Dynamics of psychotherapy-related cerebral haemodynamic changes in obsessive compulsive disorder using a personalized exposure task in functional magnetic resonance imaging
Open accessAbstract
Background: Cognitive behavioural therapy (CBT) is a successful treatment of obsessive compulsive disorder (OCD). It is known to induce changes in cerebral metabolism; however, the dynamics of these changes and their relation to clinical change remain largely unknown, precluding the identification of individualized response biomarkers. Method: In order to study the dynamics of treatment response, we performed systematic clinical and functional magnetic resonance imaging (fMRI) evaluation of 35 OCD patients immediately before a 3-month course of CBT, halfway through and at its end, as well as 6 months after. To sensitize fMRI probing, we used an original exposure task using neutral, generic and personalized obsession-inducing images. Results: As expected, CBT produced a significant improvement in OCD. This improvement was continuous over the course of the therapy; therefore, outcome could be predicted by response at mid-therapy (r2 = 0.67, p < 0.001). Haemodynamic response to the task was located in the anterior cingulate and orbitofrontal cortices and was stronger during exposure to personalized obsession-inducing images. In addition, both the anxiety ratings and the haemodynamic response to the obsession-inducing images in the anterior cingulate and the left but not the right orbitofrontal clusters decreased with symptom improvement. Interestingly, haemodynamic activity continued to decrease after stabilization of clinical symptoms. Conclusions: Using an innovative and highly sensitive exposure paradigm in fMRI, we showed that clinical and haemodynamic phenotypes have similar time courses during CBT. Our results, which suggest that the initial CBT sessions are crucial, prompt us to investigate the anatomo-functional modifications underlying the very first weeks of the therapy.
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Task-based fMRI studies of EX/RP response have been limited to contamination- or checking-related image viewing tasks with small samples or nonsignificant prediction.
“To date, research on task-based fMRI predictors of EX/ RP response has been limited to contamination-or checkingrelated image viewing paradigms with either small samples or nonsignificant treatment prediction (9,10).”
From Task-based fMRI predicts response and remission to exposure therapy in obsessive-compulsive disorder (2019) · cites this paper as [10]
The findings highlight cognitive conflict resolution in cingulo-opercular and DMN regions as a potential large-effect predictor of EX/RP response.
“Thus, our findings build on literature examining neural predictors of EX/RP response in OCD (3-10), highlighting the resolution of cognitive conflict within cingulo-opercular and DMN regions as a potential predictor of EX/RP response with large effect size.”
From Task-based fMRI predicts response and remission to exposure therapy in obsessive-compulsive disorder (2019) · cites this paper as [10]
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Cyr, M., Pagliaccio, D., Yanes-Lukin, P. K., Fontaine, M., Rynn, M. A., & Marsh, R. (2020) · Neuropsychopharmacology · doi:10.1038/s41386-020-0613-3 · Cited by 41 · see citing works
Predictive Neuroimaging Markers of Psychotherapy Response: A Systematic Review
Chakrabarty, T., Ogrodniczuk, J. S., & Hadjipavlou, G. A. (2016) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000132 · Cited by 40 · see citing works
“A symptom provocation task–related design in 12 participants found bilateral ACC activity in reaction to anxiogenic images to be associated with nonresponse, though a larger study using a similar paradigm found no such association.(33,37) Metabolite levels in the pregenual ACC were also correlated with CBT response in…”
ResultZhong, Z., Yang, X., Cao, R., Li, P., Li, Z., Lv, L., & Zhang, D. (2019) · Brain and Behavior · doi:10.1002/brb3.1201 · Cited by 35 · see citing works
Mindfulness-Based Cognitive Therapy and the Adult ADHD Brain: A Neuropsychotherapeutic Perspective
Bachmann, K., Lam, A. P., & Philipsen, A. (2016) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2016.00117 · Cited by 36 · see citing works
“For instance, neuroimaging studies in OCD (obsessive compulsive disorder) samples (23, 24) revealed that exposure is associated with improved activity in brain areas involved in obsessive compulsive behavior.”
