Abstract
Intensive cognitive-behavioral therapy (CBT) can effectively reduce symptoms in obsessive-compulsive disorder (OCD). However, many relapse after treatment. Few studies have investigated biological markers predictive of follow-up clinical status. The objective was to determine if brain network connectivity patterns prior to intensive CBT predict worsening of clinical symptoms during follow-up. We acquired resting-state functional magnetic resonance imaging data from 17 adults with OCD prior to and following 4 weeks of intensive CBT. Functional connectivity data were analyzed to yield graph-theory metrics. We examined the relationship between pre-treatment connectome properties and OCD clinical symptoms before and after treatment and during a 12-month follow-up period. Mean OCD symptom decrease was 40.4 ± 16.4% pre- to post-treatment (64.7% responded; 58.8% remitted), but 35.3% experienced clinically significant worsening during follow-up. From pre- to post-treatment, small-worldness and clustering coefficient significantly increased. Decreases in modularity correlated with decreases in OCD symptoms. Higher pre-treatment small-world connectivity was significantly associated with worsening of OCD symptoms during the follow-up period. Psychometric and neurocognitive measures pre- and post-treatment were not significant predictors. This is the first graph-theory connectivity study of the effects of CBT in OCD, and the first to test associations with follow-up clinical status. Results show functional network efficiency as a biomarker of CBT response and relapse in OCD. CBT increases network efficiency as it alleviates symptoms in most patients, but those entering therapy with already high network efficiency are at greater risk of relapse. Results have potential clinical implications for treatment selection.
Highlights
Obsessive–compulsive disorder (OCD) is characterized by recurrent, intrusive, disturbing thoughts, and/or stereotyped recurrent behaviors [1]
The goal of the current study was to investigate, for the first time, if pre-treatment functional network connectivity measures predict worsening of OCD symptoms subsequent to Cognitive-behavioral therapy (CBT) treatment
As post hoc exploratory analyses, we investigated the relationships between the graph-theory metrics and additional clinical measures of anxiety (HAMA), depression (MADRS), quality of life (Q-LES-Q), and general functioning (Sheehan) at follow-up
Summary
Obsessive–compulsive disorder (OCD) is characterized by recurrent, intrusive, disturbing thoughts (obsessions), and/or stereotyped recurrent behaviors (compulsions) [1]. Untreated OCD results in marked distress, and impaired functioning in social, occupational, and educational domains [2]. Cognitive-behavioral therapy (CBT) is an effective treatment for OCD [3]. CBT typically consists of weekly outpatient treatment or intensive daily treatment over several weeks. Intensive CBT is effective, resulting in sustained benefits [4, 5]. Intensive cognitive-behavioral therapy (CBT) can effectively reduce symptoms in obsessive–compulsive disorder (OCD). Few studies have investigated biological markers predictive of follow-up clinical status. The objective was to determine if brain network connectivity patterns prior to intensive CBT predict worsening of clinical symptoms during follow-up
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.