Skip to main content Accessibility help

Dynamics of psychotherapy-related cerebral haemodynamic changes in obsessive compulsive disorder using a personalized exposure task in functional magnetic resonance imaging

  • M. Morgiève (a1) (a2), K. N'Diaye (a1) (a2), W. I. A. Haynes (a1) (a2), B. Granger (a3), A.-H. Clair (a1), A. Pelissolo (a2) (a4) and L. Mallet (a1) (a2) (a5)...



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.


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.


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 (r 2 = 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.


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.


Corresponding author

* Address for correspondence: L. Mallet, M.D., Ph.D., Behaviour, Emotion, and Basal Ganglia Team, UPMC, Inserm UMRS 975, CNRS UMR 7225, ICM (Brain and Spine Institute), Pitié-Salpêtrière Hospital, 47, Bd de L'Hôpital, 75013 Paris, France. (Email:


Hide All
Abramowitz, JS, Foa, EB (1998). Worries and obsessions in individuals with obsessive–compulsive disorder with and without comorbid generalized anxiety disorder. Behaviour Research and Therapy 36, 695700.
Abramowitz, JS, Franklin, ME, Schwartz, SA, Furr, JM (2003). Symptom presentation and outcome of cognitive behavioral therapy for obsessive–compulsive disorder. Journal of Consulting and Clinical Psychology 71, 10491057.
Abramowitz, JS, Taylor, S, McKay, D (2009). Obsessive–compulsive disorder. Lancet 374, 491499.
Adler, CM, McDonough-Ryan, P, Sax, KW, Holland, SK, Arndt, S, Strakowski, SM (2000). fMRI of neuronal activation with symptom provocation in unmedicated patients with obsessive compulsive disorder. Journal of Psychiatric Research 34, 317324.
Apostolova, I, Block, S, Buchert, R, Osen, B, Conradi, M, Tabrizian, S, Gensichen, S, Schroder-Hartwig, K, Fricke, S, Rufer, M, Weiss, A, Hand, I, Clausen, M, Obrocki, J (2010). Effects of behavioral therapy or pharmacotherapy on brain glucose metabolism in subjects with obsessive–compulsive disorder as assessed by brain FDG PET. Psychiatry Research 184, 105116.
Baxter, LR Jr., Saxena, S, Brody, AL, Ackermann, RF, Colgan, M, Schwartz, JM, Allen-Martinez, Z, Fuster, JM, Phelps, ME (1996). Brain mediation of obsessive–compulsive disorder symptoms: evidence from functional brain imaging studies in the human and nonhuman primate. Seminars in Clinical Neuropsychiatry 1, 3247.
Beck, AT, Beamesderfer, A (1974). Assessment of depression: the depression inventory. Modern Problems of Pharmacopsychiatry 7, 151169.
Beutel, ME, Stark, R, Pan, H, Silbersweig, D, Dietrich, S (2010). Changes of brain activation pre- post short-term psychodynamic inpatient psychotherapy: an fMRI study of panic disorder patients. Psychiatry Research 184, 96104.
Blumberg, HP, Leung, HC, Skudlarski, P, Lacadie, CM, Fredericks, CA, Harris, BC, Charney, DS, Gore, JC, Krystal, JH, Peterson, BS (2003). A functional magnetic resonance imaging study of bipolar disorder: state- and trait-related dysfunction in ventral prefrontal cortices. Archives of General Psychiatry 60, 601609.
Bouvard, M (2006). Obsessive Compulsive Disorder. Principles, Therapies, Applications [In French]. Masson: Paris.
Breton-Lopez, J, Quero, S, Botella, C, Garcia-Palacios, A, Banos, RM, Alcaniz, M (2010). An augmented reality system validation for the treatment of cockroach phobia. Cyberpsychology, Behavior and Social Networking 13, 705710.
Brody, AL, Saxena, S, Schwartz, JM, Stoessel, PW, Maidment, K, Phelps, ME, Baxter, LR Jr. (1998). FDG-PET predictors of response to behavioral therapy and pharmacotherapy in obsessive compulsive disorder. Psychiatry Research 84, 16.
Butler, AC, Chapman, JE, Forman, EM, Beck, AT (2006). The empirical status of cognitive–behavioral therapy: a review of meta-analyses. Clinical Psychology Review 26, 1731.