BackgroundHaynes, W. I. A., Clair, A.-H., Fernandez-Vidal, S., Gholipour, B., Morgiève, M., & Mallet, L. (2018) · European Psychiatry · doi:10.1016/j.eurpsy.2018.01.005 · Cited by 29 · see citing works
“gov NCT01331876, Ethics Committee approval 2009-A00652-55) [49] and a pathophysiology study (Ethics Committee approval 2007-A00488-45).”
BackgroundSelf-citationTask-based fMRI predicts response and remission to exposure therapy in obsessive-compulsive disorder
Pagliaccio, D., Middleton, R., Hezel, D., Steinman, S., Snorrason, I., Gershkovich, M., Campeas, R., Pinto, A., Van Meter, P., Simpson, H. B., et al. (2019) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1909199116 · Cited by 30 · see citing works
“To date, research on task-based fMRI predictors of EX/ RP response has been limited to contamination- or checkingrelated image viewing paradigms with either small samples or nonsignificant treatment prediction (9, 10).”
BackgroundMerchán, A., Mora, S., Gago, B., Rodríguez‐Ortega, E., Fernández‐Teruel, A., Puga, J. L., Sánchez-Santed, F., Moreno, M., & Flores, P. (2018) · Genes Brain & Behavior · doi:10.1111/gbb.12489 · Cited by 31 · see citing works
Weidt, S., Lutz, J., Rufer, M., Delsignore, A., Jakob, N. J., Herwig, U., & Bruehl, A. B. (2016) · Psychological Medicine · doi:10.1017/s0033291715002998 · Cited by 30 · see citing works
“Regional blood flow in the prefrontal cortex, insular (Schienle et al. 2005), and anterior cingulate cortex (ACC; Morgieve et al. 2014) has been found to be enhanced.”
BackgroundCunningham, N. R., Kashikar‐Zuck, S., & Coghill, R. C. (2019) · PAIN Reports · doi:10.1097/pr9.0000000000000767 · Cited by 30 · see citing works
Poli, A., Pozza, A., Orrù, G., Conversano, C., Ciacchini, R., Pugi, D., Angelo, N. L., Angeletti, L. L., Miccoli, M., & Gemignani, A. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.1063116 · Cited by 25 · see citing works
Unconscious psychological treatments for physiological survival circuits
Taschereau‐Dumouchel, V., Liu, K., & Lau, H. C. (2018) · Current Opinion in Behavioral Sciences · doi:10.1016/j.cobeha.2018.04.010 · Cited by 26 · see citing works
Data-Driven Approaches to Neuroimaging Analysis to Enhance Psychiatric Diagnosis and Therapy
Zhang, X., Braun, U., Tost, H., & Bassett, D. S. (2020) · Biological Psychiatry Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2019.12.015 · Cited by 27 · see citing works
Biria, M., Cantonas, L.-M., & Banca, P. (2021) · Current topics in behavioral neurosciences · doi:10.1007/7854_2020_201 · Cited by 26 · see citing works
Early effects of exposure-based cognitive behaviour therapy on the neural correlates of anxiety
Reinecke, A., Thilo, K. V., Croft, A. J., & Harmer, C. J. (2018) · Translational Psychiatry · doi:10.1038/s41398-018-0277-5 · Cited by 21 · see citing works
Traces of culture: The feedback loop between behavior, brain, and disorder
Crafa, D., & Nagel, S. K. (2020) · Transcultural Psychiatry · doi:10.1177/1363461519879515 · Cited by 21 · see citing works
“…resulting from selfreflection, such as may occur in psychotherapy, can also bring about brain-based changes; however, this research is still in the early stages (Frewen, Dozois, & Lanius, 2008; Linden, 2006; Morgiève et al., 2013; Roffman, Marci, Glick, Dougherty, & Rauch, 2005; Zaman, 2010).”
