Resting-State Connectivity and Response to Psychotherapy Treatment in Adolescents and Adults With OCD: A Randomized Clinical Trial
Open accessAbstract
OBJECTIVE: Cortical-subcortical hyperconnectivity related to affective-behavioral integration and cortical network hypoconnectivity related to cognitive control have been demonstrated in obsessive-compulsive disorder (OCD); the study objective was to examine whether these connectivity patterns predict treatment response. METHODS: Adolescents (ages 12-17) and adults (ages 24-45) were randomly assigned to 12 sessions of exposure and response prevention (ERP) or stress management therapy (SMT), an active control. Before treatment, resting-state connectivity of ventromedial prefrontal cortical (vmPFC), cingulo-opercular, frontoparietal, and subcortical regions was assessed with functional MRI. OCD severity was assessed with the Yale-Brown Obsessive Compulsive Scale before, during, and after treatment. Usable fMRI and longitudinal symptom data were obtained from 116 patients (68 female; 54 adolescents; 60 medicated). RESULTS: ERP produced greater decreases in symptom scores than SMT. ERP was selectively associated with less vmPFC-subcortical (caudate and thalamus) connectivity in both age groups and primarily in unmedicated participants. Greater symptom improvement with both ERP and SMT was associated with greater cognitive-control (cingulo-opercular and frontoparietal) and subcortical (putamen) connectivity across age groups. Developmental specificity was observed across ERP and SMT treatments, such that greater improvements with ERP than SMT were associated with greater frontoparietal-subcortical (nucleus accumbens) connectivity in adolescents but greater connectivity between frontoparietal regions in adults. Comparison of response-predictive connections revealed no significant differences compared with a matched healthy control group. CONCLUSIONS: The results suggest that less vmPFC-subcortical connectivity related to affect-influenced behavior may be important for ERP engagement, whereas greater cognitive-control and motor circuit connectivity may generally facilitate response to psychotherapy. Finally, neural predictors of treatment response may differ by age.
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This behavioral result provides convergent evidence that patients' response inhibition in action got better with therapy, translating the neural changes into measurable performance gains.
“This behavioral result – a significant Group × Time interaction for commission error rates – provides convergent evidence that patients’ response inhibition in action got better with therapy, translating the neural changes into measurable performance gains [39].”
From Neural correlates of response inhibition following cognitive behavioral therapy in obsessive–compulsive disorder: a randomized controlled EEG study (2026) · cites this paper as [39]
The Results (Clinical Outcomes; page unavailable) report reduced OCD symptoms, not commission error rates or improved response-inhibition performance. The Methods (Resting-state fMRI; page unavailable) describe baseline connectivity used to predict symptom decline, while the Discussion (Limitations; page unavailable) cautions that the functional significance of those connections during a task is unknown. Searches for a Group × Time interaction and post-therapy behavioral performance found no supporting passage. (LLM, conf=0.76)
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- Authors
- Russman Block, S., Norman, L. J., Zhang, X., Mannella, K. A., Yang, H., Angstadt, M., Abelson, J. L., Himle, J. A., Taylor, S. F., & Fitzgerald, K. D.
- Affiliations
- Department of Psychiatry (Russman Block, Norman, Zhang, Mannella, Angstadt, Abelson, Himle, Taylor, Fitzgerald) and School of Social Work (Himle), University of Michigan, Ann Arbor; Changzhi Medical College, Changzhi, China (Zhang); Department of Psychiatry, Second Xiangya Hospital, Central South University, Changsha, China (Yang); Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York (Fitzgerald).
- Central South University (CN)
- ORCID
- Venue
- American Journal of Psychiatry
- Published
- 2023-01-01
- Volume
- 180
- Issue
- 1
- Pages
- 89-99
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- PMC
- PMC10956516
- OpenAlex
- W4311718144
- Cited by
- 30
- References
- 49
- Citations by year
- 2026: 13 · 2025: 5 · 2024: 7 · 2023: 5
- FWCI
- 3.88
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- China Scholarship Council
- National Institutes of Health (5r01mh102242-05)
- National Institute of Mental Health (R01-MH102242)
- 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, resting-state functional connectivity, treatment response prediction, exposure and response prevention, ventromedial prefrontal cortex, cingulo-opercular network, frontoparietal network, caudate nucleus, thalamus, putamen, nucleus accumbens, cognitive control, adolescents, age differences, brain development
- MeSH terms
- Adolescent, Adult, Brain Mapping, Child, Female, Humans, Magnetic Resonance Imaging, Middle Aged, Nucleus Accumbens, Obsessive-Compulsive Disorder, Psychotherapy, Putamen, Prefrontal Cortex, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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