Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-31T16:08:25.620Z Has data issue: false hasContentIssue false
  • English
  • Français

Neuroanatomical aspects of cognitive-behavioural therapy response in obsessive-compulsive disorder

An evolving perspective on brain and behaviour

Published online by Cambridge University Press:  06 August 2018

Jeffrey M. Schwartz
Jeffrey M. Schwartz*
Affiliation:
UCLA Department of Psychiatry, 760 Westwood Plaza, Room 67–468, Los Angeles, CA 90024–1759, USA. Tel: (310) 825–5493/(310) 392–4044; Fax: (310) 206–2802
Get access Rights & Permissions [Opens in a new window]

Abstract

Background Recent research has demonstrated that cognitive-behavioural therapy (CBT) for obsessive-compulsive disorder (OCD) can systematically modify cerebral metabolic activity in a manner which is significantly related to clinical outcome.

Method A substantial body of research is reviewed which supports an involvement of neural circuitry connecting the orbitofrontal cortex, cingulate gyrus and basal ganglia in the expression of the symptoms of OCD.

Results Data are presented which expand upon previous work demonstrating effects of CBTon functional interactions between limbic cortex and the basal ganglia.

Conclusions The relevance of these effects of CBTon brain function is discussed in the context of recent advances in our knowledge of cortical–basal ganglia physiology. The clinical importance of these data is best appreciated when they are seen to reflect the interactive nature of the relationships between cognitive choice, behavioural output and brain activity.

