Department of Psychiatry, Medical School, University of Michigan, Ann Arbor (Norman, Mannella, Yang, Angstadt, Abelson, Himle, Fitzgerald, Taylor); Neurobehavioral Clinical Research Section, Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, Md. (Norman); Second Xiangya Hospital, Central South University, Changsha, China (Yang).
Am J Psychiatry. 2021 Jan 1;178(1):39-47. doi: 10.1176/appi.ajp.2020.19080886. Epub 2020 Aug 28.
The authors sought to examine whether brain activity is associated with treatment response to cognitive-behavioral therapy (CBT) in adolescents and adults with obsessive-compulsive disorder (OCD), and whether any associations are treatment specific relative to an active control psychotherapy (stress management therapy; SMT).
Eighty-seven patients with OCD (age range 12-45 years; 57 female, 39 medicated) were randomly assigned to receive 12 weeks of CBT or SMT. Prior to treatment, functional MRI scans were conducted in patients performing an incentive flanker task, which probes brain activation to both cognitive control and reward processing. Voxelwise linear mixed-effects models examined whether baseline brain activation was differentially associated with change in scores on the Yale-Brown Obsessive Compulsive Scale (standard or Children's version) over the course of CBT or SMT treatment.
Within the CBT group, a better treatment response was significantly associated with greater pretreatment activation within the right temporal lobe and rostral anterior cingulate cortex during cognitive control and within the ventromedial prefrontal, orbitofrontal, lateral prefrontal, and amygdala regions during reward processing. In contrast, reduced pretreatment activation within a largely overlapping set of regions was significantly associated with a better treatment response to SMT.
The study findings demonstrate that associations between brain activation and treatment response were treatment specific to CBT relative to a control psychotherapy and that these associations were stable from adolescence to mature adulthood. Such treatment-specific associations are important for the development of biomarkers to personalize treatment in OCD.
作者试图探讨大脑活动是否与青少年和成人强迫症（OCD）患者接受认知行为疗法（CBT）的治疗反应相关，以及这些关联是否相对于一种积极的对照心理治疗（压力管理疗法；SMT）具有治疗特异性。
87 名 OCD 患者（年龄 12-45 岁；57 名女性，39 名服用药物）被随机分配接受 12 周的 CBT 或 SMT。在治疗前，患者进行了功能磁共振扫描，执行激励性侧翼任务，该任务探测了认知控制和奖励处理对大脑激活的影响。体素线性混合效应模型检验了在 CBT 或 SMT 治疗过程中，基线大脑激活是否与耶鲁-布朗强迫症量表（标准或儿童版）评分的变化存在差异相关。
在 CBT 组中，更好的治疗反应与认知控制期间右侧颞叶和额前扣带回、奖励处理期间腹内侧前额叶、眶额叶、外侧前额叶和杏仁核区域的预处理激活显著相关。相比之下，与 SMT 治疗反应更好相关的是一组广泛重叠的区域的预处理激活减少。
研究结果表明，大脑激活与治疗反应之间的关联是 CBT 治疗特异性的，与对照心理治疗相比，这些关联在从青春期到成年期是稳定的。这种治疗特异性关联对于开发生物标志物以个性化 OCD 治疗非常重要。