Chamberlain, SR, Menzies, L (2009). Endophenotypes of obsessive–compulsive disorder: rationale, evidence and future potential. Expert Review of Neurotherapeutics 9, 11331146.
Chamberlain, SR, Menzies, L, Hampshire, A, Suckling, J, Fineberg, NA, del Campo, N, Aitken, M, Craig, K, Owen, AM, Bullmore, ET, Robbins, TW, Sahakian, BJ (2008). Orbitofrontal dysfunction in patients with obsessive–compulsive disorder and their unaffected relatives. Science 321, 421422.
Chapman, HA, Bernier, D, Rusak, B (2010). MRI-related anxiety levels change within and between repeated scanning sessions. Psychiatry Research 182, 160164.
Clark, DA, Beck, AT (2010). Cognitive theory and therapy of anxiety and depression: convergence with neurobiological findings. Trends in Cognitive Sciences 14, 418424.
Denys, D, Tenney, N, van Megen, HJ, de Geus, F, Westenberg, HG (2004). Axis I and II comorbidity in a large sample of patients with obsessive–compulsive disorder. Journal of Affective Disorders 80, 155162.
Eddy, KT, Dutra, L, Bradley, R, Westen, D (2004). A multidimensional meta-analysis of psychotherapy and pharmacotherapy for obsessive–compulsive disorder. Clinical Psychology Review 24, 10111030.
Everitt, BJ, Robbins, TW (2005). Neural systems of reinforcement for drug addiction: from actions to habits to compulsion. Nature Neuroscience 8, 14811489.
Foster, PS, Eisler, RM (2001). An integrative approach to the treatment of obsessive–compulsive disorder. Comprehensive Psychiatry 42, 2431.
Gava, I, Barbui, C, Aguglia, E, Carlino, D, Churchill, R, De Vanna, M, McGuire, HF (2007). Psychological treatments versus treatment as usual for obsessive compulsive disorder (OCD). Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD005333. DOI: 10.1002/14651858.CD005333.pub2.
Gillan, CM, Papmeyer, M, Morein-Zamir, S, Sahakian, BJ, Fineberg, NA, Robbins, TW, de Wit, S (2011). Disruption in the balance between goal-directed behavior and habit learning in obsessive–compulsive disorder. American Journal of Psychiatry 168, 718726.
Goodman, WK, Price, LH, Rasmussen, SA, Mazure, C, Fleischmann, RL, Hill, CL, Heninger, GR, Charney, DS (1989). The Yale–Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Archives of General Psychiatry 46, 10061011.
Graybiel, AM (2008). Habits, rituals, and the evaluative brain. Annual Review of Neuroscience 31, 359387.
Graybiel, AM, Rauch, SL (2000). Toward a neurobiology of obsessive–compulsive disorder. Neuron 28, 343347.
Haynes, WIA, Mallet, L (2010). High-frequency stimulation of deep brain structures in obsessive–compulsive disorder: the search for a valid circuit. European Journal of Neuroscience 32, 11181127.
Hoexter, MQ, de Souza Duran, FL, D'Alcante, CC, Dougherty, DD, Shavitt, RG, Lopes, AC, Diniz, JB, Deckersbach, T, Batistuzzo, MC, Bressan, RA, Miguel, EC, Busatto, GF (2012). Gray matter volumes in obsessive–compulsive disorder before and after fluoxetine or cognitive–behavior therapy: a randomized clinical trial. Neuropsychopharmacology 37, 734745.
Huyser, C, van den Heuvel, OA, Wolters, LH, de Haan, E, Boer, F, Veltman, DJ (2013). Increased orbital frontal gray matter volume after cognitive behavioural therapy in paediatric obsessive compulsive disorder. World Journal of Biological Psychiatry 14, 319331.
Jaurieta, N, Jimenez-Murcia, S, Alonso, P, Granero, R, Segalas, C, Labad, J, Menchon, JM (2008). Individual versus group cognitive behavioral treatment for obsessive–compulsive disorder: follow up. Psychiatry and Clinical Neurosciences 62, 697704.
Kim, K, Kim, SI, Cha, KR, Park, J, Rosenthal, MZ, Kim, JJ, Han, K, Kim, IY, Kim, CH (2010). Development of a computer-based behavioral assessment of checking behavior in obsessive–compulsive disorder. Comprehensive Psychiatry 51, 8693.