ResultEmpirically supported psychological treatments and the Research Domain Criteria (RDoC)
McKay, D., & Tolin, D. F. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.10.018 · Cited by 17 · see citing works
Functional Brain Imaging and OCD
Soriano‐Mas, C. (2021) · Current topics in behavioral neurosciences · doi:10.1007/7854_2020_203 · Cited by 17 · see citing works
Krysta, K., Krzystanek, M., Janas-Kozik, M. H., Klasik, A., & Krupka-Matuszczyk, I. (2014) · Journal of Neural Transmission · doi:10.1007/s00702-014-1282-3 · Cited by 18 · see citing works
“…structures of the brain is still growing, bringing more and more findings (Lindauer et al. 2008; Buchheim et al. 2012; Cervenka et al. 2012; Gawrysiak et al. 2013; Goldin et al. 2013; Morgiève et al. 2013; Schiepek et al. 2013) Recent advances in this filed were reviewed by Barsaglini et al. 2013.”
Viol, K., Schiepek, G. K., Kronbichler, M., Hartl, A. J., Grafetstätter, C., Strasser, P., Kastinger, A., Schöller, H. J., Reiter, E.-M., Said‐Yürekli, S., et al. (2020) · BMC Psychiatry · doi:10.1186/s12888-020-02913-5 · Cited by 14 · see citing works
Developing image sets for inducing obsessive-compulsive checking symptoms
Brooks, H., Kichuk, S. A., Adams, T. G., Koller, W. N., Eken, H. N., Rance, M., Monahan, S. E., Wasylink, S., Kelmendi, B., Pittenger, C., et al. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.04.035 · Cited by 10 · see citing works
Brecke, V., Thorsen, A. L., Ousdal, O. T., Vriend, C., Alnæs, D., Hagen, K., Hansen, B. K. A., Kvale, G., & van den Heuvel, O. A. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.674020 · Cited by 10 · see citing works
Maron, E., Lan, C.-C., & Nutt, D. (2018) · Current Topics in Behavioral Neurosciences · doi:10.1007/7854_2018_49 · Cited by 9 · see citing works
Dynamic Psychotherapy: The Therapeutic Process in the Treatment of Obsessive-Compulsive Disorder
Becker, J. P., Paixão, R. A. P., Silva, S., Quartilho, M. J., & Custódio, E. M. (2019) · Behavioral Sciences · doi:10.3390/bs9120141 · Cited by 8 · see citing works
Tandt, H. L. N., de Velde, N. V., Witte, S. D., Audenaert, K., Baeken, C., & Lemmens, G. M. D. (2020) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-020-01142-x · Cited by 8 · see citing works
Dai, J., Chen, K., Zhu, Y., Xia, L., Wang, T., Yuan, Z., & Zeng, P. (2023) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2023.110906 · Cited by 5 · see citing works
Conelea, C. A., Breitenfeldt, C., Wilens, A., Carpenter, L. L., Greenberg, B. D., Herren, J. A., Jacob, S., Lewis, C. P., McLaughlin, N. C. R., Mueller, B. A., et al. (2024) · Trials · doi:10.1186/s13063-024-08629-1 · Cited by 5 · see citing works
Fournier, J. C. J., Roberts, N., & Ford, K. L. (2020) · Journal of Personality · doi:10.1111/jopy.12605 · Cited by 5 · see citing works
Mapping the neuroanatomical abnormalities in a phenotype of male compulsive rats
Martín-González, E., Prados-Pardo, Á., Sawiak, S. J., Dalley, J. W., Padró, D., Ramos‐Cabrer, P., Mora, S., & Moreno, M. (2023) · Behavioral and Brain Functions · doi:10.1186/s12993-023-00221-y · Cited by 4 · see citing works
“Finally, this pattern is also found in the clinical literature, when the potential brain differences in compulsive patients become evident during the exposition to the problem situation [15, 16, 19], supporting SIP as a valid and translational model for the study of compulsivity.”
