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Dynamics of psychotherapy-related cerebral haemodynamic changes in obsessive compulsive disorder using a personalized exposure task in functional magnetic resonance imaging

Published online by Cambridge University Press:  04 September 2013

M. Morgiève ,
K. N'Diaye ,
W. I. A. Haynes ,
B. Granger ,
A.-H. Clair ,
A. Pelissolo  and
L. Mallet
M. Morgiève
Affiliation:
Behaviour, Emotion, and Basal Ganglia Team, CNRS UMR 7225, Inserm UMRS 975, Université Pierre et Marie Curie (UPMC), ICM (Brain and Spine Institute), CHU Pitié-Salpêtrière, Paris, France Fondation FondaMental, Créteil, France
K. N'Diaye
Affiliation:
Behaviour, Emotion, and Basal Ganglia Team, CNRS UMR 7225, Inserm UMRS 975, Université Pierre et Marie Curie (UPMC), ICM (Brain and Spine Institute), CHU Pitié-Salpêtrière, Paris, France Fondation FondaMental, Créteil, France
W. I. A. Haynes
Affiliation:
Behaviour, Emotion, and Basal Ganglia Team, CNRS UMR 7225, Inserm UMRS 975, Université Pierre et Marie Curie (UPMC), ICM (Brain and Spine Institute), CHU Pitié-Salpêtrière, Paris, France Fondation FondaMental, Créteil, France
B. Granger
Affiliation:
Département de Santé Publique, de Biostatistiques et d'Information Médicale (bioSPIM), CHU Pitié-Salpêtrière, Paris, France
A.-H. Clair
Affiliation:
Behaviour, Emotion, and Basal Ganglia Team, CNRS UMR 7225, Inserm UMRS 975, Université Pierre et Marie Curie (UPMC), ICM (Brain and Spine Institute), CHU Pitié-Salpêtrière, Paris, France
A. Pelissolo
Affiliation:
Fondation FondaMental, Créteil, France Department of Psychiatry, CHU Pitié-Salpêtrière, Paris, France
L. Mallet*
Affiliation:
Behaviour, Emotion, and Basal Ganglia Team, CNRS UMR 7225, Inserm UMRS 975, Université Pierre et Marie Curie (UPMC), ICM (Brain and Spine Institute), CHU Pitié-Salpêtrière, Paris, France Fondation FondaMental, Créteil, France Clinical Investigation Centre, CHU Pitié-Salpêtrière, Paris, France
*
*Address for correspondence: L. Mallet, M.D., Ph.D., Behaviour, Emotion, and Basal Ganglia Team, UPMC, Inserm UMRS 975, CNRS UMR 7225, ICM (Brain and Spine Institute), Pitié-Salpêtrière Hospital, 47, Bd de L'Hôpital, 75013 Paris, France. (Email: [email protected])
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Abstract

Background

Cognitive behavioural therapy (CBT) is a successful treatment of obsessive compulsive disorder (OCD). It is known to induce changes in cerebral metabolism; however, the dynamics of these changes and their relation to clinical change remain largely unknown, precluding the identification of individualized response biomarkers.

Method

In order to study the dynamics of treatment response, we performed systematic clinical and functional magnetic resonance imaging (fMRI) evaluation of 35 OCD patients immediately before a 3-month course of CBT, halfway through and at its end, as well as 6 months after. To sensitize fMRI probing, we used an original exposure task using neutral, generic and personalized obsession-inducing images.

Results

As expected, CBT produced a significant improvement in OCD. This improvement was continuous over the course of the therapy; therefore, outcome could be predicted by response at mid-therapy (r2 = 0.67, p < 0.001). Haemodynamic response to the task was located in the anterior cingulate and orbitofrontal cortices and was stronger during exposure to personalized obsession-inducing images. In addition, both the anxiety ratings and the haemodynamic response to the obsession-inducing images in the anterior cingulate and the left but not the right orbitofrontal clusters decreased with symptom improvement. Interestingly, haemodynamic activity continued to decrease after stabilization of clinical symptoms.

Conclusions

Using an innovative and highly sensitive exposure paradigm in fMRI, we showed that clinical and haemodynamic phenotypes have similar time courses during CBT. Our results, which suggest that the initial CBT sessions are crucial, prompt us to investigate the anatomo-functional modifications underlying the very first weeks of the therapy.

