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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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