Koran, LM, Hanna, GL, Hollander, E, Nestadt, G, Simpson, HB, American Psychiatric Association (2007). Practice guideline for the treatment of patients with obsessive–compulsive disorder. American Journal of Psychiatry 164, 553.
Laurenceau, JP, Hayes, AM, Feldman, GC (2007). Some methodological and statistical issues in the study of change processes in psychotherapy. Clinical Psychology Reviews 27, 682695.
Linden, DE (2006). How psychotherapy changes the brain – the contribution of functional neuroimaging. Molecular Psychiatry 11, 528538.
Mataix-Cols, D, Wooderson, S, Lawrence, N, Brammer, MJ, Speckens, A, Phillips, ML (2004). Distinct neural correlates of washing, checking, and hoarding symptom dimensions in obsessive–compulsive disorder. Archives of General Psychiatry 61, 564576.
Menzies, L, Chamberlain, SR, Laird, AR, Thelen, SM, Sahakian, BJ, Bullmore, ET (2008). Integrating evidence from neuroimaging and neuropsychological studies of obsessive–compulsive disorder: the orbitofronto-striatal model revisited. Neuroscience and Biobehavioral Reviews 32, 525549.
Milad, MR, Rauch, SL (2012). Obsessive–compulsive disorder: beyond segregated cortico-striatal pathways. Trends in Cognitive Science 16, 4351.
Morcom, AM, Fletcher, PC (2007). Does the brain have a baseline? Why we should be resisting a rest. Neuroimage 37, 10731082.
Nabeyama, M, Nakagawa, A, Yoshiura, T, Nakao, T, Nakatani, E, Togao, O, Yoshizato, C, Yoshioka, K, Tomita, M, Kanba, S (2008). Functional MRI study of brain activation alterations in patients with obsessive–compulsive disorder after symptom improvement. Psychiatry Research 163, 236247.
Nakao, T, Nakagawa, A, Yoshiura, T, Nakatani, E, Nabeyama, M, Yoshizato, C, Kudoh, A, Tada, K, Yoshioka, K, Kawamoto, M, Togao, O, Kanba, S (2005). Brain activation of patients with obsessive–compulsive disorder during neuropsychological and symptom provocation tasks before and after symptom improvement: a functional magnetic resonance imaging study. Biological Psychiatry 57, 901910.
Nakatani, E, Nakgawa, A, Ohara, Y, Goto, S, Uozumi, N, Iwakiri, M, Yamamoto, Y, Motomura, K, Iikura, Y, Yamagami, T (2003). Effects of behavior therapy on regional cerebral blood flow in obsessive–compulsive disorder. Psychiatry Research 124, 113120.
Rauch, SL, Jenike, MA, Alpert, NM, Baer, L, Breiter, HC, Savage, CR, Fischman, AJ (1994). Regional cerebral blood flow measured during symptom provocation in obsessive–compulsive disorder using oxygen 15-labeled carbon dioxide and positron emission tomography. Archives of General Psychiatry 51, 6270.
Ressler, KJ, Mayberg, HS (2007). Targeting abnormal neural circuits in mood and anxiety disorders: from the laboratory to the clinic. Nature Neuroscience 10, 11161124.
Rotge, JY, Clair, AH, Jaafari, N, Hantouche, EG, Pelissolo, A, Goillandeau, M, Pochon, JB, Guehl, D, Bioulac, B, Burbaud, P, Tignol, J, Mallet, L, Aouizerate, B (2008 a). A challenging task for assessment of checking behaviors in obsessive–compulsive disorder. Acta Psychiatrica Scandinavica 117, 465473.
Rotge, JY, Guehl, D, Dilharreguy, B, Cuny, E, Tignol, J, Bioulac, B, Allard, M, Burbaud, P, Aouizerate, B (2008 b). Provocation of obsessive–compulsive symptoms: a quantitative voxel-based meta-analysis of functional neuroimaging studies. Journal of Psychiatry and Neuroscience 33, 405412.
Rotge, JY, Guehl, D, Dilharreguy, B, Tignol, J, Bioulac, B, Allard, M, Burbaud, P, Aouizerate, B (2009). Meta-analysis of brain volume changes in obsessive–compulsive disorder. Biological Psychiatry 65, 7583.
Sanavio, E (1988). Obsessions and compulsions: the Padua Inventory. Behaviour Research and Therapy 26, 169177.
Saxena, S, Brody, AL, Ho, ML, Alborzian, S, Maidment, KM, Zohrabi, N, Ho, MK, Huang, SC, Wu, HM, Baxter, LR Jr. (2002). Differential cerebral metabolic changes with paroxetine treatment of obsessive–compulsive disorder vs major depression. Archives of General Psychiatry 59, 250261.
