Predicting response to cognitive behavioral therapy in contamination-based obsessive-compulsive disorder from functional magnetic resonance imaging
Predicting response to cognitive behavioral therapy in contamination-based obsessive-compulsive disorder from functional magnetic resonance imaging
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DOI：
10.1017/s0033291713002766
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发表时间：
2014-07-01
影响因子：
6.9
通讯作者：
Mataix-Cols, D.
中科院分区：
文献类型：
--
作者：
Olatunji, B. O.;Ferreira-Garcia, R.;Mataix-Cols, D.
背景虽然认知行为疗法（CBT）是一种有效的治疗强迫症（OCD），很少有可靠的预测治疗结果已被确定。本研究探讨了强迫症患者的症状改善与CBT的神经相关性，主要是污染强迫症和洗涤强迫症，最常见的强迫症症状维度。参与者包括12名强迫症患者，他们在CBT 12周前接受功能性磁共振成像（fMRI）扫描时接受了与污染相关的图像的症状激发。症状激发期间的大脑活动模式与治疗后耶鲁-布朗强迫量表（YBOCS）的下降相关，即使在控制YBOCS和贝克抑郁量表（BDI）的基线评分以及治疗期间BDI的改善时也是如此。具体来说，参与情绪处理的大脑区域（如前颞极和杏仁核）的激活与更好的治疗反应密切相关。相比之下，在参与情绪调节的区域，如背外侧前额叶皮层，活动与治疗反应呈负相关，主要是在后期阶段内的每个区块的暴露在症状激发。在接触到威胁线索与污染为基础的强迫症患者的边缘系统区域的成功招聘可能有助于更好地应对CBT，而过度激活参与认知控制的背外侧前额叶区域可能会阻碍对治疗的反应。研究结果的理论意义及其与个性化护理方法的潜在相关性进行了讨论。
Background. Although cognitive behavioral therapy (CBT) is an effective treatment for obsessive-compulsive disorder (OCD), few reliable predictors of treatment outcome have been identified. The present study examined the neural correlates of symptom improvement with CBT among OCD patients with predominantly contamination obsessions and washing compulsions, the most common OCD symptom dimension.Method. Participants consisted of 12 OCD patients who underwent symptom provocation with contamination-related images during functional magnetic resonance imaging (fMRI) scanning prior to 12 weeks of CBT.Results. Patterns of brain activity during symptom provocation were correlated with a decrease on the Yale-Brown Obsessive Compulsive Scale (YBOCS) after treatment, even when controlling for baseline scores on the YBOCS and the Beck Depression Inventory (BDI) and improvement on the BDI during treatment. Specifically, activation in brain regions involved in emotional processing, such as the anterior temporal pole and amygdala, was most strongly associated with better treatment response. By contrast, activity in areas involved in emotion regulation, such as the dorsolateral prefrontal cortex, correlated negatively with treatment response mainly in the later stages within each block of exposure during symptom provocation.Conclusions. Successful recruitment of limbic regions during exposure to threat cues in patients with contamination-based OCD may facilitate a better response to CBT, whereas excessive activation of dorsolateral prefrontal regions involved in cognitive control may hinder response to treatment. The theoretical implications of the findings and their potential relevance to personalized care approaches are discussed.