Obsessive-compulsive (DOC) disorder is a psychiatric condition characterized by obsessive thoughts and compulsive behaviors that cause significant discomfort and interfere with daily life.
In recent years, neuroscience have provided valuable information on neural correlated of the DOCcontributing to the understanding of this complex pathology.
More recently, studies have also been conducted on the neural changes of obsessive patients as a result of the cognitive behavioral intervention considered, from a psychotherapeutic point of view, the treatment of election for this pathology.
The neural correlates of obsessive-compulsive disorder
Among the main ones neural correlates of obsessive compulsive disorder The cortic-stratum-talamic-crime circuit were identified, the anterior cingolated cortex, the prefrontal dorsolateral lap and the substantia Nigra.
- Cortico-stratia-talamic-cortical circuit (CSTC): The CSTC seems to be one of the main brain circuits implicated in the doc. This circuit is involved in the control of attention, planning and movement. Its dysfunction, and in particular one hyperactivity of the circuithas been associated with the manifestation of obsessive-compulsive symptoms.
- Front trap cortex (CCA): The front praised cortex could play a key role in the appearance and maintenance of obsessive symptoms. The CCA is involved in the evaluation of the emotional importance of stimuli and in the regulation of emotional responses. Some studies have highlighted that this region also tends to hyperactively suffer from DOC, especially during the presentation of Stimuli related to their obsessions. This data confirms, on a neural level, a difficulty on the part of people who suffer from DOC to objectively evaluate the stimuli that activate the obsessions and, consequently, to produce coherent emotional responses.
- Prefrontal dorsolateral lap: Some studies have also highlighted a hypothesis of the prefrontal dorsolateral lap in the individuals suffering from obsessive-compulsive disorder. This area is involved in the planning, organization and control of behavioral responses. The hypothesis identified in this area suggests the presence of a deficit in the ability to inhibit compulsive responses and to modify obsessive thought patterns in patients with DOC.
- Substantia Nigra (SN): SN is involved in the production of dopamine, a neurotransmitter associated with motivation, reward and control of movements. Some studies have highlighted an alteration in Substantia Nigra in patients with obsessive compulsive disorder, suggesting that the dopamine has a role in the Patophysiology of the Doc.
Cognitive behavioral therapy for DOC
Cognitive-behavioral therapy (CBT) is one of the most effective therapeutic approaches for the treatment of the DOC.
It is based on two main types of intervention, the exposure with the prevention of the response and the cognitive renovation.
Exposure with response prevention (ERP) provides for the patient’s gradual exposure to his obsessive thoughts and the consequent prevention of the compulsive response. The goal is to help the patient a Learn to tolerate anxiety associated with obsessive thoughts without resorting to compulsive behaviors.
The cognitive restructuring aims to identify and modify the distorted or dysfunctional thoughts associated with the doc. The patient thus learns to recognize the discussion to question the irrational beliefs which feed the obsessive symptoms.
Neural implications of cognitive behavioral therapy for the DOC
Parallel to the attempt to understand the DOC neural related, in recent years, several studies have examined the neural changes associated with the CBT. They offered valuable information on neural bases of symptomatological improvement In obsessive-compulsive patients treated with a cognitive-behavioral approach.
Following cognitive-behavioral interventions aimed at the treatment of obsessive symptomatology, modifications have been identified in some of the brain areas involved in the DOC manifestation.
Through functional neuroimaging techniquesfor example, changes have been highlighted in the brain activation of obsessive patients subjected to cognitive behavioral treatment. In particular, a decrease in activity was observed in some brain regions involved in the processing of obsessive stimuli, such as the anterior tracked cortex and the lower front lap.
Some studies have also highlighted one reduction of hyperactivity in some of the areas of the cortico-stratia-talamic-cortical circuit (CSTC) In patients who had responded positively to cognitive behavioral intervention.
Finally, changes have also been highlighted in neural connectivity between the brain regions involved in the doc. In particular, some differences have been identified in the functional connectivity between the dorsolateral prefrontal cortex, the anterior tracked cortex and the striped body following the cognitive behavioral treatment.
Clinical implications
The research on the neural correlates of the Doc has contributed significantly to the understanding of the pathophysiology of this disorder and to the improvement of the related treatment options.
In this regard, research on neural implications derived from cognitive-behavioral treatment for the DOC They provide an evident confirmation of the therapeutic effectiveness of the CBT, validating this intervention as the therapeutic first choice therapeutic approach in the treatment of obsessive compulsive disorder.
In the future, moreover, the identification of the neural correlates involved in the genesis and maintenance of the DOC, combined with the in -depth study of the related changes associated with the psychotherapeutic intervention may provide detailed information on the mechanisms responsible for symptomatological improvementthus opening the way to the possibility of formulating specific therapeutic approaches, in line with the peculiar needs of each patient.
Bibliography
- Fitzgerald, KD, Stern, Er, Angstadt, M., Nicholson-Muth, Kc, Maynor, Mr, Welsh, RC, … & Taylor, SF (2010). Altered Function and Connectivity of the Medial Frontal Cortex in Pediatric Obsessive-Compulsive Disorder. Biological Psychiatry, 68 (11), 1039-1047.
- Harrison, BJ, Pujol, J., Soriano-Mas, C., Hernández-Ribas, R., López-Solà, M., Ortiz, H., … & Cardoner, N. (2012). Neural Related of Moral Sensititivity in Obsessive-Compulsive Disorder. Archives of General Psychiatry, 69 (7), 741-749.
- Menzies, L., Chamberlain, Sr, Laird, AR, Thelen, SM, Sahakian, BJ, & Bullmore, et (2008). Integoting evidence from Neuroimaging and Neuropsychological Studies of Obsessive-Compulsive Disorder: The Orbitofronto-Stiatal Model Revisited. Neuroscience & Biobehavoral Reviews, 32 (3), 525-549.
- Nakao, T., & Nakagawa, A. (2017). The Neurobiological Basis for the EffectoCy of Cognitive Behavoral Therapy in the Treatment of Obsessive-Compulsive Disorder. In Cognitive Behavoral Therapy in Japan (pp. 51-66). Springer, Singapore.
- Pauls, DL, Abramovitch, A., Rauch, SL, & Geller, from (2014). Obsexive-compulsive disorder: an supplementary genetic and neurobiological perspective. Nature Reviews Neuroscience, 15 (6), 410-424.
- Saxena, S., & Rauch, SL (2000). Functional Neuroimaging and the Neuroanatomy of Obsessive-compulsive disorder. Psychiatric Clinics of North America, 23 (3), 563-586.