Keywords

Anterior cingulate cortexcognitive behavioural therapyfunctional magnetic resonance imaginglongitudinal studiesobsessive compulsive disorderorbitofrontal cortex
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 7 , May 2014 , pp. 1461 - 1473
Copyright
Copyright © Cambridge University Press 2013 

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References

Abramowitz, JS, Foa, EB (1998). Worries and obsessions in individuals with obsessive–compulsive disorder with and without comorbid generalized anxiety disorder. Behaviour Research and Therapy 36, 695–700.Google Scholar
Abramowitz, JS, Franklin, ME, Schwartz, SA, Furr, JM (2003). Symptom presentation and outcome of cognitive behavioral therapy for obsessive–compulsive disorder. Journal of Consulting and Clinical Psychology 71, 1049–1057.Google Scholar
Abramowitz, JS, Taylor, S, McKay, D (2009). Obsessive–compulsive disorder. Lancet 374, 491–499.Google Scholar
Adler, CM, McDonough-Ryan, P, Sax, KW, Holland, SK, Arndt, S, Strakowski, SM (2000). fMRI of neuronal activation with symptom provocation in unmedicated patients with obsessive compulsive disorder. Journal of Psychiatric Research 34, 317–324.Google Scholar
Apostolova, I, Block, S, Buchert, R, Osen, B, Conradi, M, Tabrizian, S, Gensichen, S, Schroder-Hartwig, K, Fricke, S, Rufer, M, Weiss, A, Hand, I, Clausen, M, Obrocki, J (2010). Effects of behavioral therapy or pharmacotherapy on brain glucose metabolism in subjects with obsessive–compulsive disorder as assessed by brain FDG PET. Psychiatry Research 184, 105–116.Google Scholar
Baxter, LR Jr., Saxena, S, Brody, AL, Ackermann, RF, Colgan, M, Schwartz, JM, Allen-Martinez, Z, Fuster, JM, Phelps, ME (1996). Brain mediation of obsessive–compulsive disorder symptoms: evidence from functional brain imaging studies in the human and nonhuman primate. Seminars in Clinical Neuropsychiatry 1, 32–47.Google ScholarPubMed
Beck, AT, Beamesderfer, A (1974). Assessment of depression: the depression inventory. Modern Problems of Pharmacopsychiatry 7, 151–169.CrossRefGoogle ScholarPubMed
Beutel, ME, Stark, R, Pan, H, Silbersweig, D, Dietrich, S (2010). Changes of brain activation pre- post short-term psychodynamic inpatient psychotherapy: an fMRI study of panic disorder patients. Psychiatry Research 184, 96–104.Google Scholar
Blumberg, HP, Leung, HC, Skudlarski, P, Lacadie, CM, Fredericks, CA, Harris, BC, Charney, DS, Gore, JC, Krystal, JH, Peterson, BS (2003). A functional magnetic resonance imaging study of bipolar disorder: state- and trait-related dysfunction in ventral prefrontal cortices. Archives of General Psychiatry 60, 601–609.Google Scholar
Bouvard, M (2006). Obsessive Compulsive Disorder. Principles, Therapies, Applications [In French]. Masson: Paris.Google Scholar
Breton-Lopez, J, Quero, S, Botella, C, Garcia-Palacios, A, Banos, RM, Alcaniz, M (2010). An augmented reality system validation for the treatment of cockroach phobia. Cyberpsychology, Behavior and Social Networking 13, 705–710.Google Scholar
Brody, AL, Saxena, S, Schwartz, JM, Stoessel, PW, Maidment, K, Phelps, ME, Baxter, LR Jr. (1998). FDG-PET predictors of response to behavioral therapy and pharmacotherapy in obsessive compulsive disorder. Psychiatry Research 84, 1–6.Google Scholar
Butler, AC, Chapman, JE, Forman, EM, Beck, AT (2006). The empirical status of cognitive–behavioral therapy: a review of meta-analyses. Clinical Psychology Review 26, 17–31.CrossRefGoogle ScholarPubMed
Chamberlain, SR, Menzies, L (2009). Endophenotypes of obsessive–compulsive disorder: rationale, evidence and future potential. Expert Review of Neurotherapeutics 9, 1133–1146.Google Scholar