Saxena, S, Brody, AL, Ho, ML, Zohrabi, N, Maidment, KM, Baxter, LR Jr. (2003). Differential brain metabolic predictors of response to paroxetine in obsessive–compulsive disorder versus major depression. American Journal of Psychiatry 160, 522532.
Schienle, A, Schafer, A, Stark, R, Walter, B, Vaitl, D (2005). Neural responses of OCD patients towards disorder-relevant, generally disgust-inducing and fear-inducing pictures. International Journal of Psychophysiology 57, 6977.
Schiepek, G, Tominschek, I, Karch, S, Lutz, J, Mulert, C, Meindl, T, Pogarell, O (2009). A controlled single case study with repeated fMRI measurements during the treatment of a patient with obsessive–compulsive disorder: testing the nonlinear dynamics approach to psychotherapy. World Journal of Biological Psychiatry 10, 658668.
Schunck, T, Erb, G, Mathis, A, Jacob, N, Gilles, C, Namer, IJ, Meier, D, Luthringer, R (2008). Test–retest reliability of a functional MRI anticipatory anxiety paradigm in healthy volunteers. Journal of Magnetic Resonance Imaging 27, 459468.
Schwartz, JM (1998). Neuroanatomical aspects of cognitive–behavioural therapy response in obsessive–compulsive disorder. An evolving perspective on brain and behaviour. British Journal of Psychiatry Supplement 3844.
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Hergueta, T, Baker, R, Dunbar, GC (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 59 (Suppl. 20), 2233; quiz 34–57.
Spielberger, C, Gorsuch, R, Lushene, R, Vagg, P, Jacobs, A (1983). Manual for the State-Trait Anxiety Inventory (form Y). Consulting Psychologists Press: Palo Alto, CA.
Steketee, G, Eisen, J, Dyck, I, Warshaw, M, Rasmussen, S (1999). Predictors of course in obsessive–compulsive disorder. Psychiatry Research 89, 229238.
Stewart, SE, Stack, DE, Tsilker, S, Alosso, J, Stephansky, M, Hezel, DM, Jenike, EA, Haddad, SA, Kant, J, Jenike, MA (2009). Long-term outcome following intensive residential treatment of obsessive–compulsive disorder. Journal of Psychiatry Research 43, 11181123.
Tolin, DF, Abramowitz, JS, Diefenbach, GJ (2005). Defining response in clinical trials for obsessive–compulsive disorder: a signal detection analysis of the Yale–Brown obsessive compulsive scale. Journal of Clinical Psychiatry 66, 15491557.
van Calker, D, Zobel, I, Dykierek, P, Deimel, CM, Kech, S, Lieb, K, Berger, M, Schramm, E (2009). Time course of response to antidepressants: predictive value of early improvement and effect of additional psychotherapy. Journal of Affective Disorders 114, 243253.
Weiskopf, N, Hutton, C, Josephs, O, Deichmann, R (2006). Optimal EPI parameters for reduction of susceptibility-induced BOLD sensitivity losses: a whole-brain analysis at 3 T and 1.5 T. Neuroimage 33, 493504.
Whiteside, SP, Port, JD, Abramowitz, JS (2004). A meta-analysis of functional neuroimaging in obsessive–compulsive disorder. Psychiatry Research 132, 6979.
Whittal, ML, Thordarson, DS, McLean, PD (2005). Treatment of obsessive–compulsive disorder: cognitive behavior therapy vs. exposure and response prevention. Behaviour Research and Therapy 43, 15591576.


Related content

Powered by UNSILO
Type Description Title
Supplementary materials

Morgieve Supplementary Material

 Word (27 KB)
27 KB
Supplementary materials

Morgieve Supplementary Material

 PDF (44 KB)
44 KB
Supplementary materials

Morgieve Supplementary Material
Supplementary Material

 Word (64 KB)
64 KB

Dynamics of psychotherapy-related cerebral haemodynamic changes in obsessive compulsive disorder using a personalized exposure task in functional magnetic resonance imaging

  • M. Morgiève (a1) (a2), K. N'Diaye (a1) (a2), W. I. A. Haynes (a1) (a2), B. Granger (a3), A.-H. Clair (a1), A. Pelissolo (a2) (a4) and L. Mallet (a1) (a2) (a5)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.