|Top: Sagittal view of the 160 nodes across the brain used for the functional connectivity graph
Bottom: Scatterplot of smallworldness values (a measure of efficiency of brain network
connectivity) vs. observed changes in OCD symptoms in the post-treatment follow-up period.
Images: Dr. Teena Moody
Tens of millions of Americans will suffer in their lives from obsessive-compulsive disorder (OCD). One of the most common and effective treatments for OCD is cognitive-behavioral therapy, which aims to help patients understand the thoughts and feelings that influence their behaviors and then work toward eliminating them. But in an estimated 20 percent of patients, symptoms eventually return after therapy is completed.
A study by researchers at the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA suggests that a certain detail from patients’ brain scans could help clinicians identify which people are more likely to relapse after cognitive-behavioral therapy — and why. “The efficiency of brain-network connectivity before treatment predicts the worsening of symptoms after treatment,” says Jamie Feusner, MD ’99 (RES ’03, FEL ’04, ’06), director of the Semel Institute’s Adult OCD Program.
The researchers used functional magnetic resonance imaging (fMRI) to study the brains of 17 people, aged 21-to-50 years old, with OCD. Scans were taken both before and immediately after the patients completed an intensive four-week course of cognitive-behavioral therapy, and the doctors monitored the patients’ clinical symptoms over the next 12 months. “We found that cognitive-behavioral therapy itself results in more densely connected local brain networks, which likely reflects more efficient brain activity,” Dr. Feusner says.
However, the researchers also found that people who had more efficient brain connectivity before they began treatment actually did worse in the follow-up period. Surprisingly, neither the severity of symptoms before treatment nor the amount symptoms improved during treatment was an accurate predictor of the patients’ post-treatment success. The researchers say that knowing more about which patients might not fare well long term could help doctors and patients choose the best course of treatment.
“Cognitive-behavioral therapy is in many cases very effective, at least in the short term. But it is costly, time-consuming, difficult for patients and, in many areas, not available,” Dr. Feusner says. “Thus, if someone will end up having symptoms return, it would be useful to know before getting treatment.”
He added that the findings don’t mean that some people with OCD cannot be helped — just that four weeks of intensive cognitive-behavioral therapy might not be the most effective long-term approach. OCD can also be treated with medication or through cognitive-behavioral therapy that lasts longer than the four-week period evaluated in the study.
“We are now starting to translate knowledge of the brain into useful information that in the future could be used by doctors and patients to make clinical decisions,” Dr. Feusner says. “Although a brain scan may seem expensive, these scans only took about 15 minutes, and thus the cost is not exceptionally high, particularly in comparison to medication or cognitive-behavioral therapy treatments, which over time can cost many thousands of dollars.”
Dr. Feusner and colleagues plan to conduct another study in a larger number of patients in an attempt to validate the findings. They also will assess additional measures of brain function and structure that they hope will offer more clues to determining the long-term course of symptoms in people being treated for OCD.
“Brain Connectivity and Prediction of Relapse after Cognitive-behavioral Therapy in Obsessive-Compulsive Disorder,” Frontiers of Psychiatry, May 20, 2015