Chamberlain, SR, Menzies, L, Hampshire, A, Suckling, J, Fineberg, NA, del Campo, N, Aitken, M, Craig, K, Owen, AM, Bullmore, ET, Robbins, TW, Sahakian, BJ (2008). Orbitofrontal dysfunction in patients with obsessive–compulsive disorder and their unaffected relatives. Science 321, 421–422.CrossRefGoogle ScholarPubMed
Chapman, HA, Bernier, D, Rusak, B (2010). MRI-related anxiety levels change within and between repeated scanning sessions. Psychiatry Research 182, 160–164.CrossRefGoogle ScholarPubMed
Clark, DA, Beck, AT (2010). Cognitive theory and therapy of anxiety and depression: convergence with neurobiological findings. Trends in Cognitive Sciences 14, 418–424.Google Scholar
Denys, D, Tenney, N, van Megen, HJ, de Geus, F, Westenberg, HG (2004). Axis I and II comorbidity in a large sample of patients with obsessive–compulsive disorder. Journal of Affective Disorders 80, 155–162.CrossRefGoogle Scholar
Eddy, KT, Dutra, L, Bradley, R, Westen, D (2004). A multidimensional meta-analysis of psychotherapy and pharmacotherapy for obsessive–compulsive disorder. Clinical Psychology Review 24, 1011–1030.Google Scholar
Everitt, BJ, Robbins, TW (2005). Neural systems of reinforcement for drug addiction: from actions to habits to compulsion. Nature Neuroscience 8, 1481–1489.Google Scholar
Foster, PS, Eisler, RM (2001). An integrative approach to the treatment of obsessive–compulsive disorder. Comprehensive Psychiatry 42, 24–31.CrossRefGoogle Scholar
Gava, I, Barbui, C, Aguglia, E, Carlino, D, Churchill, R, De Vanna, M, McGuire, HF (2007). Psychological treatments versus treatment as usual for obsessive compulsive disorder (OCD). Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD005333. DOI: 10.1002/14651858.CD005333.pub2.Google Scholar
Gillan, CM, Papmeyer, M, Morein-Zamir, S, Sahakian, BJ, Fineberg, NA, Robbins, TW, de Wit, S (2011). Disruption in the balance between goal-directed behavior and habit learning in obsessive–compulsive disorder. American Journal of Psychiatry 168, 718–726.Google Scholar
Goodman, WK, Price, LH, Rasmussen, SA, Mazure, C, Fleischmann, RL, Hill, CL, Heninger, GR, Charney, DS (1989). The Yale–Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Archives of General Psychiatry 46, 1006–1011.Google Scholar
Graybiel, AM (2008). Habits, rituals, and the evaluative brain. Annual Review of Neuroscience 31, 359–387.Google Scholar
Graybiel, AM, Rauch, SL (2000). Toward a neurobiology of obsessive–compulsive disorder. Neuron 28, 343–347.CrossRefGoogle Scholar
Haynes, WIA, Mallet, L (2010). High-frequency stimulation of deep brain structures in obsessive–compulsive disorder: the search for a valid circuit. European Journal of Neuroscience 32, 1118–1127.CrossRefGoogle ScholarPubMed
Hoexter, MQ, de Souza Duran, FL, D'Alcante, CC, Dougherty, DD, Shavitt, RG, Lopes, AC, Diniz, JB, Deckersbach, T, Batistuzzo, MC, Bressan, RA, Miguel, EC, Busatto, GF (2012). Gray matter volumes in obsessive–compulsive disorder before and after fluoxetine or cognitive–behavior therapy: a randomized clinical trial. Neuropsychopharmacology 37, 734–745.Google Scholar
Huyser, C, van den Heuvel, OA, Wolters, LH, de Haan, E, Boer, F, Veltman, DJ (2013). Increased orbital frontal gray matter volume after cognitive behavioural therapy in paediatric obsessive compulsive disorder. World Journal of Biological Psychiatry 14, 319–331.CrossRefGoogle ScholarPubMed
Jaurieta, N, Jimenez-Murcia, S, Alonso, P, Granero, R, Segalas, C, Labad, J, Menchon, JM (2008). Individual versus group cognitive behavioral treatment for obsessive–compulsive disorder: follow up. Psychiatry and Clinical Neurosciences 62, 697–704.Google Scholar
Kim, K, Kim, SI, Cha, KR, Park, J, Rosenthal, MZ, Kim, JJ, Han, K, Kim, IY, Kim, CH (2010). Development of a computer-based behavioral assessment of checking behavior in obsessive–compulsive disorder. Comprehensive Psychiatry 51, 86–93.Google Scholar
