Neurocircuit Mechanisms of OCD Across the Lifespan
Condition: Obsessive-Compulsive Disorder
MeSH terms: Obsessive-Compulsive Disorder
Study type: Interventional

Summary: 
      Obsessive-compulsive disorder (OCD), characterized by intrusive thoughts (obsessions) and
      related behavioral rituals (compulsions), is a common psychiatric illness that often emerges
      in childhood and causes life-long disability in over 50% of patients. Psychological theory
      suggests that OCD symptoms are driven by a person's difficulty disengaging their feelings
      from simple tasks (e.g. washing hands, locking a door) due to excessive anxiety about
      performance errors. Cognitive behavioral therapy (CBT), the gold standard treatment for OCD,
      repeatedly exposes patients to their OCD-stressor until this anxiety is reduced. While CBT is
      typically more effective in teenagers than adults, patients from both age groups are usually
      left with residual symptoms, highlighting the need for better treatments. In this study, CBT
      will be studied in both teen-aged and adult patients. Two groups, both with childhood onset
      OCD, will be randomized to either CBT for OCD or stress management training (SMT), an active
      therapy but with minimal effects on OCD symptoms. The investigators will also study
      age-matched, healthy controls as comparison subjects.

      Before and after 12 weeks of CBT, all subjects will undergo functional Magnetic Resonance
      Imaging (fMRI) scans to see what regions of the brain become active when a concentration task
      is performed and how that activation is changed after CBT. The purpose of this study is to
      demonstrate the brain changes associated with CBT treatment and how differences in these
      changes in teenage compared to adult patients may drive differences in CBT response.
    

Detailed description: 
      While the study itself is of parallel design for its data-collection and measurement purpose,
      it is listed as a partial-crossover design in the IRB-approved protocol because subjects
      randomized to the SMT group are given the option of entering 12-weeks of CBT sessions after
      all of their SMT data collection. To understand brain changes that occur with CBT compared to
      SMT in both age groups, the investigators will collect fMRI data before and after therapy.
      Some limited data will be collected in patients who are initially randomized to SMT but then
      opt to crossover to CBT. fMRI data will also be collected in healthy teens and adults before
      and after 12 weeks (but without intervening therapy) to allow the investigators to control
      for the simple effects of time that may cause brain changes that are not related to therapy.
    

Intervention name(s): Cognitive Behavioral Therapy - Adolescents; Stress Management Therapy - Adolescents; Optional CBT - Adolescents; Cognitive Behavioral Therapy - Adults; Stress Management Therapy - Adults; Optional CBT - Adults; fMRI only - Healthy Control Adults; fMRI only - Healthy Control Adolescents
Intervention type(s): Behavioral; Behavioral; Behavioral; Behavioral; Behavioral; Behavioral; Other; Other
Intervention description(s): A therapy which gradually yet repeatedly exposes adolescent patients to their obsessive compulsive-relevant "error" cues during a task performance until their anxiety habituates.; An active control therapy with minimal effects on OCD symptoms.; This is the cross-over element for those that completed the SMT treatment group and opt to have the OCD treatment.; A therapy which gradually yet repeatedly exposes adult patients to their obsessive compulsive-relevant "error" cues during a task performance until their anxiety habituates.; An active control therapy with minimal effects on OCD symptoms.; This is the cross-over element for those that completed the SMT treatment group and opt to have the OCD treatment.; Two fMRI's only, scheduled at 12-weeks apart. This is for Healthy Control Adults and is used only as a means for observation, NOT as an intervention to be studied.; Two fMRI's only, scheduled at 12-weeks apart. This is for Healthy Control Adolescents and is used only as a means for observation, NOT as an intervention to be studied.
Other intervention name(s): CBT; SMT; CBT; CBT; SMT; CBT
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: OCD