UCLA researchers have found that people with obsessive-compulsive disorder (OCD) when treated with a special form of talk therapy demonstrate distinct changes in their brains as well as improvement in their symptoms. In the study, people with OCD underwent daily cognitive behavioral therapy, or CBT, to learn how to better resist compulsive behaviors and decrease distress. Within one month, they had developed extensive increases in the strength of the connections between regions of their brains — which may demonstrate that the participants gained new non-compulsive behaviors and thought patterns.
The results bolster the argument for making CBT more widely available for treating the disorder, which affects more than one-in-50 people in the U.S. The study also could help guide future treatments that are faster or more effective, which would lower health care costs. “The changes appeared to compensate for, rather than correct, underlying brain dysfunction,” says Jamie Feusner, MD '99 (RES '03, FEL '04, '06), director of the Adult Obsessive-Compulsive Disorder Program at the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA and the study's senior author. “The findings open the door for future research, new treatment targets and new approaches.”
OCD is a psychiatric condition in which a person has difficult-to-control, reoccurring thoughts, as well as the urge to repeat behaviors. Common symptoms include fear of germs or contamination, unwanted or aggressive thoughts and compulsions to clean, check or put things in order. It typically is treated with medication, psychotherapy or a combination of the two.
In the new study, UCLA researchers evaluated 43 people with OCD who received intensive CBT therapy (either immediately or after a fourweek wait) and 24 people without OCD as a comparison group. All of the participants underwent scans with a neuroimaging tool called functional magnetic resonance imaging, or fMRI. Those with OCD were scanned before and after four weeks of treatment, and those who do not have OCD — and therefore did not receive treatment — also were scanned before and after the four weeks.
When the scientists compared the before-and-after brain scans of the participants who received CBT, they saw an increase in connectivity — which can signify greater communication — between the cerebellum and the striatum and between the cerebellum and the prefrontal cortex. The scans of people without OCD did not show any changes. Among the people with OCD who waited four weeks for their treatment, there also were no changes during the waiting period, demonstrating that the changes in the brain do not occur spontaneously with the passage of time.
“Mechanisms of Cognitive-behavioral Therapy for Obsessive-compulsive Disorder Involve Robust and Extensive Increases in Brain Network Connectivity,” Translational Psychiatry, September 5, 2017
Flowchart of the analysis that found stronger brain connectivity in OCD patients after cognitive behavioral therapy.
Image: Courtesy of Dr. Manish Butte
