Basolateral amygdala-ventromedial prefrontal cortex connectivity predicts cognitive behavioural therapy outcome in adults with obsessive-compulsive disorder
Open accessAbstract
Background: Cognitive behavioural therapy (CBT), including exposure and ritual prevention, is a first-line treatment for obsessive–compulsive disorder (OCD), but few reliable predictors of CBT outcome have been identified. Based on research in animal models, we hypothesized that individual differences in basolateral amygdala–ventromedial prefrontal cortex (BLA–vmPFC) communication would predict CBT outcome in patients with OCD. Methods: We investigated whether BLA–vmPFC resting-state functional connectivity (rs-fc) predicts CBT outcome in patients with OCD. We assessed BLA–vmPFC rs-fc in patients with OCD on a stable dose of a selective serotonin reuptake inhibitor who then received CBT and in healthy control participants. Results: We included 73 patients with OCD and 84 healthy controls in our study. Decreased BLA–vmPFC rs-fc predicted a better CBT outcome in patients with OCD and was also detected in those with OCD compared with healthy participants. Additional analyses revealed that decreased BLA–vmPFC rs-fc uniquely characterized the patients with OCD who responded to CBT. Limitations: We used a sample of convenience, and all patients were receiving pharmacological treatment for OCD. Conclusion: In this large sample of patients with OCD, BLA–vmPFC functional connectivity predicted CBT outcome. These results suggest that future research should investigate the potential of BLA–vmPFC pathways to inform treatment selection for CBT across patients with OCD and anxiety disorders.
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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 [8]
Better CBT response in OCD is predicted by hyperactive fronto-limbic responses to OCD-provoking stimuli and weaker amygdala-prefrontal functional connectivity.
“Neuroimaging studies indicate that better CBT response in OCD is predicted by hyperactive fronto-limbic responses to OCD-provoking stimuli and weaker amygdala-prefrontal functional connectivity [52–53].”
From Toward a neurocircuit-based taxonomy to guide treatment of obsessive-compulsive disorder (2021) · cites this paper as [53]
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References 39 · Cited by 63
Research works printed but not linked: 3
- First M, Spitzer R, Gibbon M, et al. Structured Clinical Inteview for DSM-IV Axis I Disorders-Clinician Version (SCID-CV). Washing- ton (DC): American Psychiatric Press, Inc.; 1996.
- First M, Spitzer R, Gibbon M, et al. Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Non-patient Edition (SCID-I/NP). New York (NY): New York State Psychiatric Institute; 2002.
- Goodman WK, Price LH, Rasmussen SA, et al. The Yale-Brown Obsessive Compulsive Scale. Arch Gen Psychiatry 1989;46:1006.
- Authors
- Fullana, M. A., Zhu, X., Alonso, P., Cardoner, N., Real, E., López-Solà, C., Segalàs, C., Subirà, M., Galfalvy, H., Menchón, J. M., Simpson, H. B., Marsh, R., & Soriano-Mas, C.
- Affiliations
- Universitat Autònoma de Barcelona (ES)
- CIBERSAM, Instituto de Salud Carlos III, Spain
- ORCID
- Venue
- Journal of Psychiatry and Neuroscience
- Publisher
- Canadian Science Publishing
- Published
- 2017-11
- Volume
- 42
- Issue
- 6
- Pages
- 378-385
- ISSN
- 1180-4882 (ISSN-L)
- 1488-2434
- PMC
- PMC5662459
- OpenAlex
- W2765286625
- Cited by
- 63
- References
- 39
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 9 · 2023: 6 · 2022: 11 · 2021: 12 · 2020: 5 · 2019: 8 · 2018: 3
- FWCI
- 5.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Psychiatry and Neuroscience (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Dipòsit Digital de la Universitat de Barcelona (Universitat de Barcelona) (submittedVersion, public-domain)
- Funders
- Ministerio de Educación, Cultura y Deporte
- Centro de Investigación Biomédica en Red de Salud Mental
- Agència de Gestió d'Ajuts Universitaris i de Recerca (2014 SGR 1672)
- Instituto de Salud Carlos III (CPII16/00048, PI13/01958, PI14/00413, PI14/, PI12/01306, 00048, JR14/00038)
- European Regional Development Fund (CPII16/00048, PI14/00413, PI13/01958, PI12/01306)
- 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, treatment outcome prediction, basolateral amygdala, ventromedial prefrontal cortex, resting-state functional connectivity, exposure and response prevention, selective serotonin reuptake inhibitors, individual differences, treatment selection
- MeSH terms
- Adult, Brain Mapping, Female, Humans, Magnetic Resonance Imaging, Male, Neural Pathways, Obsessive-Compulsive Disorder, Prognosis, Regression Analysis, Rest, Cognitive Behavioral Therapy, Selective Serotonin Reuptake Inhibitors, Prefrontal Cortex, Basolateral Nuclear Complex
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