BackgroundMorgiève, M., N’Diaye, K., Clair, A.-H., Pelissolo, A., & Mallet, L. (2016) · L Encéphale · doi:10.1016/j.encep.2016.03.004 · Cited by 3 · see citing works
Self-citationAupperle, R. L., Berg, H. E., & Armstrong, J. (2024) · Current topics in behavioral neurosciences · doi:10.1007/7854_2024_549 · Cited by 3 · see citing works
Morphopathological changes in obsessive-compulsive disorder
Drăgoi, A. M., Pecie, L.-G., Patrichi, B. E., & Ladea, M. (2020) · Romanian Journal of Morphology and Embryology · doi:10.47162/rjme.61.1.06 · Cited by 3 · see citing works
“The aim is to regain cortical control over these dysfunctional behaviors [37].”
BackgroundInfluentialUnconscious Psychological Treatments for Physiological Survival CircuitsPreprint
Taschereau‐Dumouchel, V., Liu, K., & Lau, H. C. (2018) · doi:10.31234/osf.io/c7jfd · Cited by 4 · see citing works
Morgiève, M., & Briffault, X. (2014) · Socio-logos · doi:10.4000/socio-logos.2882 · Cited by 2 · see citing works
Self-citationNeurowissenschaftliche Befunde zur Psychotherapie von Angststörungen
Brühl, A. B., Herwig, U., Rufer, M., & Weidt, S. (2015) · Zeitschrift für Psychiatrie Psychologie und Psychotherapie · doi:10.1024/1661-4747/a000229 · Cited by 2 · see citing works
Karch, S., Maywald, M., Schwartz, C., Heil, C., Neumüller, J., Keeser, D., Garcia, S., Tschentscher, N., Pogarell, O. M., Paolini, M., et al. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1256046 · Cited by 2 · see citing works
Support Group as a Management Modality for Burning Mouth Syndrome: A Randomized Prospective Study
Becker, T., Hamzani, Y., Chaushu, G., Perry, S., & Yahya, B. H. (2021) · Applied Sciences · doi:10.3390/app11167207 · Cited by 2 · see citing works
Maciaszek, J., Zabłocka, A., Rejek, M., Senczyszyn, A., Rudy, K., Błoch, M., Bubniak, A., Leszynska, K., Jakubczyk, D., Bogudzińska, B., et al. (2025) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2025.02.060 · Cited by 1 · see citing works
Heinzel, S., Kaufmann, C., Grützmann, R., Elsner, B., Reuter, B., Klawohn, J., Riesel, A., Bey, K., Wagner, M., & Kathmann, N. (2025) · Translational Psychiatry · doi:10.1038/s41398-025-03608-9 · Cited by 1 · see citing works
“A current meta-analysis [17] identi fi ed four studies in OCD that used task-based fMRI to predict psychotherapy response, based on fear conditioning [18], symptom provocation [19, 20], and incentive fl anker [21] tasks.”