Koran, LM, Hanna, GL, Hollander, E, Nestadt, G, Simpson, HB, American Psychiatric Association (2007). Practice guideline for the treatment of patients with obsessive–compulsive disorder. American Journal of Psychiatry 164, 5–53.Google ScholarPubMed
Laurenceau, JP, Hayes, AM, Feldman, GC (2007). Some methodological and statistical issues in the study of change processes in psychotherapy. Clinical Psychology Reviews 27, 682–695.CrossRefGoogle Scholar
Linden, DE (2006). How psychotherapy changes the brain – the contribution of functional neuroimaging. Molecular Psychiatry 11, 528–538.Google Scholar
Mataix-Cols, D, Wooderson, S, Lawrence, N, Brammer, MJ, Speckens, A, Phillips, ML (2004). Distinct neural correlates of washing, checking, and hoarding symptom dimensions in obsessive–compulsive disorder. Archives of General Psychiatry 61, 564–576.CrossRefGoogle ScholarPubMed
Menzies, L, Chamberlain, SR, Laird, AR, Thelen, SM, Sahakian, BJ, Bullmore, ET (2008). Integrating evidence from neuroimaging and neuropsychological studies of obsessive–compulsive disorder: the orbitofronto-striatal model revisited. Neuroscience and Biobehavioral Reviews 32, 525–549.Google Scholar
Milad, MR, Rauch, SL (2012). Obsessive–compulsive disorder: beyond segregated cortico-striatal pathways. Trends in Cognitive Science 16, 43–51.Google Scholar
Morcom, AM, Fletcher, PC (2007). Does the brain have a baseline? Why we should be resisting a rest. Neuroimage 37, 1073–1082.CrossRefGoogle Scholar
Nabeyama, M, Nakagawa, A, Yoshiura, T, Nakao, T, Nakatani, E, Togao, O, Yoshizato, C, Yoshioka, K, Tomita, M, Kanba, S (2008). Functional MRI study of brain activation alterations in patients with obsessive–compulsive disorder after symptom improvement. Psychiatry Research 163, 236–247.CrossRefGoogle ScholarPubMed
Nakao, T, Nakagawa, A, Yoshiura, T, Nakatani, E, Nabeyama, M, Yoshizato, C, Kudoh, A, Tada, K, Yoshioka, K, Kawamoto, M, Togao, O, Kanba, S (2005). Brain activation of patients with obsessive–compulsive disorder during neuropsychological and symptom provocation tasks before and after symptom improvement: a functional magnetic resonance imaging study. Biological Psychiatry 57, 901–910.Google Scholar
Nakatani, E, Nakgawa, A, Ohara, Y, Goto, S, Uozumi, N, Iwakiri, M, Yamamoto, Y, Motomura, K, Iikura, Y, Yamagami, T (2003). Effects of behavior therapy on regional cerebral blood flow in obsessive–compulsive disorder. Psychiatry Research 124, 113–120.CrossRefGoogle ScholarPubMed
Rauch, SL, Jenike, MA, Alpert, NM, Baer, L, Breiter, HC, Savage, CR, Fischman, AJ (1994). Regional cerebral blood flow measured during symptom provocation in obsessive–compulsive disorder using oxygen 15-labeled carbon dioxide and positron emission tomography. Archives of General Psychiatry 51, 62–70.Google Scholar
Ressler, KJ, Mayberg, HS (2007). Targeting abnormal neural circuits in mood and anxiety disorders: from the laboratory to the clinic. Nature Neuroscience 10, 1116–1124.Google Scholar
Rotge, JY, Clair, AH, Jaafari, N, Hantouche, EG, Pelissolo, A, Goillandeau, M, Pochon, JB, Guehl, D, Bioulac, B, Burbaud, P, Tignol, J, Mallet, L, Aouizerate, B (2008 a). A challenging task for assessment of checking behaviors in obsessive–compulsive disorder. Acta Psychiatrica Scandinavica 117, 465–473.Google Scholar
Rotge, JY, Guehl, D, Dilharreguy, B, Cuny, E, Tignol, J, Bioulac, B, Allard, M, Burbaud, P, Aouizerate, B (2008 b). Provocation of obsessive–compulsive symptoms: a quantitative voxel-based meta-analysis of functional neuroimaging studies. Journal of Psychiatry and Neuroscience 33, 405–412.Google Scholar
Rotge, JY, Guehl, D, Dilharreguy, B, Tignol, J, Bioulac, B, Allard, M, Burbaud, P, Aouizerate, B (2009). Meta-analysis of brain volume changes in obsessive–compulsive disorder. Biological Psychiatry 65, 75–83.Google Scholar
