MedicalResearch.com Interview with:
Jamie D. Feusner, M.D.
Associate Professor of Psychiatry and Biobehavioral Sciences
Director, Adult OCD Program
Director, Eating Disorder and Body Dysmorphic Disorder Research Program
Semel Institute for Neuroscience and Human Behavior
David Geffen School of Medicine at UCLA
University of California, Los Angeles
Los Angeles, CA 90095
Medical Research: What is the background for this study? What are the main findings?
Dr. Feusner: Cogntive-behavioral therapy (CBT), is an effective treatment for most people OCD,with response rates between 50-70%. However, a portion of the people who respond will experience a return of their symptoms after the therapy, with 20% meeting criteria for relapse. In this study we set out to determine if brain connectivity patterns prior to treatment, derived from fMRI brain scans, can help predict worsening of symptoms after a course of intensive CBT.
We found that a pattern of “small-worldness,” which is a measure of efficiency of brain network organization, was significantly associated with worsening of OCD symptoms after 4 weeks of intensive cogntive-behavioral therapy. Those with higher network efficiency, interestingly, were the ones more likely to experience worsening. Yet almost all of the participants improved in their OCD symptoms with the treatment. So (although it remains to be further studied) one possible interpretation is that brain network reorganization may need to occur contemporaneously with symptom improvement during CBT in order to maintain the gains beyond the therapy period. Those who are already at the “ceiling” of network efficiency may not have room for this network reorganization.
Another interesting finding was that the severity of symptoms prior to treatment, and even after treatment, did not predict who would experience worsening of symptoms in the follow-up period.
Medical Research: What should clinicians and patients take away from your report?
Dr. Feusner: In addition to the finding that CBT is an effective treatment for obessive compulive disorder that results in reorganization of brain networks, this is a promising early indication that in the future we may be able to use brain scans to help predict who may do better or worse in the long run after CBT. This could potentially help improve personalization of treatment, so that we can identify which treatments (e.g. shorter or longer courses of CBT, medications, medications plus CBT, brain stimulation) could be the most likely to help an OCD sufferer, in the long run. This could reduce time, cost, and suffering otherwise associated with “trial and error” approaches to treatment for OCD.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Feusner: This is a small, preliminary study. Thus, we need to replicate the results in a larger sample of people with OCD, and with a more controlled follow-up so we can make sure that other factors are not contributing to changes in symptoms after CBT. In addition, we plan to test whether combinations of other brain factors such as neurochemistry and other connectivity patterns may be able to provide even better predictors, which could eventually be tested to determine their predictive value on the level of an individual person.
Brain connectivity and prediction of relapse after cognitive-behavioral therapy in obsessive–compulsive disorder
Jamie D. Feusner,1,* Teena Moody,1 Tsz Man Lai,1 Courtney Sheen,1 Sahib Khalsa,2,3 Jesse Brown,4 Jennifer Levitt,1 Jeffry Alger,5 and Joseph O’Neill1
Front. Psychiatry, 20 May 2015
Jamie D. Feusner, M.D. Associate Professor of Psychiatry and Biobehavioral Sciences, & Director, Adult OCD Program (2015). Brain Scans May Predict Which OCD Patients Will Improve With Cogntive-Behavioral Therapy