van der Straten Anouk, Bruin Willem, van de Mortel Laurens, Ten Doesschate Freek, Merkx Maarten J M, de Koning Pelle, Vulink Nienke, Figee Martijn, van den Heuvel Odile A, Denys Damiaan, van Wingen Guido
Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
Amsterdam Neuroscience, Amsterdam, Netherlands.
Depress Anxiety. 2024 Jan 4;2024:6687657. doi: 10.1155/2024/6687657. eCollection 2024.
Initial treatment for obsessive-compulsive disorder (OCD) consists of pharmacological treatment with selective serotonin reuptake inhibitors (SSRIs) and/or psychological treatment with cognitive behavioral therapy (CBT). The assumption is that both treatments have different neural working mechanisms, but empirical evidence is lacking. We investigated whether these treatments induce similar or different functional neural changes in OCD. We conducted a longitudinal nonrandomized controlled trial in which thirty-four OCD patients were treated with sixteen weeks of CBT or SSRIs. Functional magnetic resonance imaging was performed before and after treatment during emotional processing (emotional face matching and symptom provocation tasks) and response inhibition (stop signal task). Twenty matched healthy controls were scanned twice with a similar time interval. Both CBT and SSRIs were successful in reducing OCD symptoms. Compared to healthy controls, treatment led to a reduction of insula activity in OCD patients during symptom provocation. The comparison between treatment groups revealed widespread divergent brain changes in the cerebellum, posterior insula, caudate nucleus, hippocampus, and occipital and prefrontal cortex during all tasks, explained by relative increases of activity following CBT compared to relative decreases of activity following SSRIs. Pharmacological and psychological treatment primarily lead to opposite changes in brain function, with a common reduction of insula activity during symptom provocation. These findings provide insight into common and specific neural mechanisms underlying treatment response, suggesting that CBT and SSRIs support recovery from OCD along partly distinct pathways. This trial is registered with NTR6575.
强迫症（OCD）的初始治疗包括使用选择性5-羟色胺再摄取抑制剂（SSRI）进行药物治疗和/或使用认知行为疗法（CBT）进行心理治疗。假设这两种治疗具有不同的神经作用机制，但缺乏实证证据。我们研究了这些治疗在强迫症中是否会引起相似或不同的功能性神经变化。我们进行了一项纵向非随机对照试验，其中34名强迫症患者接受了为期16周的CBT或SSRI治疗。在治疗前后，对患者进行了功能性磁共振成像，检测其在情绪加工（情绪面孔匹配和症状激发任务）和反应抑制（停止信号任务）过程中的大脑活动。20名匹配的健康对照者在相似的时间间隔内接受了两次扫描。CBT和SSRI均成功减轻了强迫症症状。与健康对照者相比，治疗使强迫症患者在症状激发过程中的脑岛活动减少。治疗组之间的比较显示，在所有任务中，小脑、后脑岛、尾状核、海马以及枕叶和前额叶皮质存在广泛的不同脑区变化，这可以解释为与SSRI治疗后活动相对减少相比，CBT治疗后活动相对增加。药物治疗和心理治疗主要导致大脑功能的相反变化，在症状激发过程中脑岛活动均有共同减少。这些发现为治疗反应背后的共同和特定神经机制提供了见解，表明CBT和SSRI沿着部分不同的途径支持强迫症的康复。该试验已在荷兰国家试验注册库（NTR）注册，注册号为NTR6575。
