Intensive Cognitive-Behavioral Therapy For Obsessive-Compulsive Disorder
Condition: Obsessive-Compulsive Disorder (OCD)
MeSH terms: Compulsive Personality Disorder; Obsessive-Compulsive Disorder
Study type: Interventional

Summary: 
      Even with the best available treatments for obsessive-compulsive disorder (OCD), most
      patients only partially recover and many patients do not respond at all. Such incomplete and
      inadequate response contributes to greater public health costs in terms of morbidity and
      patient care expenses. This study aims for a better understanding of abnormal brain chemistry
      in OCD and how it is affected by cognitive-behavioral therapy (CBT) in order to develop novel
      therapies and improve the success of existing therapies. The main hypothesis is that CBT will
      change levels of the excitatory neurotransmitter glutamate in OCD patients in a region of the
      brain involved in OCD known as the cingulate cortex.
    

Detailed description: 
      This study will characterize the neurochemical abnormalities in important brain circuits
      underlying obsessive-compulsive disorder (OCD) symptoms and the effects of
      cognitive-behavioral therapy (CBT). Identification of such metabolite biomarkers will provide
      an important foundation for translational clinical studies to maximize the ability of CBT to
      reduce symptoms and to design medications that target core features of the disease, which is
      particularly important for those who do not respond to, or have access to, CBT.

      OCD is an often disabling and chronic psychiatric condition that affects approximately 2% of
      the world's population. Most patients respond only incompletely to current treatments and
      many do not respond at all. CBT, a form of psychotherapy, is one of the most effective
      treatments for OCD, yet its mechanism of action is not fully understood. The objective of
      this study is to use neuroimaging to understand how neurometabolite abnormalities in neural
      circuits relate to OCD symptoms, and how these are affected by CBT. In OCD, dysfunction is
      suspected in several subregions of the cingulate gyrus, a brain region involved in relevant
      neural circuits. This study will use magnetic resonance spectroscopic imaging (MRSI) to
      measure concentrations of brain metabolites, including glutamate (Glu), in the cingulate. Glu
      is an important excitatory neurotransmitter that is suspected to be disturbed in OCD. In this
      study, MRSI scans will be performed on 25 adult OCD patients before and after 4 weeks of
      daily CBT. They will be compared to 25 untreated healthy controls scanned 4 weeks apart. A
      third group of 25 OCD patients will be scanned before and after 4 weeks while on the
      waitlist, will then receive 4 weeks of CBT, and will be scanned a third time at its
      completion. The specific aims of this study are: 1) Determine if levels of the Glu in the
      "emotional" and "cognitive" subregions of the cingulate differ between OCD patients and
      controls; 2) Determine if Glu changes after CBT or waitlist in the OCD patients and if they
      change in the controls after simple passage of time; 3) Determine if there are relationships
      between Glu and clinical and neurocognitive symptoms of OCD before and after CBT.
    

Intervention name(s): Intensive Cognitive Behavioral Therapy (CBT); Waitlist
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Nondrug psychotherapy administered daily 5 days/week for 4 weeks; Minimal contact waitlist weekly for 4 weeks
Other intervention name(s): Exposure and Response Prevention (ERP)
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: obsessive-compulsive disorder (OCD); cognitive-behavioral therapy (CBT); magnetic resonance spectroscopy (MRS); glutamate; cingulate gyrus