Brain scan leads to understanding more precise treatments for OCD. This is first time brain connectivity has been used to predict effectiveness of post-treatment clinical course.

Researchers at the Semel Institute for Neuroscience and Human Behavior, UCLA suggest that visualizing certain aspects of the human brain could help doctors identify the people who are more prone to relapses after receiving cognitive-behavioral therapy for obsessive-compulsive disorder (OCD).

The reason for these relapses could also be understood, stated the study, which was published in the open-access Journal Frontiers in Psychiatry. This is the first time brain connectivity has been used to predict the effectiveness of a post-treatment clinical course.  

OCD – The Present Problem

About 2 percent of the entire American population will suffer from obsessive compulsive disorder at some point in their lives. OCD is characterized by having repetitive, intrusive and distressing thoughts or urges – obsessions – that are followed by a stereotyped recurrent behavior or action – compulsion. If not treated, the condition can become extremely stressful for the patient, affecting his or her ability to succeed in daily activities and hindering his role as a productive member of society.   

Among the most common and effective modes of OCD treatment is cognitive-behavioral therapy. This form of treatment aids the patient in understanding the thoughts and urges that negatively influence his behavior, and then help in eliminating them. However, all sufferers of OCD do not benefit from this treatment over the course of time – about 20 percent of patients experience a relapse of symptoms after the treatment has been completed.

What Study Revealed?

Feusner and Joseph O’Neill, a UCLA Associate Professor of Child Psychiatry and a Research Scientist at the Semel Institute, were co-principal investigators in the study. Using functional magnetic resonance imaging (fMRI), the team of researchers studied the brains of 17 individuals suffering from OCD, who were between the ages of 21 and 50. Brain scans were taken before and instantly after the individuals had completed a rigorous course of cognitive-behavioral therapy that lasted for four weeks. Also, doctors monitored the clinical symptoms of the individuals over the following 12 months.

“The efficiency of brain network connectivity before treatment predicts the worsening of symptoms after treatment,” explained Feusner. “We found that cognitive-behavioral therapy itself results in more densely connected local brain networks, which likely reflects more efficient brain activity.”

Moreover, the results also demonstrated that people who had a higher level of brain connectivity before receiving treatment actually exhibited worsening follow-ups. To the researcher’s surprise, the severity of their symptoms and the improvement in their symptoms through the course of treatment could not accurately predict whether the treatment would be successful in the long run.

Using Results For Better Future With OCD

“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,” said Feusner. “Thus, if someone will end up having their symptoms return, it would be useful to know before they get treatment.”

Feusner explained further that the findings did not conclude that people with OCD could not be helped with cognitive-behavioral therapy. The period of administering the treatment – currently four weeks – could be extended or alternative approaches, such as medication should also be looked into.  

The researchers are pursuing several other studies to help ascertain the effects of cognitive-behavioral therapy on the brains of people with OCD-like symptoms, such as anorexia nervosa.

“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,” stated Feusner.

They also plan to conduct another similar study using a larger sample, assessing various measures of brain structure and function, in the hopes of discovering more evidence that may help determine the effectiveness of treatment for OCD.