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Reshaping the OCD Brain: How Therapy Changes Neural Connectivity

Summary: A new study finds that exposure and response prevention (EX/RP), a primary therapy for obsessive-compulsive disorder (OCD), effectively reshapes brain connectivity. This therapy improves cognitive control by strengthening connections within key neural networks.

Using advanced MRI techniques, researchers observed significant changes in the frontoparietal, cingulo-opercular, and default networks in OCD patients who underwent EX/RP compared to those who received stress management training. These results shed light on the neurological underpinnings of the effectiveness of EX/RP in the treatment of OCD.


  1. EX/RP therapy improves brain function in patients with OCD by improving connectivity in three critical cognitive control networks.
  2. The study used sophisticated MRI analysis to demonstrate patient-specific brain changes after EX/RP therapy, a new insight into the treatment of OCD.
  3. Ongoing research includes the use of cognitive training video games to further improve the outcomes of EX/RP therapy for patients with OCD.

Source: Elsevier

A first-line treatment for obsessive-compulsive disorder (OCD) reshapes brain connectivity, according to a new study published in Biological Psychiatry: Cognitive Neurosciences and Neuroimagingpublished by Elsevier.

OCD is an anxiety disorder characterized by repetitive thoughts and behaviors that can be disruptive or even disabling. The first-line treatment for OCD, a form of cognitive behavioral therapy called exposure and response prevention (EX/RP), is effective for many people with OCD, but how it works remains unclear.

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After treatment, OCD participants who received EX/RP showed enhanced connectivity between cognitive control networks, which was not observed in participants who received stress management. Credit: Neuroscience News

This new study shows that EX/RP training reshapes brain activity for better cognitive control.

In people with OCD, functional brain activity is affected in three neural networks that participate in cognitive control. The networks are the frontoparietal network (FPN), the cingulo-opercular network (CON), and the default mode network (DMN).

For the new study, 111 adolescents and adults with OCD received either EX/RP, designed to develop a patient’s coping skills through gradual exposure, or stress management training as a control treatment. Next, participants underwent magnetic resonance imaging (MRI) while performing a cognitive task.

After treatment, OCD participants who received EX/RP showed enhanced connectivity between cognitive control networks, which was not observed in participants who received stress management.

Lead author Kate Fitzgerald, MD, at Columbia University, said the study “is important because it shows how EX/RP improves brain function to treat OCD.” Specifically, EX/RP improved the connectivity of brain circuits underlying cognitive control, the ability to adjust repetitive thoughts and behaviors.

Leveraging the expertise of co-author Adriene Beltz, PhD, of the University of Michigan, the researchers used a sophisticated new analysis technique. Dr. Fitzgerald explained: “This allowed us to ‘see’ brain changes specific to the EX/RP patient that we were previously unable to discover using an older type of analysis that averages brain differences between patients. »

In an upcoming study, Dr. Fitzgerald uses a cognitive training video game to exercise brain circuits for cognitive control before patients even begin EX/RP therapy. “We hope this pre-treatment training will exercise the brain to help children respond more fully to EX/RP so they can overcome OCD.”

Cameron Carter, MD, editor-in-chief of Biological Psychiatry: Cognitive Neurosciences and Neuroimagingsaid of the work: “This study provides an important and clear example of how our growing understanding of the functional organization of brain circuits can be harnessed to develop highly targeted therapies and measure their impact on both symptoms painful symptoms of OCD. as well as the underlying brain circuits affected by the disorder.

About this research news on OCD and neuroscience

Author: Eileen Leahy
Source: Elsevier
Contact: Eileen Leahy – Elsevier
Picture: Image is credited to Neuroscience News

Original research: Free access.
“Changes in Brain Network Connections Following Exposure and Response Prevention Therapy for OCD in Adolescents and Adults” by Kate D. Fitzgerald et al. Biological Psychiatry Cognitive Neurosciences and Neuroimaging


Changes in Brain Network Connections After Exposure and Response Prevention Therapy for OCD in Adolescents and Adults


Functional alterations of tripartite neural networks during cognitive control (i.e., frontoparietal network (FPN), cingulo-opercular network (CON), and default mode network (DMN)) occur in patients suffer from obsessive-compulsive disorder (OCD) and may contribute to the expression of the illness.

However, the extent to which changes in these networks are driven by the reference treatment (e.g., exposure and response prevention; EX/RP) remains unknown. Understanding how EX/RP modulates network connectivity in adolescent and adult OCD patients may help identify developmentally sensitive treatment targets that improve cognitive control.


A total of 169 adolescent (13 to 17 years) and adult (25 to 40 years; 57% female) patients with OCD (n = 111) and healthy controls (HC; n = 58) were randomized to one group. EX/RP or a control group. active control therapy (stress management training; SMT). Participants performed a secondary task during functional magnetic resonance imaging (fMRI) pre-processing and post-processing. To retain sensitivity to individual differences in connectivity, group iterative multiple model estimation (GIMME) was used to assess functional connectivity (i.e., density) within and between brain networks. .


Significant increases in FPN density and decreases in FPN-DMN density were observed before and after treatment in patients who received EX/RP. The opposite patterns of change occurred in those who received TMS. These treatment-related changes in network density did not differ by age group.


Results suggest EX/RP-specific changes in task-based connectivity in OCD patients. Considering the baseline differences between HC and patients by age group, these treatment-related changes may indicate restoration of healthy development of FPN and DMN in patients, thereby providing targets for improving response to EX /RP.

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