L’imagerie au service de la stimulation cérébrale profonde
Aouizerate, B. (2015) · Annales Médico-psychologiques revue psychiatrique · doi:10.1016/j.amp.2015.01.005 · Cited by 1 · see citing works
Rabasco, A., Ambrosino, M., & McKay, D. (2019) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2019.100452 · Cited by 1 · see citing works
Psychiatry and Neuroscience: At the Interface
Nicola, V. D., & Stoyanov, D. (2021) · Springer eBooks · doi:10.1007/978-3-030-55140-7_4 · Cited by 1 · see citing works
Functional Magnetic Resonance Imaging Studies of Obsessive-Compulsive and Related Disorders
Han, J., & Kwon, J. S. (2018) · Cambridge University Press eBooks · doi:10.1017/9781108164313.010
The biological mechanism of cognitive behavioral therapy
Gao, J. H., Wang, P., & Li, Z. (2019) · Advances in Psychological Science · doi:10.3724/sp.j.1042.2019.00522
“近 10 年来, 越来越多的研究显示免疫因素在 精神疾病的发生发展中起到了至关重要的作用 , 荟萃分析结果显示, 在抑郁患者中促炎细胞因子 白细胞介素 6 (interleukin 6, IL-6)以及肿瘤坏死因 子 α (tumor necrosis factor-α, TNF-α)的浓度显著 高于正常对照(Dowlati et al., 2010; Liu, Ho, & Mak, 2012)。而 CBT 在改善抑郁患者临床症状的 同时, 患者血清内 IL-6 的水平同时也下降, 这提 示 CBT可以调节患者外周血内促炎细胞因子水平 (Gazal et al., 2013)。也有研究同样发现经过 CBT 治疗后, MDD 患者血…”
InfluentialTherapy in the Past and Present
Wasserman, T. H., & Wasserman, L. D. (2019) · Springer eBooks · doi:10.1007/978-3-030-26921-0_2
Basic mechanisms of, and treatment planning/targets for, obsessive–compulsive disorder
Burguière, E., & Mallet, L. (2020) · doi:10.1093/med/9780198713005.003.0094
Self-citationTCC et neurosciences : l’évaluation de la TCC par la neuro-imagerie cérébrale
Cottraux, J. A. (2020) · Elsevier eBooks · doi:10.1016/b978-2-294-76778-4.00025-9
Obsessive Compulsive Disorder: Neurobiology and Treatment
Hoffman, K. L. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-820472-6.00161-4
Clair, A.-H., & Trybou, V. (2018) · Dunod eBooks · doi:10.3917/dunod.clair.2018.01.0213
Neuroanatomy of Obsessive-Compulsive and Related Disorders
Thorsen, A. L., & van den Heuvel, O. A. (2023) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780190068752.013.7
Viol, K., Schiepek, G., Kronbichler, M., Hartl, A. J., Grafetstätter, C., Strasser, P., Kastinger, A., Schöller, H. J., Reiter, E.-M., Said‐Yürekli, S., et al. (2020) · Figshare · doi:10.6084/m9.figshare.13290493
Vriend, C., Broekhuizen, A., Wolf, N., van Oppen, P., van den Heuvel, O. A., & Visser, H. A. D. (2026) · medRxiv · doi:10.64898/2026.02.10.26345974
Haynes, W. I. A. (2014) · doi:10.70675/bc75d92dz55b5z447azbb70z2e28f320b4e7
Self-citationVriend, C., Broekhuizen, A., Wolf, N., van Oppen, P., van den Heuvel, O. A., & Visser, H. A. D. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.122145
- Authors
- Morgiève, M., N'Diaye, K., Haynes, W. I. A., Granger, B., Clair, A.-H., Pelissolo, A., & Mallet, L.
- Affiliations
- Centre National de la Recherche Scientifique (FR)
- Pitié-Salpêtrière Hospital (FR)
- Corresponding author
- Mallet, L.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2013-09-04
- Volume
- 44
- Issue
- 7
- Pages
- 1461-1473
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2153281793
- Cited by
- 74
- References
- 64
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 3 · 2023: 4 · 2022: 2 · 2021: 7 · 2020: 11 · 2019: 9 · 2018: 11 · 2017: 2 · 2016: 8 · 2015: 9 · 2014: 4
- FWCI
- 7.77
- Type
- journal article
- Language
- en
- Open access
- green
- hal.science
- Licence
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion, other-oa)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- obsessive-compulsive disorder, cognitive behavioral therapy, anterior cingulate cortex, orbitofrontal cortex, treatment response biomarkers, anxiety
- MeSH terms
- Adult, Cerebral Cortex, Cerebrovascular Circulation, Female, Hemodynamics, Humans, Magnetic Resonance Imaging, Male, Obsessive-Compulsive Disorder, Cognitive Behavioral Therapy, Treatment Outcome
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