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The effects of cognitive behavioral therapy on resting-state functional brain network in drug-naive patients with obsessive-compulsive disorder


Li P, Yang X, Greenshaw AJ, et al. The effects of cognitive behavioral therapy on resting-state functional brain network in drug-naive patients with obsessive-compulsive disorder. Brain Behav. 2018;8(5):e00963. doi:10.1002/brb3.963



What the study asked

Cognitive behavioral therapy (CBT) is an effective treatment for obsessive-compulsive disorder (OCD), but how it works in the brain is poorly understood. This study looked at how CBT changes the brain's resting-state functional networks. To the authors' knowledge, it was the first to do this in people with OCD who had never taken medication and had no other psychiatric diagnosis.



How it was done

Twenty people with OCD who were drug-naive (no psychotropic medication or psychotherapy before) and had no other psychiatric disorder had a resting-state functional MRI scan before and after 12 weeks of individual CBT (14 sessions of 60 minutes). None took psychoactive medication during the treatment. Twenty healthy controls, matched for age and gender, were scanned twice, 12 weeks apart. The researchers used graph theory (to find the most connected "hub" regions) and functional connectivity (how closely different regions' activity is linked) to compare the whole-brain network.



What was found

  • There was a significant group-by-time interaction in the left dorsolateral prefrontal cortex (DLPFC), a hub region. Its connectedness fell significantly after CBT.
  • Functional connectivity between the left DLPFC and the right orbitofrontal cortex was increased in the patients at baseline and returned to normal after CBT.
  • Changes in connectivity between the left DLPFC and the default mode network (DMN) went along with changes in clinical symptoms: the more the connectivity changed, the more the symptoms changed.


Conclusion

The findings suggest that CBT can change the hub regions of the brain network in the cortico-striato-thalamo-cortical circuit in people with OCD. Connectivity of the cognitive control network and the DMN may be a potential imaging marker for evaluating CBT in OCD. The authors note that the sample was small, because it is hard to find patients who receive only CBT without medication.

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