Type
Research Article
Information
The British Journal of Psychiatry , Volume 173 , Issue S35: New perspectives in research and treatment of obsessive-compulsive disorder , August 1998 , pp. 38 - 44
Copyright
Copyright © 1998 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aosaki, T., Kimura, M. & Graybiel, A. M. (1995) Temporal and spatial characteristics of tonically active neurons of the primate striatum. Journal of Neurophysiology, 73, 1234–1252.CrossRefGoogle Scholar
Baxter, L. R. (1995) Neuroimaging studies of human anxiety disorders: cutting paths of knowledge through the field of neurotic phenomena. In Psychopharmacology: The Fourth Generation of Progress (eds Bloom, F. E. & Kupfer, D. J.), pp. 1287–1299. New York: Raven Press.Google Scholar
Baxter, L. R., Schwartz, J. M., Guze, B. H., et al (1990) Neuroimaging in obsessive-compulsive disorder: seeking the mediating neuroanatomy. In Obsessive-Compulsive Disorders: Theory and Management (2nd edn) (eds Jenike, M. A., Baer, L. & Minichiello, W. E.), pp. 167–188. Chicago, IL: Yearbook Medical Publishers.Google Scholar
Baxter, L. R., Schwartz, J. M., Bergman, K. S., et al (1992) Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder. Archives of General Psychiatry, 49, 681–689.Google Scholar
Baxter, L. R., Saxena, S., Brody, A. L., et al (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 Scholar
Breiter, H. C., Rauch, S. L., Kwong, K. K., et al (1996) Functional magnetic resonance imaging of symptom provocation in obsessive-compulsive disorder. Archives of General Psychiatry, 53, 595–606.CrossRefGoogle ScholarPubMed
Chalmers, D. J. (1996) The Conscious Mind: In Search of a Fundamental Theory. New York: Oxford University Press.Google Scholar
Cummings, J. L. (1993) Frontal-subcortical circuits and human behavior. Archives of Neurology, 50, 873–880.Google Scholar
Dubois, B., Defontaines, B., Deweer, B., et al (1995) Cognitive and behavioral changes in patients with focal lesions of the basal ganglia. In Advances in Neurology Volume 65, Behavioral Neurology of Movement Disorders (eds Weiner, W. J. & Lang, A. E.), pp. 29–41. New York: Raven Press.Google Scholar
Eblen, F. & Graybiel, A. M. (1995) Highly restricted origin of prefrontal cortical inputs to striosomes in the macaque monkey Journal of Neuroscience, 15, 5999–6013.CrossRefGoogle ScholarPubMed
Flaherty, A. W. & Graybiel, A. M. (1994) Input-output organization of the sensorimotor striatum in the squirrel monkey. Journal of Neuroscience, 14, 599–610.CrossRefGoogle ScholarPubMed
Fuster, J. M. (1989) The Prefrontal Cortex (2nd edn). New York: Raven Press.Google Scholar
Gerfen, C. R. (1992) The neostriatal mosaic: multiple levels of compartmental organization in the basal ganglia. Annual Review of Neuroscience, 15, 285–320.CrossRefGoogle ScholarPubMed
Goodman, W. K., Price, L. H., Rasmussen, S. A., et al (1989) The Yale-Brown Obsessive-Compulsive Scale. Archives of General Psychiatry, 46, 1006–1016.Google Scholar
Graybiel, A. M., Aosaki, T., Flaherty, A. W., et al (1994) The basal ganglia and adaptive motor control. Science, 265, 1826–1831.Google Scholar
Greist, J. H., Jefferson, J. W., Kobak, K. A., et al (1995) Efficacy and tolerability of serotonin transport inhibitors in obsessive-compulsive disorder. Archives of General Psychiatry, 52, 53–60.CrossRefGoogle ScholarPubMed
Hand, I. (1988) Obsessive-compulsive patients and their families. In Handbook of Behavioral Therapy (ed. Faloon, I. R. H.), pp. 231–256. New York: Guilford Press.Google Scholar
Hand, I. (1992) Behavior therapy for OCD: methods of therapy and their results. In Obsessive-Compulsive Disorders: New Research Results (eds Hand, I., Goodman, W. K. & Evers, U.), pp. 231–256. Berlin: Springer-Verlag.Google Scholar
Hikosaka, O., Sakamoto, M. & Usni, S. (1989a) Functional properties of monkey caudate neurons. I. Activities related to saccadic eye movements. Journal of Neurophysiology, 61, 780–798.CrossRefGoogle ScholarPubMed
