重要意义。
