Essay on Predicting the Response to Cognitive Behavioral Therapy in Obsessive-Compulsive Disorder Using Functional Connectivity

Introduction

Obsessive-compulsive disorder is a condition in which victims engage in unusual behaviors and repetitive activities, such as multiple washing of hands. The most widely used clinical treatment of OCD is cognitive-behavioral therapy (CBT). However, CBT is an expensive therapy that consumes a lot of time with its effectiveness ranging from moderate or high.

The ability to predict various responses by OCD victims to CBT is a crucial medical concern that is significant in enabling the minimization of the resources used for treatment. This paper examines the multivariate patterns of the brain in foretelling an individual’s response to CBT therapy and shows how studying brain functional connectivity (FC) has tremendous benefits in understanding OCD and its treatment.

Summary

One of the most commonly applied control of obsessive-compulsive disorder (OCD) is cognitive-behavioral therapy (CBT). However, studies indicate that different patients respond differently to the treatment, thus creating the need for finding ways to predict the outcome of the procedure. The objective of this paper is to assess the severity of post-therapy symptoms using functional connectivity (FC) as a prediction tool.

A total of forty-two participants took part in the four-week manualized CBT after recruitment, which involved scoring over fifteen points on the Yale-brown Obsessive Compulsive Scale. Brain examinations of patients on a quiet mode enabled the collection of fMRI records for two categories of patients: treatment and waitlist. Results indicated thirty-nine percent and 3.2 percent improvement in post-treatment and post-waitlist symptoms, respectively. The default mode network (DMN) showed stronger improvement of post-treatment symptoms with a record of sixty-seven percent. These changes in post-therapy symptoms indicated that OCD was more closely associated with CBT than passing the time. Furthermore, these results showed the possibility of OCD patients to return to normal.

In conclusion, Reggente et al. observed that predicting the outcome of CBT treatment on OCD patients was possible. As a result, they recommended that healthcare providers should adopt the pretreatment projection of individual responses to CBT because this move would improve the recovery rate of patients.

Discussion

Reggente et al.¹ claim that functional connectivity can completely cure and normalize the symptoms of OCD through intensive pretest brain examination. This claim raises various questions concerning the safety of such intense brain stimulation, and Bosanac et al.² share different views.

In a study involving a father and his son with OCD, Bosanac et al. observed that the burden of normality following a deep brain stimulation (DBS) surgery resulted in distorted self-concept.² According to Bosanac et al., the sudden shift from a severe state of illness to a sharp relief had a negative implication on OCD patients, mostly psychological problems. However, Bosanac et al.² also highlight the need for more profound research on the subject of DBS for allowing generalization of results.

On the contrary, Gabriel et al.³ argue that DBS might be a reliable alternative treatment for OCD based on their research involving the review of 279 articles. Gabriel et al. found five DBS procedures for curing OCD, which showed a significant similarity in the outcome, thus terming DBS as a promising therapy.³ However, Gabriel et al. recommend further studies to help comprehend the workings of deep brain stimulation treatment.

Conclusion

Functional connectivity has a significant role in predicting how obsessive-compulsive disorder (OCD) responds to treatment. This paper examines procedures for cognitive behavioral therapy (CBT) and how responsive the method is to brain stimulation. A series of individual treatment sessions on forty-two OCD patients were conducted for four weeks, and the post-treatment measurements recorded. The experiment tested positive, leading to the conclusion that cognitive-behavioral therapy is significantly responsive to functional connectivity procedures.

References

1. Reggente N, Moody TD, Morfini F, Sheen C, Rissman J, O’Neill J, Feusner JD. Multivariate resting-state functional connectivity predicts response to cognitive behavioral therapy in obsessive–compulsive disorder. Proceedings of the National Academy of Sciences. 2018 Feb 27;115(9):2222-7
2. Bosanac P, Hamilton BE, Lucak J, Castle D. Identity challenges and ‘burden of normality’ after DBS for severe OCD: a narrative case study. BMC psychiatry. 2018 Dec;18(1):186.
3. Gabriëls L, Cosyns P, Nuttin B, Demeulemeester H, Gybels J. Deep brain stimulation for treatment‐refractory obsessive‐compulsive disorder: psychopathological and neuropsychological outcome in three cases. Acta Psychiatrica Scandinavica. 2003 Apr;107(4):275-82.