Treatment-Specific Associations Between Brain Activation and Symptom Reduction in OCD Following CBT: A Randomized fMRI Trial

This study examined if brain activity is associated with treatment response to CBT (cognitive behavioral therapy) in adolescents and adults with OCD. This was compared to a control group (stress management therapy). 

This was a RCT of 87 participants. 42 were assigned to CBT and 45 were assigned to SMT. Patients were required to have an early age at symptom onset (<15 years) and moderate or greater levels of symptoms at baseline – score >16 on either the standard or the Children’s version of the Yale-Brown Obsessive Compulsive Scale.

Participants received either 12 weeks of CBT incorporating exposure and response prevention or 12 weeks of SMT. Y-BOCS assessment of OCD severity occurred at the beginning, middle, and end of treatment (weeks 1, 6, and 12) by an independent rater blind to treatment assignment. Patients were also assessed for anxiety and depression symptoms and underwent scanning at the Functional MRI Laboratory at the University of Michigan, 6 weeks before treatment. SMT was included to control for potential nonspecific effects of time and weekly meetings with a therapist on symptom change

Both treatments showed a significant decrease in symptoms over time. CBT resulted in a steeper reduction in Y-BOCS scores over time compared with SMT. In the CBT group, a pattern of greater pretreatment activation during cognitive control and reward processing was associated with a better treatment response, while relatively less activation in these regions prior to treatment was associated with better outcomes after treatment in the SMT group. Follow-up analyses in adolescent and adult subgroups indicated that findings were conserved across age.

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