Sanavio, E (1988). Obsessions and compulsions: the Padua Inventory. Behaviour Research and Therapy 26, 169–177.Google Scholar
Saxena, S, Brody, AL, Ho, ML, Alborzian, S, Maidment, KM, Zohrabi, N, Ho, MK, Huang, SC, Wu, HM, Baxter, LR Jr. (2002). Differential cerebral metabolic changes with paroxetine treatment of obsessive–compulsive disorder vs major depression. Archives of General Psychiatry 59, 250–261.CrossRefGoogle ScholarPubMed
Saxena, S, Brody, AL, Ho, ML, Zohrabi, N, Maidment, KM, Baxter, LR Jr. (2003). Differential brain metabolic predictors of response to paroxetine in obsessive–compulsive disorder versus major depression. American Journal of Psychiatry 160, 522–532.Google Scholar
Schienle, A, Schafer, A, Stark, R, Walter, B, Vaitl, D (2005). Neural responses of OCD patients towards disorder-relevant, generally disgust-inducing and fear-inducing pictures. International Journal of Psychophysiology 57, 69–77.Google Scholar
Schiepek, G, Tominschek, I, Karch, S, Lutz, J, Mulert, C, Meindl, T, Pogarell, O (2009). A controlled single case study with repeated fMRI measurements during the treatment of a patient with obsessive–compulsive disorder: testing the nonlinear dynamics approach to psychotherapy. World Journal of Biological Psychiatry 10, 658–668.Google Scholar
Schunck, T, Erb, G, Mathis, A, Jacob, N, Gilles, C, Namer, IJ, Meier, D, Luthringer, R (2008). Test–retest reliability of a functional MRI anticipatory anxiety paradigm in healthy volunteers. Journal of Magnetic Resonance Imaging 27, 459–468.Google Scholar
Schwartz, JM (1998). Neuroanatomical aspects of cognitive–behavioural therapy response in obsessive–compulsive disorder. An evolving perspective on brain and behaviour. British Journal of Psychiatry Supplement 38–44.CrossRefGoogle ScholarPubMed
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Hergueta, T, Baker, R, Dunbar, GC (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 59 (Suppl. 20), 22–33; quiz 34–57.Google Scholar
Spielberger, C, Gorsuch, R, Lushene, R, Vagg, P, Jacobs, A (1983). Manual for the State-Trait Anxiety Inventory (form Y). Consulting Psychologists Press: Palo Alto, CA.Google Scholar
Steketee, G, Eisen, J, Dyck, I, Warshaw, M, Rasmussen, S (1999). Predictors of course in obsessive–compulsive disorder. Psychiatry Research 89, 229–238.Google Scholar
Stewart, SE, Stack, DE, Tsilker, S, Alosso, J, Stephansky, M, Hezel, DM, Jenike, EA, Haddad, SA, Kant, J, Jenike, MA (2009). Long-term outcome following intensive residential treatment of obsessive–compulsive disorder. Journal of Psychiatry Research 43, 1118–1123.Google Scholar
Tolin, DF, Abramowitz, JS, Diefenbach, GJ (2005). Defining response in clinical trials for obsessive–compulsive disorder: a signal detection analysis of the Yale–Brown obsessive compulsive scale. Journal of Clinical Psychiatry 66, 1549–1557.Google Scholar
van Calker, D, Zobel, I, Dykierek, P, Deimel, CM, Kech, S, Lieb, K, Berger, M, Schramm, E (2009). Time course of response to antidepressants: predictive value of early improvement and effect of additional psychotherapy. Journal of Affective Disorders 114, 243–253.CrossRefGoogle ScholarPubMed
Weiskopf, N, Hutton, C, Josephs, O, Deichmann, R (2006). Optimal EPI parameters for reduction of susceptibility-induced BOLD sensitivity losses: a whole-brain analysis at 3 T and 1.5 T. Neuroimage 33, 493–504.Google Scholar
Whiteside, SP, Port, JD, Abramowitz, JS (2004). A meta-analysis of functional neuroimaging in obsessive–compulsive disorder. Psychiatry Research 132, 69–79.CrossRefGoogle ScholarPubMed
Whittal, ML, Thordarson, DS, McLean, PD (2005). Treatment of obsessive–compulsive disorder: cognitive behavior therapy vs. exposure and response prevention. Behaviour Research and Therapy 43, 1559–1576.Google Scholar
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