Hikosaka, O., Sakamoto, M. & Usni, S. (1989b) Functional properties of monkey caudate neurons. II. Visual and auditory responses. Journal of Neurophysiology, 61, 799–813.Google Scholar
Hikosaka, O., Sakamoto, M. & Usni, S. (1989c) Functional properties of monkey caudate neurons. III. Activities related to expectation of target and reward. Journal of Neurophysiology, 61, 814–832.Google Scholar
Hoehn-Saric, R. & Benkelfat, C. (1994) Structural and functional brain imaging in obsessive-compulsive disorder. In Current Insights in Obsessive-Compulsive Disorder (eds Hollander, E., Zohar, J., Marazziti, D., et al), pp. 183–211. Chichester/New York: John Wiley & Sons.Google Scholar
Insel, T. R. (1992) Towards a neuroanatomy of obsessive-compulsive disorder. Archives of General Psychiatry, 49, 739–744.Google Scholar
Marks, I. M., Lelliott, R., Basoglu, M., et al (1988) Clomipramine, self-exposure and therapist-aided exposure for obsessive-compulsive rituals. British Journal of Psychiatry, 152, 522–534.CrossRefGoogle ScholarPubMed
Modell, J. G., Mountz, J. M., Curtis, G. C., et al (1989) Neurophysiological dysfunction in the basal ganglia/ limbic striatal and thalamocortical circuits as a pathogenic mechanism of obsessive-compulsive disorder. Journal of Neuropsychiatry and Clinical Neurosciences, 1, 27–36.Google Scholar
Nemiah, J. C. & Uhde, T. W. (1989) Obsessive-compulsive disorder. In Comprehensive Textbook of Psychiatry, V (eds Kaplan, H. I. & Sadock, B. J.), pp. 984–1000. Baltimore: Williams & Wilkins.Google Scholar
Neziroglu, F., Hoffman, J., Yaryura-Tobias, J. A., et al (1996) Current issues in behavior and cognitive therapy for obsessive-compulsive disorder. CNS Spectrums, 1, 47–54.Google Scholar
Niki, H., Sakai, M., & Kubota, K. (1972) Delayed alternation performance and unit activity of the caudate head and medial orbitofrontal gyrus in the monkey. Brain Research, 38, 343–353.Google Scholar
Niki, H. & Watanabe, M. (1979) Prefrontal and cingulate unit activity during timing behavior in the monkey. Brain Research, 171, 213–224.CrossRefGoogle ScholarPubMed
Rapoport, J. L. (1991) Recent advances in obsessive-compulsive disorder. Neuropsychopharmacology, 5, 1–10.Google ScholarPubMed
Rapoport, J. L. & Wise, S. R. (1988) Obsessive-compulsive disorder: is it a basal ganglia dysfunction? Psychopharmacological Bulletin, 24, 380–384.Google ScholarPubMed
Rauch, S. L., Jenike, M. A., Alpert, N. M., et al (1994) Regional cerebral blood flow measured during symptom provocation in obsessive-compulsive disorder using 15O-labeled CO2 and positron emission tomography. Archives of General Psychiatry 51, 62–70.CrossRefGoogle Scholar
Rolls, E. T. (1995) A theory of emotion and consciousness, and its application to understanding the neural basis of emotion. In The Cognitive Neurosciences, (ed. Gazzaniga, M. S.), pp. 1091–1106. Cambridge, MA: MIT Press.Google Scholar
Rolls, E. T. & Johnstone, S. (1992) Neurophysiological analysis of striatal function. In Neuropsychological Disorders Associated with Subcortical Lesions (eds Vallar, G., Cappa, S. F. & Wallesch, C.-W.), pp. 61–97. Oxford: Oxford University Press.CrossRefGoogle Scholar
Rosenkilde, C. E., Bauer, R. H. & Fuster, J. M. (1981) Single cell activity in ventral prefrontal cortex of behaving monkeys. Brain Research, 209, 375–394.Google Scholar
Saint-Cyr, J. A. & Taylor, A. E. (1992) The mobilization of procedural learning: the “key signature” of the basal ganglia. In Neuropsychology of Memory (2nd edn) (eds Squire, L. R. & Butter, N.), pp. 188–202. New York: Guilford Press.Google Scholar
Saint-Cyr, J. A. & Taylor, A. E., Trepanier, L. L., et al (1992) The caudate nucleus: head ganglion of the habit system. In Neuropsychological Disorders Associated with Subcortical Lesions (eds Vallar, G., Cappa, S. F., Wallesch, C.-W.), pp. 204–226. Oxford: Oxford University Press.CrossRefGoogle Scholar
Saint-Cyr, J. A. & Taylor, A. E. & Nicholson, K. (1995) Behavior and the basal ganglia. In Advances in Neurology Volume 65, Behavioral Neurology of Movement Disorders (eds Weiner, W J. & Lang, A. E.), pp. 1–28. New York: Raven Press.Google Scholar
Salkovskis, P. M. (1996) Cognitive-behavioural approaches to the understanding of obsessional problems. In Current Controversies in the Anxiety Disorders (ed. Rapee, R. M.). New York: Guilford Press.Google Scholar
Schneider, J. S. (1984) Review: basal ganglia role in behavior: importance of sensory gating and its relevance to psychiatry. Biological Psychiatry, 19, 1693–1710.Google Scholar
Schneider, J. S. & Lidsky, T. I. (eds) (1987) Basal Ganglia and Behavior: Sensory Aspects of Motor Functioning. Toronto: Hans Huber Publishers.Google Scholar
Schwartz, J. M. (1996) Brain Lock: Free Yourself from Obsessive-Compulsive Behavior. New York: Harper Collins.Google Scholar
Schwartz, J. M. (1997a) Obsessive-compulsive disorder. Science and Medicine, 4, 14–23.Google Scholar
Schwartz, J. M. (1997b) Cognitive-behavioral self-treatment for obsessive-compulsive disorder systematically alters cerebral metabolism: A mind-brain interaction paradigm for psychotherapists. in Obsessive-Compulsive Disorders: Diagnosis, Etiology, Treatment. In Obsessive-Compulsive Disorders: Diagnosis, Etiology, Treatment (eds Hollander, E. & Stein, D. J.), pp. 257–281. New York: Marcel Dekker Inc.Google Scholar
Schwartz, J. M., Martin, K. M. & Baxter, L. R. (1992) Neuroimaging and cognitive-behavioral self-treatment for obsessive-compulsive disorder: practical and philosophical considerations. In Obsessive-Compulsive Disorders: New Research Results (eds Hand, I., Goodman, W. K. & Evers, U.), pp. 82–101. Berlin: Springer-Verlag.Google Scholar
Schwartz, J. M., Stoessel, P. W., Baxter, L. R., et al (1996) Systematic changes in cerebral glucose metabolic rate after successful behavior modification treatment of obsessive-compulsive disorder. Archives of General Psychiatry, 53, 109–113.Google Scholar
Silananda, U. (1990) The Four Foundations of Mindfulness. Boston: Wisdom Press.Google Scholar
Smith, A. (1976) The Theory of Moral Sentiments (6th edn, 1790) (eds Raphael, D. D. & Macfie, A. L.). Oxford: Oxford University Press.Google Scholar
Stanley, M. A. & Turner, S. M. (1995) Current status of pharmacological and behavioral treatment of obsessive-compulsive disorder. Behavior Therapy, 26, 163–186.Google Scholar
Steketee, G. (1994) Behavioral assessment and treatment planning with obsessive-compulsive disorder: a review emphasizing clinical application. Behavior Therapy, 25, 613–633.Google Scholar
Stuss, D. T. & Benson, D. F. (1986) The Frontal Lobes. New York: Raven Press.Google Scholar
Swerdlow, N. R. (1995) Serotonin, obsessive-compulsive disorder and the basal ganglia. International Review of Psychiatry, 7, 115–129.CrossRefGoogle Scholar
Swerdlow, N. R., Caine, S. B., Braff, D. L., et al (1992) The neural substrates of sensorimotor gating of the startle reflex: a review of recent findings and their implications. Journal of Psychopharmacology, 6, 176–190.Google Scholar
Tallis, F. (1995) Obsessive-Compulsive Disorder: A Cognitive and Neuropsychological Perspective. New York: John Wiley & Sons.Google Scholar
Thorpe, S. J., Rolls, E. T. & Maddison, S. (1983) The orbitofrontal cortex: neuronal activity in the behaving monkey. Experimental Brain Research, 49, 93–115.Google Scholar
Vallar, G., Cappa, S. F. & Wallasch, C.-W. (eds) (1992) Neuropsychological Disorders Associated with Subcortical Lesions. Oxford: Oxford University Press.Google Scholar
van Oppen, P., De Haan, E., Van Balkom, A. J. L. M., et al (1995) Cognitive therapy and exposure in vivo in the treatment of obsessive-compulsive disorder. Behavior Research and Therapy, 33, 379–390.CrossRefGoogle ScholarPubMed
Zald, D. H. & Kim, S. W. (1996a) Anatomy and function of the orbital frontal cortex, I: anatomy, neurocircuitry, and obsessive-compulsive disorder. Journal of Neuropsychiatry, 8, 125–138.Google Scholar
Zald, D. H. & Kim, S. W. (1996b) Anatomy and function of the orbital frontal cortex, II: function and relevance to obsessive-compulsive disorder. Journal of Neuropsychiatry, 8, 249–261.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.